My name is Erik Nilssen. I’m a board certified orthopedic surgeon, dual fellowship trained in both sports medicine and foot and ankle surgery. I think passion is what drove me into healthcare in the first place and it still sustains my interest as we speak today. If you’re looking at personal injury patients, those that are in car accidents, what’s often misunderstood for these patients if they don’t have healthcare insurance, oftentimes the patient’s car insurance will cover the first $10,000 of their health care.
And I’ve noticed over the last five, six years, I’ll see these patients well after they’ve been treated somewhere else, Urgent Cares, ERs, and they just… the funds are taken up and they don’t have the money to be treated. So it puts the patient in a really difficult spot. If you look at healthcare today with cost quality and access, we’re trying to provide really cheap costs, keep the costs really low for the patient, provide the best quality and give everybody access.
So it’s an interesting question. When it comes to an injury, let’s say car accidents for example, the typical fender bender, my suggestion is if you’ve been hurt at all, if you have any sprain or strain… because I’ve seen in the past what you deem as a sprain could actually be a stress fracture. So I think if you have any type of pain, or injury, or concern after a car accident, you should seek medical care. For those accidents where it’s just a simple fender bender and you actually have zero pain for a couple of days, maybe you can avoid it. But otherwise I would err on the side of caution.
So as a board certified orthopedic surgeon, our training involves, multi specialties of the musculoskeletal system. So for example, in our training we do spine. We spent a good year of our training as a resident in spine. We do a year of total joint replacements involving hips and knees. We do sports medicine for a year. We do pediatric injuries as well for a year. And we also do foot and ankle and hand for a year. So it’s a five year training program. And after that you can go ahead and become practicing physician.
I actually sort additional training on top of residency, which is called fellowships. So I did a one year fellowship in sports medicine, which involves an intense focused training of shoulders, elbows, and knees, and also hips. Also sports related injuries in terms of athletes of all different levels. And then on top of that I did another year of focused foot and ankle injuries as well. So with that background, it really gives us the ability to diagnose any musculoskeletal injury in terms of spine injuries, shoulder injuries, elbow, hand, knee, wrist, pelvic injuries, foot and ankle, it doesn’t really matter. We can diagnose it and put you on a proper treatment plan.
We break this into two categories. There’s nonsurgical and surgical. So nonsurgical involves things like physical therapy, involves durable medical equipment such as boots and braces, anti-inflammatories. It’s really the nonsurgical modalities which the majority of injuries can be treated in mobilization. And again, the key is to really getting an adequate diagnosis to put you on the right treatment plan. If indeed you have a more serious injury or something that fails, sort of nonsurgical treatment, or someone comes in with an acute fracture that needs to be fixed we also have surgical options and we have the ability to take you to surgery and operate, if you will, on the various different body parts.
And again, if it’s something highly specialized in something that we personally are not comfortable with, we have a team of physicians that are really just glorified mechanics. We have the oil guy, the timing belt guy, the tire guy. So we all have sort of a specialty that we really focus on and give you the best quality of care.
So in terms of recovery, it really depends on your type of injury, what you’ve had done and whether it was a nonsurgical or surgical injury. If by chance, say you had a fracture, you broke a bone, in general, whether it’s surgical or nonsurgical, bones take eight to 12 weeks to heal. There’s also some recovery in terms of therapy. So it really depends on what your injury is, but it can be as little as two months up to a year, depends on what you’ve had done.
Yeah. So for those patients that do not have health insurance, they have the ability to use their personal injury insurance under their car insurance. Now for those patients that have health insurance and have car insurance, I think you can still use your car insurance under that, but you have the ability to use your own health insurance as well. So for those uninsured patients that don’t have health insurance, it’s really, really helpful for them to have that personal injury protection in their car insurance to cover them. It’s why it’s really imperative to see someone early who knows what they’re doing, to use that allocated money very wisely to get them back to where they were before.
Our caller phone number, which is (850) 435-4800 ask for Tara, my scheduler, or you can go to our website @www.nilssenorthopedics.com.
My mission as a surgeon is to put people back as close to the way they were prior to their injury or incident or whatever has harmed them. I think our true goal as surgeons is to think of our work as sort of artwork, and each surgeon has an autograph, and every time we look at that X-ray or a picture of their foot or ankle to know that we’ve basically impacted them for the rest of their lives, and our mission is to know that we’ve put them back to the way they were before anything ever happened to them.
