Lisfranc and midfoot injuries
What are Lisfranc and midfoot injuries?
These injuries commonly occur during sports and motor vehicle accidents. The Lisfranc ligament is one of the ligaments that connect the long bones of the toes to the joints in the middle of the foot. It is a major stabiliser of the midfoot joints and helps keep key joints together during push off.
Various patterns of injuries have been described based on the mechanism of injury and the direction of movement of the bones after injury. These injuries may be associated with multiple fractures of the bones around the ligament.
What are the symptoms of Lisfranc and midfoot injuries?
If you notice these symptoms, consulting a specialist can help address the condition and prevent it from worsening.
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Inability to bear weight on the foot
- Any attempted weight bearing on the foot is painful around the middle/ arch of the foot.
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Swelling on top of the foot
- The top of the foot is swollen and painful to touch.
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Bruising of the foot
- The foot is bruised on the top as well as on the sole of the foot.
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Restricted movement of the toes
- It is painful to move the toes after this injury, and patients often complain of stiff, tingly toes.
What does surgery for Lisfranc and midfoot injuries involve?
Further MRI and CT scans of the foot will reveal the complexity of the injury. Surgery is usually indicated for more severe injuries with complete disruption of the ligaments and if the bones in the midfoot are no longer aligned correctly.
Surgery is carried out through one or two incisions on the top of the foot. The nerves and vessels that run on top of your foot are protected throughout surgery. The top of your foot is usually numb immediately after the injury, and this can persist for some time.
after surgery. This numbness only affects the skin and does not stop you being able to walk or move your toes.
A plate is applied to the middle of the foot to stabilise the bones and help the ligaments to heal. This plate may be left permanently in your foot especially for more severe injuries. In most other cases, the plate may be removed around nine to twelve months after surgery. This is a much shorter procedure than the initial operation.
What are the risks associated with surgery on Lisfranc and midfoot injuries?
Swelling and numbness
Swelling of the foot and ankle is common after most foot surgery. This can be minimised by rest, elevation and the use of a compression sock immediately after surgery.
Numbness on top of the foot and in the toes will settle as your swelling starts to reduce in the weeks after surgery. Your foot may be swollen for six to twelve months after surgery.
Infections
Infection after surgery (reduced risk with minimally invasive techniques) can be prevented by ensuring that you keep your foot dry, rested and elevated as much as possible in the first three to four weeks after surgery. Feet are closer to the ground and tend to swell more than other areas of the body, putting additional stress on healing wounds. Feet and shoes are colonised with bacteria that can flourish in wet conditions and around fresh bleeding wounds.
Deep Vein Thrombosis (DVTs)
Deep Vein Thrombosis may occur when you have certain risk factors and are unable to bear weight on your leg for a prolonged period. We will prescribe blood-thinning medication to prevent DVTs from forming. Drinking plenty of fluids and frequent range of motion(ROM) exercises of the leg may prevent DVTs.
Joint Stiffness and arthritis in the midfoot
General foot and ankle stiffness may improve with exercises. Removal of metalwork may be required for more troublesome symptoms. Arthritis in the midfoot is common following moderate to severe midfoot injuries.
Scarring around surgical wounds
Foot wounds can take longer to heal and can sometimes scar poorly. Unlike other areas of the body (face, hands), we advise patients to avoid manipulating or massaging a foot scar until it is well healed (usually around five to six weeks following foot and ankle surgery).
Lisfranc and midfoot injury surgery aftercare
General post-operative and wound care instructions will be emailed to you before your surgery. These documents also contain the date and time of your first appointment.
Dressings
Your foot and ankle will be heavily bandaged after surgery. These bandages are necessary to prevent bleeding after surgery. It is advisable to keep the foot dry, rested and elevated in the first three to four weeks after surgery. This requires you to seal the area when taking quick showers. Frequent change of dressings and getting your dressings wet and dirty may predispose you to an infection. We strongly discourage dressing changes at home.
A wound care document is emailed to you along with all your preoperative paperwork.
Post-operative wound care is our priority. Following our instructions will ensure that all your wounds heal well. You are encouraged to call or email us to ask for advice or to discuss any concerns around wound care.
Boots, mobility aids and physiotherapy
A back slab is applied in the operating theatre after surgery is completed. The back slab is replaced with a boot at the first follow-up appointment.
