What are the top signs of a serious ankle injury. How can you differentiate between a common sprain and a Lisfranc injury. When should you seek medical attention for foot swelling. What are the potential complications of untreated foot sprains. How are Lisfranc injuries diagnosed and treated.

Understanding Ankle and Foot Sprains: Beyond the Common Twist

Ankle sprains are among the most frequent podiatric injuries, but they’re not the only type of sprain that can affect your foot. While less common, sprains on the top of the foot can be equally serious and potentially more complex. These injuries, known as Lisfranc or midfoot injuries, require careful attention and proper medical treatment to prevent long-term complications.

The Anatomy of a Lisfranc Injury

The Lisfranc joint complex, named after 19th-century surgeon Jacques Lisfranc de St. Martin, is a crucial part of your foot’s structure. It’s the point where your metatarsal bones (the long bones leading to your toes) connect with your tarsal bones (the bones in your foot’s arch). The Lisfranc ligament, a tough band of tissue, joins two of these bones, providing essential alignment and strength to the joint.

Recognizing the Symptoms of a Lisfranc Injury

Lisfranc injuries can occur due to various reasons, including falls, sports-related incidents, car accidents, or any trauma to the midfoot. Identifying the symptoms is crucial for proper diagnosis and treatment. Here are the key signs to watch for:

• Pain in the midfoot area
• Bruising on both the top and bottom of the foot
• Swelling, particularly on the top of the foot
• Difficulty or inability to bear weight on the affected foot

The severity of these symptoms can vary depending on the extent of the injury. In milder cases, the ligament may stretch or experience tiny tears. More severe injuries can result in a complete ligament tear.

The Importance of Proper Diagnosis for Foot Sprains

Many Lisfranc injuries go undiagnosed or are mistaken for simple sprains. This misdiagnosis can lead to inadequate treatment and potential long-term complications. Why is proper diagnosis so crucial?

• Lisfranc injuries are not simple sprains that will heal on their own
• They often require months of healing time
• Some cases may necessitate surgical intervention
• Untreated injuries can lead to severe complications

If you’re experiencing persistent midfoot pain or swelling, especially if it prevents you from bearing weight on your foot, it’s essential to seek medical attention promptly.

Potential Complications of Untreated Lisfranc Injuries

Failing to properly treat a Lisfranc injury can result in several serious complications:

1. Compartment syndrome: A painful condition caused by pressure buildup in the muscles
2. Arthritis: Premature wear and tear on the joint surfaces
3. Chronic instability: Ongoing weakness and instability in the foot

These complications can significantly impact your mobility and quality of life, underlining the importance of seeking prompt medical attention for persistent foot pain or swelling.

Diagnostic Procedures for Lisfranc Injuries

Accurately diagnosing a Lisfranc injury requires a comprehensive approach. A foot and ankle specialist will typically employ several diagnostic methods:

• Physical examination: Assessing pain, swelling, and range of motion
• X-rays: To identify any bone fractures or joint misalignments
• MRI or CT scans: For a more detailed view of soft tissue damage
• Stress tests: To evaluate the stability of the joint

These diagnostic procedures help determine the severity of the injury and guide the development of an appropriate treatment plan.

Treatment Options for Lisfranc Injuries

The treatment approach for a Lisfranc injury depends on its severity. What are the primary treatment options available?

Non-Surgical Treatment

For milder injuries, non-surgical treatments may be sufficient:

• Rest and ice to reduce swelling
• Immobilization with a cast or walking boot
• Crutches or a wheelchair to avoid weight-bearing
• Physical therapy to restore strength and flexibility

Surgical Intervention

More severe injuries may require surgical treatment:

• Internal fixation: Using screws or plates to realign the joints
• Fusion: Permanently joining affected bones in severe cases
• Tendon grafts: To replace severely damaged ligaments

The choice between surgical and non-surgical treatment depends on factors such as the severity of the injury, the patient’s overall health, and their activity level.

