Feet > Midfoot Sprain > Treatments

   Open 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.

   Prior 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.

   Any 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.

   Understand 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.

   Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   To 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:

   You 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.

   Arrange for someone to drive you home when you are released.

   Wear 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.

   Take 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.

Surgery Procedure

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 procedure.

   A two- to three-centimeter incision typically is made lengthwise along the top of your foot.

   Your surgeon removes any loose bone chips and damaged soft tissue from your midfoot.

   Any of your fractured long metatarsal bones are put back into place in your midfoot joint.

   Screws 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 cuneiform bones.

   Depending 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.

   Your 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:

   Ten 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.

   Two 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.

   Eight 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.

   Twelve 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 ones.

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 demanding activities.

SHOES

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.