ORIF Lisfranc (w/o fusions) Midfoot Dislocation

Postop Protocol

 

Note: This protocol is for open reduction and internal fixation of Lisfranc midfoot dislocations (injury to the tarsometatarsal joint complex) with NO FUSIONS. If the patient had fusions to treat this condition, please use the postop protocol for foot fusions found here.

 

Phase I- Maximum Protection (Weeks 0 to 6)

  • Splint for 2 weeks
  • Cast for week 2 through 6
  • Elevate the ankle above the heart
  • Non-weight bearing x 6 weeks
  • Multi-plane hip strengthening
  • Core and upper extremity strengthening

Phase II- Range of Motion and Early strengthening (Weeks 6 to 8)

  • If smooth wires are placed into 4/5th TMT joints, they are removed at 6 weeks postop
  • Begin progressive weight bearing per physicians instructions
  • Restoration of normal gait mechanics
  • Full active and passive ROM all planes
  • Isometric and early isotonic ankle
  • Foot intrinsic strengthening
  • Bilateral progressing to unilateral squat and linear step progression
  • Proprioception training with shoe support
  • Non-impact cardiovascular work

Phase III- Progressive Strengthening (3 to 6 months)

  • Pool progressing to dry land running
  • Functional training linear gradually progressing to lateral and rotational
  • Sport specific drills on field or court with orthotic
  • Sport test at 6 to 9 months based on progress

Implant Removal

  • If smooth wires are placed into 4/5th TMT joints, they are removed at 6 weeks postop
  • If patient is asymptomatic and screws transfix only first through third TMT joints, they may be left in place
  • If implants bother patient at any time and at least 6 months have passed since surgery, removal can be discussed