To be able to create that quality of life that they need, to get them back to the activities they like to do, whether it’s walking with their wife on the beach or getting back to some professional sport. Our true mission is to help people get back to the quality of life they need.
So, one of my main reasons for going into foot and ankle was sports medicine. In the past, there really was no sports medicine discipline or philosophy in foot and ankle. So, when I did my training up at McGill, most of the residents did two fellowships after they were done. So, I was torn but I definitely loved sports medicine. That was why I went into orthopedics and then foot and ankle came on later. So, I decided to marriage the two together.
So, I pursued a fellowship with Dr. Andrews, the biggest Sports Medicine orthopedic surgeon in the world, and did a year with him. Stayed on and did another year in foot and ankle after that and marriaged the two and been down at Andrews’ Institute now for six years and have really blossomed from a sports medicine perspective in foot and ankle and have had the pleasure of taking care of various collegiate teams, currently Jackson State, all the athletes at Auburn University, and various professional teams, players, and even Olympic athletes.
All this experience has really served our center well and has allowed us to bring all this experience and produce new techniques and outcomes for you the patient.
Let’s talk about ankle sprains. So there’s really two types of ankle sprains. There’s your classic ankle sprain where you roll your ankle and you hurt the ligaments on the outside of your ankle, something we’ve all done, typically. There’s also the high ankle sprain, which is a more rare ankle sprain, if you will. It involves different set of anatomy, different set of ligaments. Classically, it’s more of a high energy sprain. You see this with more of our collegiate and professional athletes, a little bit higher up in the ankle. It’s more of a rotational issue.
So let’s talk about your classic ankle sprain first. Typically what happens is, we see a lot of ankle sprains, very common. Probably the most common ankle injury, really, in the world. So what happens is the foot typically is, usually you’re on your toes. When you maybe say playing basketball, you jump up for a rebound, you come down and you step on someone’s foot and the ankle rolls. Or you’re just walking into the grocery store and you step on the curb or step on a pebble and your ankle gives. Either way, you roll that ankle.
Typically for a onetime sprain, even second, sometimes third, the treatment for that is typically going to be a a nonoperative treatment. So what we do is we see someone who has an acute ankle sprain, we obviously get an X ray, make sure you didn’t break anything. We do a physical exam, see where you’re sore. But generally speaking we’re going to put you into what’s called a walking boot. Ice, elevate, maybe some compression, some gentle mobilization, moving your ankle up and down after we see you. But a boot to protect you initially, just to get going, bring you back in a week or two, reexamine you and see how you’re doing, making sure you’re progressing.
It’s those people that aren’t progressing. Huge swollen ankle, still having a hard time walking. We begin to think, “Well maybe it’s not just an ankle sprain.” We give a nice talk at our football course every year about things you don’t want to miss on an ankle sprain. Then maybe we start digging a little deeper and making sure we’re not missing something. Maybe after two weeks we may consider getting an MRI just to give us a better imaging modality to make sure we’re not missing a fracture or a stress fracture or something else it could be.
But generally speaking, 90% after an acute ankle sprain are going to get well, just going take time. So it’s those patients that have a recurrent ankle sprains, ankle instability, where it keeps rolling on them regardless. Walk into a movie theater, step out of a car. So for those people that have failed physical therapy multiple times: bracing, taping. So bracing and taping can help quite a bit, but it’s very difficult to wear a brace the rest of your life as you’re going in to work every day. Obviously for playing sporting events, a little bit easier to do that. But for those recurrent sprains, we start saying, “Well, if it’s not going to stabilize itself, then maybe we have to go there and fix it.”
The reason for fixing it is for a couple reasons, A, so you don’t sprain your ankle anymore. But every time you roll your ankle, you keep knocking off cartilage or keep stressing the ankle joint more and more, which can set in arthritis, which is a loss of cartilage. If we have to fix it, the good news is it’s a great surgery, has about a 99% success rate. It’s probably the best surgery that we ever do. And there’s great literature to support all that.
So we typically do, it’s called a, technical term is called a brostrom gould or a lateral stabilization. We go in there and we typically put a camera in your ankle. We look around, make sure the ankle looks okay and then make an incision on the outside of your ankle. Typically what we do is we, those ligaments, when they tear, they heal back, but they heal back typically loose. They’ll tear again. Pretty soon, it’s intact but it’s just very, very loose. So we go in and we cut that ligament in half and we take suture and we suture it on top of each other and make it tight. Sometimes we’ll augment that repair with an anchor or a special type of suture that’s called an internal brace that provides much more stability to the ankle. Typically we do that.
