Treatments for Forefoot and Midfoot Fractures
Nonoperative Care for Non-Displaced Tarsal-Metatarsal Injury (Lisfranc)
It’s advisable for certain individuals to undergo nonoperative management for non-displaced Tarsal-Metatarsal Injury (Lisfranc).
Conditions: When the fracture/joint dislocation is less than 2 mm.
Treatment: Utilizing a non-weight-bearing cast for a duration of six weeks.
Surgical Management for Displaced Tarsal-Metatarsal Injury (Lisfranc)
For unstable cases of tarsal-metatarsal injury, surgical management is the recommended course.
Indications: In instances of joint dislocation exceeding 2 mm and fracture joint displacement.
Procedure: The recovery process may initiate with therapy, spanning four to five months, followed by the removal of hardware before engaging in full-fledged activities.
Basis for Recommendation: Therapy serves as an initial phase in the recovery process, persisting for a considerable period, with the removal of hardware preceding full activity. Supported by evidence on Lisfranc injury management.
Non-Surgical Approach for Non-Displaced Metatarsal Fractures
The preferred strategy for non-displaced metatarsal fractures involves non-operative management.
Indications: Applicable to shaft fractures featuring dorsal angulation below 10 degrees, with no displacement or a displacement of up to 3 to 4 mm either dorsally or plantarly.
Surgical Management for Displaced Metatarsal Shaft Fractures
For metatarsal shaft fractures presenting misalignment, a surgical approach is recommended.
Indications: In cases where several metatarsals fracture, coupled with a shaft fracture near the metatarsal head leading to dislocation.
Procedure: Internal fixation involving screws, plates, or percutaneous pinning, accompanied by four to six weeks of non-weight-bearing, followed by gradual weight-bearing over the subsequent four to six weeks using a walking cast or fracture shoe/boot. Full weight-bearing can commence in stiff-soled footwear once radiographic evidence confirms union.
Rationale for Recommendation: Optimal immobilization or fixation is determined based on physical and radiographic findings.
Non-Surgical Management for Proximal Fifth Metatarsal Fractures (Including Joints and Avulsion)
A non-operative approach is recommended for specific cases of proximal fifth metatarsal fractures.
Indications: Non-displaced fractures, a 1 to 2 mm step-off on the articular surface, or less than 30% articular surface involvement with a cuboid; avulsion of the tuberosity; Jones fracture. Patient/provider preference may influence the decision.
Procedure: Conservative treatment, such as non-weight-bearing for one to six weeks. For Jones fractures, immobilization in a non-weight-bearing short-leg cast is advised for one to six weeks, followed by transitioning to a walking cast or hard-sole shoe until union is confirmed.