Recovery and Rehabilitation After a Lisfranc Injury

Recovery from a Lisfranc injury can be a lengthy process, often taking several months. What does the typical recovery timeline look like?

• Initial recovery: 6-8 weeks of immobilization and non-weight bearing
• Gradual weight-bearing: Slowly increasing weight on the affected foot
• Physical therapy: Exercises to improve strength, flexibility, and balance
• Return to activities: Gradually resuming normal activities over 3-6 months

The recovery process requires patience and adherence to your doctor’s instructions. Rushing the recovery can lead to re-injury or incomplete healing.

Preventing Lisfranc Injuries: Tips for Foot Health

While not all Lisfranc injuries can be prevented, there are steps you can take to reduce your risk:

• Wear proper footwear for your activities
• Strengthen your foot and ankle muscles through exercises
• Avoid sudden changes in direction or twisting motions
• Be cautious when walking on uneven surfaces
• Warm up properly before engaging in sports or physical activities

By taking these precautions, you can help protect your feet from potential injuries and maintain overall foot health.

When to Seek Medical Attention for Foot Pain

Knowing when to consult a medical professional is crucial for proper foot care. Seek medical attention if you experience:

• Persistent pain that doesn’t improve with rest
• Swelling that doesn’t subside within a day or two
• Bruising on both the top and bottom of your foot
• Inability to bear weight on your foot
• Any deformity or change in the shape of your foot

Remember, early intervention can prevent more serious complications and ensure a faster recovery.

Differentiating Between Common Ankle Sprains and Lisfranc Injuries

While both ankle sprains and Lisfranc injuries can cause pain and swelling, there are key differences to be aware of:

Ankle Sprains

• Pain typically located on the outer side of the ankle
• Swelling often concentrated around the ankle joint
• May still be able to bear some weight, albeit with pain
• Usually improve with rest, ice, compression, and elevation (RICE)

Lisfranc Injuries

• Pain centered in the midfoot area
• Swelling on the top of the foot
• Often unable to bear any weight on the affected foot
• May have bruising on both top and bottom of the foot
• Typically require professional medical intervention

Understanding these differences can help you determine when to seek immediate medical attention versus when home care might be sufficient.

The Role of Imaging in Diagnosing Foot Injuries

Imaging plays a crucial role in accurately diagnosing foot injuries, particularly Lisfranc injuries. What are the primary imaging techniques used?

X-rays

X-rays are often the first imaging test performed. They can reveal:

• Bone fractures
• Misalignment of joints
• Widening between the first and second metatarsals (a key sign of Lisfranc injury)

MRI (Magnetic Resonance Imaging)

MRI scans provide detailed images of soft tissues, helping to identify:

• Ligament tears
• Cartilage damage
• Subtle bone injuries not visible on X-rays

CT (Computed Tomography) Scans

CT scans offer detailed 3D images of the foot’s bony structures, useful for:

• Identifying complex fracture patterns
• Planning surgical interventions
• Assessing healing progress post-treatment

These imaging techniques, combined with a physical examination, allow for a comprehensive assessment of foot injuries and guide treatment decisions.

Long-Term Outlook for Lisfranc Injury Patients

The long-term prognosis for patients with Lisfranc injuries can vary depending on several factors. What can patients expect in the years following their injury?

Factors Affecting Long-Term Outcomes

• Severity of the initial injury
• Timeliness and appropriateness of treatment
• Patient compliance with rehabilitation protocols
• Individual healing capacity

Potential Long-Term Effects

Even with proper treatment, some patients may experience:

• Chronic pain or stiffness in the midfoot
• Decreased range of motion
• Development of post-traumatic arthritis
• Need for supportive footwear or orthotics

However, many patients can return to their pre-injury level of activity with appropriate care and rehabilitation. Regular follow-ups with a podiatrist can help manage any long-term effects and maintain optimal foot health.

Advances in Lisfranc Injury Treatment

Medical research continues to improve our understanding and treatment of Lisfranc injuries. What are some recent advancements in this field?