Mobility aids like crutches, frames and knee scooters will be provided by the hospital physiotherapist. Feel free to take your own mobility aids with you when you present to the hospital. The physiotherapist will make sure that you are using them correctly.
You must leave the boot on when mobilising with a knee scooter, crutches or a frame. You may take the boot off in bed, but be sure to put it back on when you are up and about. You are required to wear the boot for eight to ten weeks and will be unable to bear weight on the foot until the injury is healed on X-rays. Gradual weight bearing in the boot is allowed after this period and progresses to full weight bearing over the next few weeks.
Early gentle ROM exercises and rehabilitation are encouraged in order to get the best outcome following surgery. You may continue upper body and abdominal strengthening as well as straight leg raising (SLR) exercises while recovering from your surgery.
Formal physiotherapy sessions to regain balance and strength may commence when you are able to bear full weight on your foot.
Rest and elevation
Feet and ankles are more likely to swell after surgery. Swelling can cause a lot of pain and discomfort, requiring the use of excessive pain-relieving medication. The most reliable way of reducing immediate post-operative swelling is to keep your foot elevated above the level of the heart. Reducing physical activity can help control swelling and pain, especially in the first three to four weeks after surgery.
Blood-thinning medication to prevent Deep Vein Thrombosis (DVTs)
You will be prescribed a dose of Aspirin to be taken for two to three months following surgery. The presence of certain risk factors may necessitate blood-thinning injections for a period after surgery. Drinking plenty of fluids and frequent range of motion(ROM)exercises may prevent DVTs.
Pain medication
Our anaesthetists will provide you with adequate pain-relieving medication to take home after your surgery. The anaesthetist may also discuss having a nerve block for pain relief just before surgery.
The most reliable way to reduce pain and swelling after surgery is to rest and elevate your foot as much as possible.
Prevention of infections
Intravenous antibiotics are administered at the start of every operation, and the foot is thoroughly cleaned. You will be given a script for antibiotics upon your discharge from the hospital. Rest and elevation, using your moon boot and leaving all dressings dry and intact, can help prevent postoperative infections.
Driving
Driving is unsafe for a minimum of six weeks following surgery and for as long as you are required to wear post-operative shoes or boots, as advised by us.
Holidays and long-distance travel after surgery
It is advisable to avoid surgery if you have a planned holiday or long-distance travel plans within weeks after surgery. Please discuss these plans with us so that we can advise you on the most appropriate time to have surgery.
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Why choose SA Foot & Ankle Surgery?
Quick bookings at multiple locations
With multiple clinic locations across Adelaide, we offer immediate availability, often seeing patients within 24 hours of receiving a referral.
Advanced care for your condition
Our specialised procedures, including advanced surgeries like ankle fusions, prioritise quicker recovery and less discomfort.
Foot and ankle specialist surgeon
Unlike general practices, we specialise exclusively in foot and ankle conditions, ensuring you receive expert care tailored to your specific needs.
Tailored treatment plans
We thoroughly assess your needs and present personalised treatment options, including non-surgical solutions where appropriate.
Patient-centred care
We take the time to explain your condition and treatment options, ensuring you’re fully involved in every decision regarding your health.
Low gap (total out-of-pocket cost) *
For most operations, your gap paid to the practice is the only out of pocket cost for surgery, without additional or hidden costs. There is a separate gap payable to the anaesthetist and the surgical assistant who work alongside, but independently of Dr. Silveira.
* Complex procedures may attract additional costs that will be discussed with you at the initial consultation.
Meet Dr Gayle Silveira, the surgeon behind your care
Gayle Silveira is a fellowship-trained foot, ankle and trauma surgeon. She completed Orthopaedic training in Adelaide and is a Fellow of the Royal Australasian College of Surgeons.
Gayle gained further experience in complex surgical techniques through advanced training in foot and ankle surgery under the guidance of Dr. Simon Platt. She is proficient in keyhole surgery/minimally invasive techniques and management of sports injuries. In addition, her Master’s in Biomechanics and Sports Physiology complements her expertise in foot and ankle pathology.
Gayle is committed to offering her patients high-quality care with compassion and respect. She spends time listening to you whilst carefully formulating a tailored management plan. Her goal is to help you achieve your desired outcome.
Fellow of the Royal Australasian College of Surgeons (Orthopaedics)
Member of the Australian Foot and Ankle Society
Bachelor of Medicine and Surgery
Master's Sports Studies (Biomechanics and Sports Physiology)
Member of the American Foot and Ankle Society
