Sprain > Treatments
Reduction and Internal Fixation
If your midfoot bones shift
out of their normal position (displace), you may need
to undergo surgery to reconstruct the bones in the middle
of your foot and your midfoot joint. Through an open
incision, surgeons can return your fractured bones into
the normal position and fix your midfoot bones in place
using wires. Surgery can be performed the same as the
injury and it typically is performed within a few days
of the diagnosis.
The actions you take before surgery
can be every bit as important as the procedure itself
in ensuring a healthy recovery.
to your return home from the hospital, make sure that
you have received any equipment you will need when you
get home. This may include crutches or household items
to make movement around the house easier. You should
receive prescriptions for any of these from your doctor
before you go home from the hospital.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any new medications you are taking.
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
a second opinion from another qualified surgeon is often
advisable, particularly in rare or unique cases.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will
go to “patient admissions” to check in for
your operation. There may be separate check-in areas
for ambulatory outpatient (patients go home the same
day after surgery) and for overnight inpatient surgery,
so be sure to ask your doctor or an assistant about
this. After you have checked in to the hospital, you
will go to a holding area where the final preparations
are made. The mandatory paperwork is completed, and
your foot may be shaved, though this is not always necessary.
You will be asked to change into a hospital gown and,
if applicable, remove your watch, glasses, dentures,
and jewelry. You will have the opportunity to speak
with your orthopedic surgeon or an assistant and meet
the anesthesiologist or nurse anesthetist (a nurse who
has done graduate training to provide anesthesia under
the supervision of an anesthesiologist). Then, you will
walk or ride on a stretcher to the operating room. Most
patients are not sedated until they go into the operating
room. Here are some important steps to remember for
the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under anesthesia.
for someone to drive you home when you are released.
a loose pair of shorts, sweatpants, or other clothing
that will fit comfortably over your short leg cast or
splint when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Open reduction and internal fixation of your
midfoot sprain and fracture can take between two and
three hours to perform, depending on how many fractured
bones your surgeon needs to fix in place. Spinal anesthesia
typically is given to numb you from the waist down,
and you usually are sedated so you sleep through the
two- to three-centimeter incision typically is made
lengthwise along the top of your foot.
surgeon removes any loose bone chips and damaged soft
tissue from your midfoot.
of your fractured long metatarsal bones are put back
into place in your midfoot joint.
typically are used to fix the second metatarsal bone
to the smaller cuneiform bones in your midfoot. A screw
may be inserted from the second metatarsal to the medial
cuneiform on the inside of your foot, or the screw may
attach the second metatarsal to the middle of the three
on the size of your bones, wires may be used instead
of screws to fix other metatarsal bones towards the
outside of your foot that also may have displaced.
incision is closed with stitches. A splint is applied
to immobilize your foot and ankle, and you are taken
to the recovery room.
After your midfoot sprain and fracture
is repaired, you will be transported to the recovery
room where you will be closely observed for one to two
hours while the immediate effects of anesthesia wear
off. Your foot will be elevated and immobilized in a
plaster splint when you wake up. There usually is minimal
bleeding after surgery. You typically cannot see the
incision in your foot because it is wrapped in the splint.
After surgery, you usually experience some pain. Adequate
pain medications will be prescribed for you. You will
be given intravenous (IV), oral, or intramuscular pain
medications as needed. Your surgeon will prescribe crutches
and you are usually instructed to keep weight off your
foot for the first eight to ten weeks. Your temperature,
blood pressure, and heartbeat will be monitored by a
nurse who, with the help of the doctor, will determine
when you can prepare to go home. You typically spend
one night in the hospital after surgery so physicians
can help manage your pain.
For four to five days after open reduction
and internal fixation of your midfoot fracture, you
should keep off your feet, elevate your foot above heart
level, and move around the house as little as possible.
You should try to rest and avoid too much movement for
at least a week. Crutches usually are prescribed for
about six to eight weeks so you can keep your body weight
off your foot. Rest as much as possible with your ankle
elevated. This helps blood drain away from your foot
and can control swelling. The more weight you put on
your ankle, the greater your chances of disrupting the
healing process in your foot. Household tasks that require
you to be on your feet may be difficult for six to eight
weeks. Try to have someone around the house to help
with any physical chores. The dressing covering your
wound inside your post-surgery foot splint usually does
not need to be changed until the splint is removed.
A typical follow-up schedule after you leave the hospital
may go as follows:
to 14 days – Stitches are removed and your foot
and ankle are put into a short leg cast. Most casts
need to be kept dry when bathing.
weeks later – Return for a check-up. Possibly
receive X-rays and, if necessary, a new cast. For the
next four weeks, you may return for a few more check-ups.
to ten weeks after surgery – If your physician
sees signs of healing in your foot, your cast may be
removed. The wires in your foot also can be removed,
and you usually can start bearing some weight while
using your crutches. You typically receive a removable
brace that can be worn inside your shoes. Weight bearing
increases as you can tolerate the pain.
weeks after surgery – You may be able to bear
your full body weight with the use of a rigid arch support.
Your physician will prescribe an arch support to be
worn in all your shoes for over a year after surgery.
Arch supports typically wear out in six months and you
should regularly visit your physician to receive new
Complications after a midfoot sprain and fracture are
especially common after a fracture that involved dislocations.
Midfoot fractures are difficult to rehabilitate and
you may not be able to return to competitive sports
for as long as a year after surgery. It is important
to strengthen the muscles and tendons in your foot and
lower leg to protect your midfoot bones. You usually
can begin range of motion exercises when your cast comes
off six to eight weeks after the injury. You may be
able to perform stretching and strengthening exercises
on your own. But active people who want to speed their
recovery time may benefit from supervised physical therapy.
After open reduction and internal fixation surgery
for your midfoot fracture, you typically can return
to normal daily activities within four months of the
injury. To prevent reinjury, you may want to take it
easy on your foot and avoid activities that could result
in falls or direct contact with your midfoot. Unfortunately,
midfoot fractures may be associated with long-term complications.
Your midfoot is at an increased risk of redislocation,
osteoarthritis, and some patients continue to feel stiffness
in their feet. To prevent complications after a midfoot
fracture, it is important to make stretching and strengthening
exercises part of your everyday routine. If you do not
suffer any complications and your midfoot heals properly,
you may be able to return to sports and activities about
one year after the injury. However, midfoot fractures
are serious injuries, and your physician may restrict
you from playing contact sports and other physically
Finding a shoe with the proper shape and support for
your foot can help prevent abnormal foot strain. Your
athletic shoes should have good shock absorption in
the heel, a stiff sole to prevent bending in your midfoot,
and sturdy materials to prevent side-to-side motion.
Try to avoid walking long distances in unpadded dress
shoes or boots. Women should avoid wearing everyday
shoes with heels higher than 1.5 inches. Wearing an
orthotic arch support device in all your shoes can help
stabilize your midfoot and prevent reinjury. Based on
your activity level, shoe inserts usually wear out within
six months and need to be replaced.