Lisfranc Injury: Part 2

Last month, we talked about the anatomy, the mechanism of injury, and my own history with Lisfranc Injury. Rehab is never an easy process and the journey requires patience, consistency, and hard work. Here at Competitive Edge, we use a wide variety of high tech biofeedback tools to aid in the rehab process. These tools include Inertia Measurement Unit Sensors (IMU Sensors), electromyography (EMG) sensors, and an in ground force plate among others to gather patient specific movement data. More importantly, this data helps me minimize compensations and prevent future injuries by pinpointing objective feedback gathered in the lab.   

During the beginning phases of my rehabilitation I utilized a progressive activation and strengthening program. This includes a comprehensive overhaul of all the all muscles in the lower extremity. Each joint is connected to another and our bodies are designed masterfully to coordinate several muscles during everyday movement. Now in the lab we can find out exactly what type of stressors and impact we are having on our bodies as we go through our daily activities and more importantly how we can be more efficient throughout the entire rehab process. For me specifically, I needed to strengthen not just my foot muscles but my knee and hip muscles as well. With these tools we can pinpoint exactly what’s going on and how we can create the best possible strategic plan for strengthening while minimizing reinjury.

Over 4 years as a Physical Therapist I’ve taught numerous people how to squat and do deadlifts without technology, however, using precise feedback is such a huge game changer that I’ll never train people the same again. EMG sensors give feedback on whether or not the right muscles are activated while lifting and performing exercises. Being able to recognize the activation of specific muscles is extremely difficult to do without the tech.  Now for some these sensors will initially make some lifts more difficult due to the correct muscles finally being activated and minimizing the compensations on other muscle groups. These sensors work by being connected to electrodes strategically placed on the body at the motor points of a muscle. This allows the patient to clearly see on the screen if they are getting the correct activation, while practicing how to correlate the activation with the exercise. This greatly expedites the rehab process especially so that when doing the exercise later on your own you have the correct mechanics ingrained preemptively. In addition to the EMG feedback sensors, Competitive Edge utilizes IMU sensors to read joint angles from your trunk, hip, knee, and foot. This specific data provides necessary information to assist with biomechanical movement analysis specifically for running, jumping, and cutting. This data is especially important for basketball athletes.

During my rehabilitation, I noted some inside (medial) knee pain and outside (lateral) foot pain. These are worth noting simply because these symptoms specifically are away from my surgical site. Since this isn’t typical, the data from the IMU sensors and the pressure plate was used to identify my own compensations as a critical part of confirming that these symptoms were not a greater issue. Naturally, my body compensated by avoiding pressure onto the inside of my foot and placed most of my weight bearing on the outside of my foot, as you can see from the picture below. My doctor also prescribed some custom orthotics to place more forces on the outside of my foot, which was also confirmed using the pressure plate feedback.

Pressure Graph

From blue to red, the graph represents an increase in pressure. The picture on the left represents my walking in October 2018 with my orthotics, the left picture represents February 2019. Less pressure overall, especially, my lateral border critical data for objectively gauging progress.  

Along with mirror feedback and videos, the IMU sensors provided strong data with specific joint angles from my hips, knees, and feet. Along with my foot alignment I had a lower dynamic malalignment. With movement into a single leg position my knee demonstrated an increase in genu varum: when the knee moves outward (laterally) but distally the lower leg moves inward (medially). With my femur bone excessively rotating inwards, it began to compress into the tibia on the inside. This rotation is more evident with fast movements such as running and cutting. An orthotic further increased my pressure outwards which increase the knee angle into a more tibial varum.

Depth Jump

Depth Jump

Triple Hop with Video and Avatar

Triple Hop

As I progressed I slowly ditched the orthotics training my ankle and foot muscles to be without it. With the help of IMU feedback and glute feedback, I efficiently trained my glutes and improved my hip flexibility to maintain stability in the hips so I don’t further compress the inside of the knee. I also practiced maintaining good lower extremity alignment with squatting and single leg squat position. This was critical at this state especially as part of the steady process of reintegrating normal movement patterns.

Now at the end I’m finally getting back to playing basketball, I know my body is better prepared for the demands of play. This is due in large to my thorough rehabilitation program here at Competitive Edge. I know that my rehabilitation required strategic strengthening exercises. By utilizing quantitative feedback with this technology not only was rehabilitation made easier, faster, and more efficient, but it also further assisted with minimizing compensation, preventing future pains and aches, and minimizing the total time required for my healing process. For a comprehensive examination of anatomy, muscle activation, and biomechanics for your sport, check out Competitive Edge Physical Therapy; we have all the tools to help you not just get better quickly but to keep those same injuries from coming back.  

Feel free to check out our running gait analysis or return to sport analysis at or schedule a free consultation by phone at our clinic in San Jose, CA 408-784-7167.

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