Prevention and Treatment of Midfoot Injuries

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Lisfrans joint injuries are rare, complex and often misdiagnosed and if left untreated can have severe consequences. Typical signs and symptoms include pain, swelling, and inability to bear weight. These injuries can vary from mild sprains to fracture dislocations that can be caused by a sporting activity resulting in a fall from a high setting or a twisting fall. Lisfrancs dislocations and sprains have a high risk of chronic secondary disabilities, including degenerative arthritis or degenerative joint disease. Non surgical treatment includes a short leg walking cast, a removable short leg orthotic or a non weight bearing cast worn 4-6 weeks followed by rehabilitation. If surgery is needed, you podiatrists will discuss the options available to you depending on your individual needs.

Tendons connect muscles to bones and are able to stretch across the joints enabling you to bend that joint. The posterior tibial tendon is the most important tendon in your lower extremity. Starting in the calf, it stretches downward and behind the inside of the ankle and attaches to bones in the middle of the foot. Posterior tibial tendon dysfunction, PTTD, is an inflammation or overstretching of the tendon. This tendon is one of the major supporting structures of your foot allowing you to functionally walk. But in PTTD, the tendon ability to function properly is impaired often resulting in the flattening of the foot. Posterior tibial tendon dysfunction is an overuse injury caused by fatigue associated with walking, running, or sports. The symptoms of PTTD are pain, swelling, loss of arch and inward rolling of the ankle as the condition progresses the foot and toes will roll outward, as the inward rolling of the ankle worsens. Developing arthritis in both the foot and ankle becomes more probable as the arch deteriorates further and the foot flattens even more. Diagnosis of PTTD can be done by a complete physical examination by your podiatrist focusing on you gait, stance, ability to stand up on your toes and by Xrays, ultrasound or MRI. In early stages of PTTD, you podiatrist may treat with rest, non steroidal anti inflammatory drugs, and immobilization for 6-8 weeks and after the cast has been removed, you will more likely be prescribed orthotics. Surgery may be required if these treatments do not correct your posterior tibial tendon dysfunction.

Surgical procedures used to treat PTTD include:

• Tenosynovectomy: removal of inflamed tissue around the tendon.
• Osteotomy: heel bone re-alignment.
• Tendon transfers: fibers from another tendon is used to repair the posterior tibial tendon.
• Lateral column lengthening: hip bone is used to lengthen your heel bone and recreate the arch.
• Arthrodesis: fusion of the one or more bones together.

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