You’re non weight bearing for about four weeks, sometimes two. Then you start walking after that surgery at about the four-week mark, in a boot. We start therapy at the six week mark. But it’s a process. I mean in terms of people that say, “When can I start running or jumping?” It’s at least three to four months after that surgery before you sort of cut loose and do what you want to do. But you’re probably going to be walking in a shoe about eight weeks after surgery out of that boot with physical therapy. So that’s our typical ankle sprain, the most common one we see.
The high ankle sprain is very complicated. It’s a much more involved, like I said, anatomy. Luckily for us, we have a weightbearing CT scanner. That weightbearing CT scanner has changed the way we can treat these, because we’re able to see the relationship on the normal side versus the abnormal side. It just gives us much more information. The high ankle sprain is, like I said, very complicated to go into. But basically it has to do with the shin bone and the bone on the outside, your tibia and your fibula. There’s a ligament that goes across there. It keeps those two bones together and actually keeps the [inaudible 00:05:22] talus bone, the ankle bone, from shifting out. So if there’s any change in that, we’re going to have to go in there and stabilize that ligament with a procedure.
The nonoperative treatment, again, is a boot, a brace, those things we talked about. But the healing time for a high ankle sprain is much, much longer than your traditional ankle sprain. So hopefully that gives you some insight as to the two, and hope that gives you better understanding.
Let’s talk about arthritis. Arthritis is, pure and simple, is the loss of cartilage. It’s not the presence of any kind of disease, it’s just the loss of cartilage. Now, within arthritis, you can get it a number of ways. Say, for example a rheumatoid patient, so there’s inflammatory arthritis, where the body actually eats its own cartilage. Some people get post-traumatic. Say you’re in a car accident and you break a bunch of bones and you hurt a bunch of joints. As time goes down the road, you begin to lose cartilage because of the trauma, so that’s post-traumatic arthritis. Post trauma loss of cartilage. There’s also a genetic component. Some people say, “Well, I’ve got osteoarthritis.” Well, osteoarthritis is just wear and tear over time and you lose cartilage. Maybe some genetic component, may just be because, but either way, you lost cartilage.
Unfortunately in the foot, there’s over 20 joints in the foot, so versus the knee, there’s really one joint. We’ve all known about knees, so if someone gets arthritis in the knee, you treat it non-operatively with some anti-inflammatories, physical therapy, some bracing, maybe a knee scope, and eventually they go on to what’s called a total knee replacement. We use some of the same principles in the foot and ankle, but it’s a little bit different because there’s so many joints. It’s much more complicated than the knee, my personal opinion.
Arthritis. So, we break the foot up into three segments. There’s the hindfoot, the midfoot, and the forefoot. In the hindfoot, it’s typically made up of two joints; the ankle joint, which makes your ankle go up and down, and the subtalar joint, which is under the ankle joint and gives you that side to side motion. If you’re walking on an incline of a hill sideways, it’s that subtalar joint which is what’s going to give you the stability. Going to the beach, that subtalar joint’s really rocking, really firing for to keep you stable.
Ankle arthritis. Again, irrespective of how you got the arthritis, what can you do about it? Well, much like the knee, we try non-operative treatment first, bracing, a boot, anti-inflammatories, physical therapy. We try all these things and exacerbate this, and comes down to really one question; how much pain are you having, and how is this affecting your activities of daily living? Things you like to do. When you begin to travel less, can’t go to work, have a hard time going to the store, trying to plan out where you can park, you start getting into indications where what can we do surgically to that ankle to make you better? Again, we’re really treating pain and function.
From an ankle standpoint, there’s really two procedures in general that we can do. We look at ankle fusions, and total ankle replacements. Ankle fusions; people get spooked because, “Well, you’re going to fuse my ankle and my foot won’t move.” Well, that’s totally not true. Like I said, the foot has a hindfoot, a midfoot, and a forefoot. We can fuse your ankle, people think the entire foot is locked in, it doesn’t move, which is totally not true. You get compensatory motions of your forefoot and your midfoot, even some of your subtalar joint. You can actually have someone fuse their ankle, walk down the hall, sometimes you can’t even tell they’ve had an ankle fusion. Again, it’s for pain and function. We do plenty of ankle fusions. It’s a great procedure, it’s stood the test of time, it’s still sort of the gold standard as we speak today.