Minimally Invasive Surgical Techniques

Newer surgical approaches aim to minimize tissue damage and promote faster recovery:

• Arthroscopic procedures for less severe injuries
• Smaller incisions and specialized instruments
• Potential for reduced scarring and faster healing

Advanced Imaging and Diagnostic Tools

Improvements in imaging technology allow for more accurate diagnosis:

• High-resolution MRI for detailed soft tissue assessment
• Weight-bearing CT scans for functional evaluation
• 3D printing for surgical planning and patient education

Biological Treatments

Emerging biological therapies show promise in promoting healing:

• Platelet-rich plasma (PRP) injections
• Stem cell therapies for tissue regeneration
• Growth factor treatments to enhance healing

These advancements offer hope for improved outcomes and faster recovery times for patients with Lisfranc injuries.

Can You Sprain the Top of Your Foot?

One of the most common types of podiatric injuries is ankle sprains. Still, other parts of the foot can sustain a sprain, including the top of the foot.

Spraining the top of the foot is much rarer than ankle sprains, but it can cause serious damage without proper medical treatment. This type of sprain is called a Lisfranc, or midfoot, injury. 

What are the symptoms of a sprained foot, and what should you do if you sprain the top of your foot? 

Lisfranc (Midfoot) Sprains 

The midfoot is also known as the Lisfranc joint complex, named after 19th-century surgeon Jacques Lisfranc de St. Martin.

“The Lisfranc joint is the point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. This is important for maintaining proper alignment and strength of the joint,” explains the American College of Foot and Ankle Surgeons.  

Lisfranc injuries can inflict pain and may lead to severe complications without proper medical treatment. 

Causes & Symptoms of a Lisfranc Injury

The Lisfranc joints and ligaments can experience sprain due to a fall, sports injury, auto accident, or any form of trauma to the midfoot.

Symptoms of a Lisfranc injury include: 

• Pain
• Bruising on the top and bottom of the foot
• Swelling
• Inability to bear weight

As with other types of sprains, damage may vary from mild to severe. In mild cases, the ligament stretches and may experience tiny tears. In severe cases, the ligament tears completely. The intensity of the injury will affect pain level, treatment methods, and recovery time. 

What To Do For a Midfoot Sprain

Unfortunately, Lisfranc injuries often go undiagnosed and do not receive the necessary treatment.

The American Academy of Orthopaedic Surgeons says, “Injury to the Lisfranc joint is not a simple sprain that should be simply ‘walked off. ’ It is a severe injury that may take many months to heal and may require surgery to treat.” 

If you are experiencing persistent midfoot sprain symptoms and suspect you may have a Lisfranc injury, it’s crucial to seek medical attention from a trained podiatrist. 

Failure to treat a Lisfranc injury may lead to severe complications such as compartment syndrome, arthritis, and instability in the foot. 

“Call your doctor whenever you have symptoms of a sprained foot, such as pain, swelling or bruising, especially if pain prevents you from bearing weight on your injured foot or does not subside over a day or two,” recommends Harvard Health Publishing. 

A foot and ankle surgeon can assess the damage through an exam, X-rays, and other methods. After diagnosis, your podiatrist will help you make a treatment plan. 

Depending on the severity, non-surgical treatment may bring about a full recovery. In other cases, your podiatrist may recommend surgery to restore alignment within the foot.  

San Joaquin Valley Podiatrist

Canyon Oaks Foot & Ankle has three offices across the San Joaquin Valley offering top-notch podiatric care. With our conservative and compassionate approach to patient care, we will help you get back on your feet as soon as possible. 

Contact us at one of our locations in Fresno, Visalia, or Porterville to make an appointment. 

Sprained Ankle (Twisted Ankle): Symptoms and Treatments

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• 
  
  

  A sprained ankle happens if you injure the ligaments (strong bands of tissue) that support and connect the bones in your ankle joint. This can happen if you twist or turn your foot beyond its normal range of movement and stretch or tear your ligaments.

