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Osteopathic Manipulative Treatment For Postoperative Arthritis Following Midfoot Arthrodesis: A Case Report

Journal: The AAO Journal Date: 2025/06, 35(2):Pages: 19. doi: Subito , type of study: case report

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/2/article-p13.xml)

Keywords:

arthritis [76]
case report [710]
foot [66]
male [784]
OMT [3752]
osteopathic manipulative treatment [3772]
post-operative care [73]

Abstract:

Introduction: Unstable Lisfranc injuries can lead to significant disability and are difficult to manage. Treatment commonly involves open reduction and internal fixation (ORIF) or primary arthrodesis (PA). Common complications after surgery are diminished joint mobility, soft tissue trauma, and early development of arthritis within the foot, prompting persistent pain and physical activity limitations. Osteopathic manipulative treatment (OMT) is a positive adjunct to standard postoperative management to improve pain and quicken recovery. Objective: To demonstrate the utility of OMT as a successful adjunctive treatment to standard postoperative management. Case: Description: A 37-year-old male with an unstable Lisfranc fracture, s/p ORIF in 2015 with hardware removal in 2016, maintained moderate pain levels with sharp exacerbations to prolonged walking and running. He received corticosteroid injections (CSI) in the second and third metatarsals (MT) every 6 months with 6 weeks of pain reduction to mild levels. In 2018, he underwent PA without further relief. Outcomes: The patient received 5 OMT treatments over the course of 4 months from 2023 to 2024. Techniques used were balanced ligamentous/membranous tension, ligamentous articulatory strain, and osteopathy in the cranial field. He had successful pain resolution and maintenance with prolonged walking and running. Discussion: Post-traumatic arthritis and post-surgical compensatory changes of the ankle and foot will develop over time after initial Lisfranc ORIF. OMT is a powerful modality to restore motion and function allowing return to pain-free normal activities. OMT would be more effective at increasing patient satisfaction scores and relieving the undue burden of additional medical costs when performed within the first postoperative year. Further cases treated within the first year of surgery will demonstrate the full utility of OMT with post-surgical changes in variable presentations.


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