From a total ankle perspective, they started off in about 1998, 1999 in this country. We’re behind total hips and total knees, but they’ve made tremendous strides, and actually it’s a darn good procedure. We’re doing total ankles now. The technology is just so advanced now. We’re actually accumulating long-term data now and getting ten, 15 year results. The big knock on these total ankles when they first came out was, well, they fail within a year. Who wants a surgery that’s going to fail in a year? That’s all changed now. We’ve got people that have these ankles in for ten, 15 years that are still going. It’s a great procedure. A lot of different companies have come out with different ankles, and we have one or two that we typically like to use. It’s pretty cool, we actually can CT scan your ankle, we send the CT scan off to the company and they actually custom make cutting jigs and the instrumentation to fit your specific anatomy, which is, to me, what I call a game changer. It makes our life easier, makes your recovery better, and that’s really what it’s all about.
Two great options. It’s sort of patient dependent, what’s your situation, what kind of things you like to do. We look at your lifestyle, how active are you, what are your goals, how old are you? There’s a lot of things we look at. Everyone’s treated dependent upon what your situation is. Either way, ankle fusions are typically non weight bearing for six weeks, total ankle replacements you’re off it for four weeks. The recovery period is not that much different, and your rehab and stuff after that is all just the same for the most part. Both viable options.
Subtalar joint, unfortunately we cannot replace your subtalar joint. Typically for that, when that joint wears out, we fuse your subtalar joint. Again, your subtalar joint only has about five to ten degrees of motion normally. So post-traumatic, like heel fracture, you fall off a ladder, break your heel bone, five years later joint’s killing you, we go in there and fuse that. It’s a very simple procedure, about 45 minutes. We go in there and prepare the joint surfaces, expose it, get good bleeding bone, put it together. We typically use one screw, sometimes two screws to compress that joint, and over time the body sees both sides of the bone, it begins to fuse and become one. Your pain goes away because there’s no joint.
People always ask, “Well, after you do this surgery, is the arthritis going to go away?” Well, arthritis involves a joint, and if we fuse your joint, there is no joint. That pain should go away completely. That’s a subtalar fusion. Downside for you is we see you every two weeks for six weeks, then at six weeks we CT scan you, make sure the bone is fused, and the bone starts to fuse, then we get you into a walking boot, you can begin to start walking. At that point, do some physical therapy, but it’s a recovery. Bones completely heal about six to 12 weeks after surgery. That’s a subtalar fusion.
Moving down the foot, in the midfoot and forefoot, same issue. There’s a lot of small joints. The only other joint that could possibly be replaced is the first big toe, the big toe joint. I personally do not do big toe joint replacements. I typically take a lot of those joint replacements out. I have a cup in my office, has a lot of paperweights in there. It’s an expensive paperweight. I don’t think those joint replacements, they put a metal cap on one end, and I just, in my hands and my experience and what the data shows, I don’t think that’s a great surgery. For big toes we can go in there and clean the joint out itself. We can actually just go in, give it a clean up job, it’s called a cheilectomy. You don’t burn any bridges. It may buy you some time. If you still have pain in that big toe and the joint’s completely destroyed and you’re not doing so well, you always go back and fuse the big toe. We fuse the big toe joint, leave the joint distal to that joint open, exposed, and it’s a great surgery. Patients are very satisfied. Works really well.
In the midfoot, there’s so many joints in the midfoot. Very little motion. If those joints wear out, we typically try non-operative treatment. We can try some injections occasionally under, fluoroscopically. We have an interoffice fluoro machine, which is kind of cool. We visualize your joints and under direct vision put a small, little needle in the small joint. May buy you some time, but over time, generally speaking, it’s a pain issue. If it bothers you that bad, affects your activities of daily living, we go ahead and fuse those midfoot joints. Again, six weeks non-operative, or, sorry, six weeks of non weight bearing. We get a CT scan at that point, check for fusion, and get you in a boot at that point and then bridge you along.
Anyway, we have lots of ways to treat arthritis. It’s probably the most common thing we see. Just give you some insight into what we do, and hope it gives you just a better understanding.
What is plantar fasciitis? Plantar fasciitis is the number one cause of heal pain. One in every ten people will suffer from this condition some time in their life and women are six times more likely to suffer from plantar fasciitis. There are two million new cases of plantar fasciitis reported each year. Did you know that 25% of your bones are located in your feet and 83% of people with heel pain are active working adults between the ages of 25 and 65, so you are probably asking yourself, what are some contributing factors of plantar fasciitis?