• 
  
  

  The symptoms of a sprained ankle will depend on how bad your injury is. But you may have pain, swelling or bruising around your ankle. You may also find it difficult to move your foot, or your ankle may feel unstable (wobbly) when you try to stand on it. Sometimes, you may find it difficult to put weight on your foot or find it more painful when you do. For more information, see our symptoms section above.

• 
  
  

  There are lots of treatments to help ease the symptoms of a sprained ankle. These include:

  • self-help measures such as following the POLICE and HARM principles outlined in our self-help section above
  • taking over-the-counter medicines such as paracetamol or ibuprofen
  • applying ibuprofen gels or creams to the skin on your ankle
  • when you’re ready, doing gentle exercises (wearing a brace or splint may help with these)
  • an exercise programme tailored to you by a physiotherapist
  • in rare cases, surgical assessment by an orthopaedic surgeon

  Speak to your doctor or physiotherapist for more advice on the best treatment for you and see our self-help and treatment sections above for more information.

• 
  
  

  Some people do have ongoing problems after spraining an ankle. This is more likely if your ankle sprain is severe. You’re also more likely to sprain your ankle again if you’ve already had a sprained ankle, especially if the ligaments haven’t healed properly.

  Long-term problems after a sprained ankle include:

  • chronic pain – pain that lasts a long time
  • chronic instability – when your ankle remains unstable (wobbly when you stand on it) for a long time
  • muscle weakness and loss of function
  • occasional swelling of your ankle

  After your injury, it’s important to begin gentle exercises when you can to prevent stiffness and keep your ankle moving. If needed, you can wear an elastic support, ankle tape or a brace to help to protect your ankle from further sprains.

• 
  
  

  A high ankle sprain is when you damage one of the ligaments just above your ankle (called the syndesmotic ligaments). These ligaments are between the two bones in your lower leg (tibia and fibula). It often happens if your lower leg and foot twist too far outwards. You may sprain other ligaments or fracture one of the bones in your lower leg at the same time.

  If you have a high ankle sprain, you may feel pain at the front of your lower leg and when you move your foot outwards. This area may be tender to touch.

  High ankle sprains take longer to heal than the more usual type of ankle sprain. Your treatment may include wearing a fracture boot or short leg cast for several weeks.

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Ligamentous injuries of the ankle joint (ankle joint instability) — symptoms, diagnosis, treatment
Injuries to the ligaments of the ankle joint occur as a result of an injury – a twist of the foot, often – when playing sports or in winter, with ice.

Pain may not occur immediately. In a short time or immediately after the injury, swelling of the ankle joint appears, its contours are smoothed out, subcutaneous hematomas (bruises) appear. Sometimes patients report a “click” at the time of injury. Movement in the ankle joint causes acute pain, it is almost impossible to lean on the leg.
It is necessary to apply cold and fix the damaged joint, then go to a medical institution, where you will have an x-ray of the ankle joint. Often this is not enough and a number of additional examinations may be required, such as ultrasound examination of the joint, magnetic resonance imaging (MRI) to assess the condition of the soft tissue structures (ligaments, tendons) of the ankle joint.

Conservative treatment of ankle ligament injuries

If the ligaments are partially damaged, then we are usually talking about conservative treatment – wearing a plaster or polymer bandage, special bandages, orthoses. Courses of physiotherapy and exercise therapy are prescribed.
Ineffective and incorrect treatment of this pathology can lead to serious complications, such as arthrosis, chronic instability of the ankle joint, lameness and others.

Surgical treatment of ankle ligament injuries

If all these measures are ineffective – pain, swelling, a feeling of instability in the joint, repetitive injuries, as well as complete damage to the external or internal complex of the ligamentous apparatus of the ankle joint, surgical treatment is indicated – restoration of the ligaments (ligament plasty) to prevent the above complications.

