Exercise Program After a Lisfranc Fracture and Dislocation

Lisfranc fracture is a painful injury involving a break and possible dislocation of your metatarsal and tarsal bones in your foot. It usually is caused by a twisting motion in your mid-foot, and it can lead to significant dysfunction and difficulty with walking, running, and other functional tasks.

If you have suffered a Lisfranc fracture, your healthcare provider may need to perform surgery to help stabilize your foot. Sometimes surgery is not necessary. A period of immobilization is usually required after a Lisfranc injury whether surgery was performed or not.

You may benefit from the skilled services of a physical therapist if you have suffered a Lisfranc injury. Your physical therapist can assess your condition and can offer treatments to help decrease your pain and improve your range of motion (ROM), strength, and overall functional mobility.

Exercise after a Lisfranc injury is one component of your rehab program. Your physical therapist will likely prescribe exercises to help your foot and ankle move better and feel better.

This step-by-step exercise program is an example of something your PT may prescribe to help you recover after a Lisfranc injury. It starts with simple mobility exercises and progresses to strengthening exercises and advanced balance and plyometric exercises.

The program should not be started until your healthcare provider clears you to exercise, so check in with him or her before starting this, or any other, exercise program.


Ankle and Foot Range of Motion Exercises.

Your physical therapy may use a goinometer (could be used as part of a lisfranc physical therapy protocol)
Ankle dorsiflexion range of motion after a Lisfranc fracture. Brett Sears, PT, 2011

After a Lisfranc fracture, your foot and ankle will likely be immobilized in a cast or walking boot. During this time, you may be walking with crutches. Once the Lisfranc fracture is fully healed and you are allowed to start moving your ankle, your PT will likely prescribe ankle mobility exercises. These exercises are simple, yet they are an important first step in regaining normal ROM in your ankle and foot.

To start, lie on your bed with your foot hanging slightly over the edge.  Then perform the following motions:

  • Ankle plantar flexion: point your toes down as far as possible.
  • Ankle dorsi flexion: flex your foot and toes up towards your knee as far as possible.
  • Ankle inversion: point your foot and toes in the direction of your big toe.
  • Ankle eversion: point your foot and toes in the direction of your pinky toe.

Repeat each ankle ROM exercise for 10 repetitions, holding each position for three to five seconds.

Your PT may also prescribe a fun exercise called the ankle alphabet. To do this, simply draw the letters of the alphabet with your toes. This helps to improve your ankle ROM in all directions.


Toe and Mid Foot Arch Flexibility Stretch

You can easily stretch your plantar fascia (could be used as part of a lisfranc physical therapy protocol)
Gently rest your toes up a wall to stretch the plantar fascia and arch of your foot. Brett Sears, PT, 2012

A Lisfranc fracture affects the mobility of your foot's arch. After the injury and after a period of immobilization, your arch may feel tight, or the tendons that course along the bottom of your foot to your toes may become tight.

Stretching your arch and the tendons of your foot is a simple way to improve your overall foot mobility. To do the exercise, place your toes up against a wall with your heel on the floor. Gently press your toes into the wall until you feel a stretch on the underside of your foot. Hold the position for 15 to 30 seconds, and then relax. You can perform the stretch three to five times, several times per day.

If you feel intense pain in the bottom or top of your foot during the mid foot arch stretch, stop the exercise and consult your physical therapist or healthcare provider.


Mid Foot Arch Massage

Sometimes after a Lisfranc fracture, continued pain in the arch of your foot may make walking difficult. You can use the ice bottle arch massage to help decrease your pain and massage your arch at the same time.

To perform the ice bottle massage, simply freeze a bottle of water. (Be sure the bottle isn't filled all the way to allow for some expansion.) When the bottle is frozen, sit in a chair and slowly massage your arch over the frozen bottle. You can perform this for a few minutes, just be sure to listen to your body's cues that tell you when to stop icing.


Calf Stretches

runner's calf stretch (could be used as part of a lisfranc physical therapy protocol)
The runner's calf stretch is a simple stretch to keep your calf muscles flexible. Brett Sears, PT, 2014

After a Lisfranc fracture and the immobilization period that follows, many people experience calf tightness in the back of their lower leg. This is natural, and the best way to remedy that tightness is to perform calf stretches.

The easiest way to stretch your calf is with the runner's stretch. Simply stand about 3 feet from a wall, place both hands on the wall and leave the foot to be stretched behind you with your heel on the ground. Lean towards the wall until you feel a stretch in your calf. Hold the stretched position for 20 to 30 seconds, and then relax. Repeat 3 to 5 times.

To stretch the soleus muscle of your lower leg, simply perform the runner's stretch, but bend the knee of the calf you are stretching. This focuses the stretch on the soleus muscle, and you should feel the stretch behind your ankle and heel bone. Again, hold the stretch for 20 to 30 seconds, and then relax. Repeat 3 to 5 times.


Ankle and Foot Strengthening Exercises

Once you have regained flexibility and ROM around your foot and ankle, it is time to start working to regain normal strength in your ankle and foot. To do this, you can perform ankle strengthening exercises with a resistance band. (Your physical therapist can give you a resistance band, or you can purchase one at a local sporting goods store.)

To perform resisted ankle exercises, tie one end of a resistance band around your foot, taking care not to restrict blood flow. Tie the other end around something stable like a table leg. Move your foot in the same directions as you did during ankle ROM exercises earlier in this program: plantar flexion, dorsiflexion, inversion, and eversion. Hold each position for a few seconds and press into the resistance provided by the exercise band.

Perform 10 to 15 repetitions of each exercise. You may wish to perform several sets of the exercises each day to maximize the challenge to your ankle muscles.

To strengthen the muscles within your foot, perform the towel scrunch exercise. This exercise helps to form the medial arch of your foot. To do the exercise, place your foot on a towel on the floor and simply use your toes to grab at the towel and scrunch it up. Perform 10 to 15 repetitions of the towel scrunch exercise.


Balance Exercises

A person on a wobble board (could be used as part of a lisfranc physical therapy protocol)
A wobble board can provide an unsteady surface on which to perform balance exercises. Rollover/Getty Images

You may notice that your balance has been affected been by the long immobilization period that you had while your Lisfranc fracture was healing. Maintaining proper balance is a complex task with many systems in your body working together. Returning to normal activities requires that you regain normal balance, and this requires specific exercises.

Start balance exercises with simple single leg standing. You should stand on one foot for 15 to 30 seconds while trying to maintain stability. If this is easy, you can increase the challenge by standing on a pillow on one foot or by closing your eyes.

When single leg balance exercises become easy, you may wish to progress to advanced balance exercises. These exercises may involve using specialized equipment like a BAPS board or a wobble board, so speak with your PT before starting advanced balance exercises.


Plyometrics and Jumping Exercises

If you are an active person who is planning on returning to high level athletics after your Lisfranc fracture and dislocation, then you may wish to work with your PT on jumping and plyometric exercises. These exercises are designed to improve your body's ability to jump and land properly, and they are important to work on before returning to running.

Plyometric exercises may include:

  • Simple jumping and landing drills
  • The drop jump exercise
  • The single leg hop exercise 

Since plyometric exercises are advanced and place a high amount of stress and strain on your body, you must consult your PT or healthcare provider before starting them.

A Word from Verywell

A Lisfranc fracture can be a painful injury that leads to difficulty walking, running, and enjoying your normal activities. Your physical therapist can work with you to devise a specific exercise program that can help you return to your normal activity level quickly and safely.

7 Sources
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By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.