There are a multiple ways that the plantar fascia can be damaged, the most common way is to wear shoes with poor support. This can cause microscopic tears in the plantar fascia, if these tears remain untreated, you will eventually begin to experience pain. Now, let’s talk about symptoms, just to name a few. Pain and stiffness in the bottom of the heal, heal pain upon taking your first steps in the morning. Sharp stabbing foot pain after physical activity affects one foot but may not occur in both.
If you are having these symptoms, here are some treatment options, try to limit or stop daily activity that can cause heel pain. Wear shoes or orthotics that support arches. Perform toe and cuff stretches on a daily basis. If the pain persists, you might want to visit an orthopedic, ankle, and foot specialist. To learn more visit nilssenorthopedics.com.
So os trigonum is a often overlooked and often misdiagnosed condition of the ankle. Patients typically present with posterior ankle pain. What happens is, this is an extra bone that never fuses in the back of the talus. It’s attached to a small little fibrous band, and oftentimes it’s very asymptomatic. So essentially, they’re born with two bones in the back. In the normal course, is that that bone fuses and becomes one bone.
Unfortunately, for these patients it doesn’t fuse, and typically it’s a soccer player or a volley ball player, often a basketball player or even a dancer. They get a hyperflexion of their foot, so their foot hyper-flexes, and it knocks that little bone in the back of their ankle loose and causes pain. So symptomatically, it’s posterior ankle pain, a type of injury where they hyper-flex their foot. For a baseball player, for example, oversteps a base and their heel hits the back of a base and their foot plantar flexes, and it causes what’s called like a nutcracker in the back of their heel. Their calcaneus bone jams up into the tibia, and it knocks that bone loose and becomes painful, and most people don’t know what that is. So they hard to see sometimes on x-ray sometimes, if it’s not a perfect lateral. So they come in with posterior ankle pain.
So an exam, they typically have pain the very back, it’s a anterior tibia, Achilles tendon, just in back of the tibia. They’ll have a normal walking, exacerbated by running. Again on x-ray, you can sometimes a big, big almost ball bone in the back. An MRI is really your key image to get, because what what it’ll show is, it will show that loose piece of bone that’s detached from the talus. You’ll see this big fluid around that bone.
Oftentimes, it’s very difficult to treat non-operatively, because you can put them in a boot and try to calm them down, but oftentimes once that bone gets knocked loose, they typically don’t do that well. If you were going to go down the non operative treatment, it would be rest, ice, compression, immobilization in a boot, just to calm things down. Generally speaking, I tell patients, “This is typically a surgical intervention, because it’s such a great procedure. It’s had such a high success rate in the past. You would have to make a incision and do an open dissection, and the neurovascular structures are right there. It’s pretty risky, and take that bone out, because you’re not going to fix it. You just take it out.”
Where we’ve developed, we can do this arthroscopically. We go in from the very back, and we do a posterior ankle scope where we can access this bone through to small poke holes, grab that bone, and all we’re doing is just removing. So we’re not really fixing anything. We’re just taking this away. Oftentimes this is an outpatient, 20 minute procedure, two poke holes, soft dressing, a walking boot. They can walk afterwards. Very satisfying and probably play, but return to sports as early as four to six weeks, and that usually does it.
For more information on os trigonum, you can visit nilssenorthopedics.com.
So today we’re going to be talking about lisfranc injuries. These are actually my favorite injuries to discuss because the complexity of the injury. It’s a very interesting injury. They’re often misdiagnosed. It’s one of the most misdiagnosed injuries that presents themselves in emergency rooms. So typically what happens, the mechanism of the injury is always the most important thing when discussing an injury. Oftentimes it’s a football player or a soccer player, jumps up in the air, they land on their foot, and just a subtle landing with a lot of force can cause the midfoot to be injured.
Other times, somebody can land on their foot in a hyper flex position, and some of them will land on the back of their heel. And what that’ll do is it’ll drive the foot down in the ground. And so this midfoot region through here will splay apart and it can be very subtle. They can get a subtle injury of the midfoot where they’ll sprain a ligament, or it can be much more involved where they actually dislocate or sublux bones.