Depending on the degree of damage, one of the methods of surgical intervention is used:

• stitching ligaments (if they are in place but deformed)
• periosteal valve (if ligaments are torn or not visible)
• grafting of tendons and ligaments, use of plantar material, or tendons to replace from 2-3 ligaments, when performing these interventions, absorbable (absorbable) materials are used for fixation

The operation is performed under arthroscopic control (using a video camera inserted into the joint, its cavity is examined). Thanks to this, it is possible to diagnose and eliminate problems not only with damaged ligaments, but also within the joint during one surgical intervention.

Immediately after the operation, the joint is fixed with a plaster cast so as not to expose it to unnecessary stress. This will lead to a speedy recovery. The sutures are removed on the 12-14th day. After the stitches are removed, restorative treatment can begin. After 4 weeks, the cast can be changed to a semi-rigid U-shaped ankle brace. Walking without crutches with full load on the joint is possible after a few weeks.

Rehabilitation treatment after ankle ligament injuries

It is very important to consider a course of rehabilitation treatment for such injuries in order for the function of the ankle joint to recover to the maximum extent. Upon discharge from the hospital, the patient receives a detailed recovery plan.
Rehabilitation treatment includes a course of physiotherapy, shock wave therapy, a set of active and passive exercises aimed at strengthening and stretching muscles with a partial load on the joint, and exercises to develop movements in the joint.
In addition, at the NCC No. 2 (CCH RAS), a biomechanics laboratory was created on the basis of the rehabilitation treatment department, in which patients undergo rehabilitation after various injuries of the musculoskeletal system, incl. professional athletes. On its basis, various parameters of walking are studied, an optimal rehabilitation plan is developed in accordance with the data obtained.

Injury of the ligaments of the ankle joint – surgical treatment in the Dnieper in the inpatient department of Garvis

An ankle sprain is an injury (partial rupture) of one or more ligaments in this area, usually on its outer side. More often than others, the external ligaments of the ankle joint are damaged. Typically, this occurs when walking awkwardly or walking on uneven surfaces when the foot is tucked inward.

Modern medicine distinguishes three degrees of damage to the ligaments of the ankle joint:

• The first degree of damage – individual fibers of the ligament are torn off or torn;
• Second degree – partial rupture of the ligament. Despite the fact that in this case a significant part of the ligament is torn, this does not lead to a complete loss of ligament functions;
• Third degree – complete rupture of the ligament or separation of the ligament from its attachment to the bone tissue.

How can you tell if your ankle ligaments are damaged?

In the first degree of ligament injury, the patient complains of mild pain when walking and probing the ligament. Swelling of tissues appears in the area of ​​attachment of the ligaments;

In the second degree of damage or partial rupture of the ligaments, the spread of edema to the front and outer surface of the foot is characteristic. The patient feels severe pain, especially when probing the place of torn ligament. Pain during probing is severe, especially at the site of torn ligament. At the same time, walking is noticeably difficult due to increased pain in the joint during movement;

With the third degree of damage to the ligaments of the ankle joint, the patient’s walking is almost impossible, since any attempt to step on the injured leg is accompanied by severe, acute pain. Edema and swelling are strongly pronounced on the entire surface of the foot.

In order to clarify the degree of damage to the ankle joint, the traumatologist asks the patient in detail about the mechanism of damage, carefully analyzes all the symptoms and examines the leg. X-rays and MRIs may be ordered to clarify the nature of the injury and the presence of concomitant complications.

It should be remembered that the lack of timely treatment can lead to chronic instability of the ankle joint, which will provoke constant discomfort and lead to the development of arthrosis of the joint.

It is important to know that in the treatment of ligaments of the ankle joint, as in no other case, it is important to see a doctor in a timely manner. This is explained by the fact that ligament suturing under arthroscopic control, without joint incision, is possible only in the first 3-7 days after injury. If the patient is late with a visit to the clinic, most often, it is necessary to perform ligament plasty, which significantly increases the rehabilitation period, which takes up to 6 weeks, while in the first case – no more than two to three weeks.