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I have a Lisfranc injury (diagnosed by an orthopedic surgeon). I'm in a walking cast for four weeks, then off to physical therapy. How long before I'm back on the tennis court?

Injuries of the midfoot called Lisfranc injuries affect the area of the foot between the base of the toes and the ankle/heel complex. The proper anatomical term is the tarsometatarsal (TMT) joint. Metatarsals are the long bones of the forefoot. These are the bones of each toe between the ankle (tarsal bones) and the bones we usually refer to as the toes. Lisfranc injuries describe any injury that occurs at the tarsometatarsal joints. This could be at the base of any of the five metatarsals (toes) or the place where the metatarsals glide against the tarsals (ankle bones). There is also an actual Lisfranc ligament at the base of the second toe. Damage to this ligament can also be called a Lisfranc injury. Recovery depends on quite a few variables. First of all, the severity of the injury -- was there a fracture? Did the bones displace (separate, shift, or move)? If so, how much displacement is there? Were the ligaments damaged? Do you use tobacco products or have a poor diet (both are factors in healing)? If there has been a fracture but it's not displaced, then immobilization in a cast for four to six weeks may be adequate. Physical therapy after that to regain motion, sensation, stability, and strength will take another four to six weeks. You may be cleared to return to the tennis courts sometime during the rehab phase when you can handle sports-specific activities. The physician may rely on MRI studies to help determine when it's safe to return to play status. The midfoot must be in good alignment and stable. Early diagnosis of midfoot instability because of ligamentous damage usually results in surgery to repair the area. When surgery is involved or when there isn't a fracture and just ligamentous damage, recovery takes a bit longer (a minimum of four months before therapy begins). The physical therapist helps the patient regain full motion, strength, proprioception (joint awareness), and kinesthia (movement awareness and accuracy). These are important components of rehab to help prevent future injuries or re-injuries of the same area. This is especially important for the athlete who must make sudden changes in direction on the field or push-off on toes or jump and land on the midfoot.

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