And so we break the foot up into the forefoot, midfoot, and the hind foot. And so this injury [pertails 00:01:12] to the midfoot. And it’s interesting how we were designed because the midfoot, essentially it acts like the Roman arch. If you see how the Roman arches were made with those blocks of stone, they’re very, very stable. And that’s how this midfoot is. These are called cuneiform bones. And so they form a nice arch, and the metatarsal bones key in very nicely. And for whatever reason, there’s a ligament that attaches from each metatarsal at the base as it goes one and keeps them nice and stable.
Well between the second metatarsal in the first metatarsal, that ligament doesn’t exist. It actually makes a hard turn and attaches to one of the cuneiform bones. So it leaves the first metatarsal somewhat free, much like your thumb. So for that reason it provides an area of weakness when you land a certain way. And so like I mentioned before, they can be very subtle. So typical presentation is, for the subtle ones, they come in the emergency room or your office and they’ve got midfoot bruising and swelling. And so one of the telltale signs on the plantar aspect of the foot, which is the bottom of the foot, you’ll see a band of swollen, an area of swelling tissue along with some bruising and then also see some bruising on top. They’re typically pinpoint tender on top of the midpoint as well where you palpate.
There’s something called a piano key sign. So if that ligament becomes unstable, we can take our hands and we can stabilize these metatarsals and we can kind of squeeze in between and the first metatarsal will piano key and be very unstable. And so those are clinical findings that we look for. But again, I mean for someone, we see this every day so it’s very easy for us. Whereas people that don’t see these every day are often over-missed, and you have to have a high suspicion. And my assumption, anytime I see bruising in the midfoot or they’re tender in the after an acute injury, I assume it’s a lisfranc injury until proven otherwise.
So x-rays, a lot of times people get non-weight bearing views, which really is not beneficial because it can be missed. The key is to get someone to put weight on it, which is very challenging because their foot hurts and they don’t want to walk. And so if you can get them to put some weight on it, it’s very important that you load the foot. And when you load the foot, that’s when you’ll see the subtle dislocations where it’ll sublux over and it won’t align with one of the cuneiform bones. That’s a subtle pickup you’ll look for.
More advanced imaging obviously is a CT scanner. And again, most CT scanners are non-weight bearing. We have the luxury of having a weightbearing CT scanner right here in the office. And so what we’ll do is we can put the normal uninjured foot next to the injured foot standing and get weight bearing views and pull that up on the screen in about a minute after it’s scanned and have the luxury of identifying these subtle injuries and see if there’s any variation. And that’s what’s so nice is because everyone’s different. We have guidelines that we go by, but every individual is different.
And so what may be abnormal-looking on a single x-ray for one person may be normal for somebody else. So it’s a very nice luxury to have. Obviously there’s motor vehicle accidents where these are traumatic dislocations where the whole foot subluxes and that’s a much more devastating injury. So the concern is for, it’s just a ligamentous injury where the ligament’s torn, and the foot, if it’s partially torn and not really unstable, those can be treated non-operatively, typically in a cast, non-weight bearing for a few weeks and then advancing to a boot. But these take a long time to heal and if you’re going to go non-weight bearing, you have to be sure that you’re being treated by someone that sees these injuries and knows what they’re doing. So weight bearing views, high, very detailed clinical examination and probably an MRI or a CT scan.
MRI is typically the gold standard for most people. I like the CT scan because it’s a weight bearing, and like again, most people don’t have that luxury. If it’s a true subluxation, the concern is at the end of the bone is cartilage and cartilage is that precious material we’re trying to preserve. And when you have a shear injury, a lot of times it will shear the cartilage off. And what’ll end up happening down the road is they’ll end up getting post traumatic arthritis. And so if there’s any variation in the anatomy, we typically are very aggressive and we fix this. And the reason we take this to surgery because we want to restore the anatomy and return the foot to its pre-injury condition. And oftentimes that involves sometimes open incisions. Sometimes we can do in percutaneously with small poke holes. Oftentimes it’s screws, sometimes it’s plates.
But we’ve gotten so good with our hardware that are some really good anatomical plates that can align everything perfectly how it was before the injury occurred. And so in summary, these can be real subtle, they can be very complex. But in all, they’re bad injuries to occur. Very common in the NFL. They end people’s careers. But you just want to make sure you’re seeking proper treatment and getting a professional that knows what they’re doing and how to treat these. If you want to get more information on this injury, please visit our website, NilssenOrthopedics.com, and look up lisfranc injury.