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ANTICIPATED MMI & RTW
Roya Mirmiran, DPM, FACFAS
FOOT & ANKLE TRAUMA
TYPES OF TRAUMA Low Energy High Energy
TYPES OF TRAUMA Open Fracture Closed Fracture
TYPES OF TRAUMA Comminuted fracture Simple fracture
TYPES OF TRAUMA Isolated trauma Multi-region trauma
Trauma of the Foot & Ankle Bone: fracture, dislocation, contusion Joint: OCD lesion, post-traumatic DJD Tendon: tenosynovitis, ruptures Ligaments: sprain or strain Nerve: neuropraxia to CRPS Others: ganglion cyst, LOK
Anticipated Treatment & MMI
Trauma Surgery P.T. Orthotics MMISmall toe fracture
Only if displaced
NO NO 6 weeks
Great toe fracture
Only if displaced
NO NO 8 weeks
Metatarsal fractures
(shaft or base)
Only if
1) displaced,
2) intra-articular,
3) comminuted or
4) non-union
NO Yes 8 weeks
Anticipated Return to Work
Trauma Sedentary Light Medium Heavy
Small toe fracture
One week 3-4 weeks 6-8 weeks 6-8 weeks
Great toe fracture
One week 4-6 weeks 8-12 weeks 8-12 weeks
Metatarsal fractures
(shaft or base)
One week 4-6 weeks 8-12 weeks 4-6 months
Anticipated Treatment & MMITrauma Surgery P.T. Orthotics MMI
Lisfranc fracture-dislocation
YES NO YES
(A must)
6 months
Talar/Cuboid fracture
YES YES YES 6 months
Calcaneal fracture
YES YES YES
(A must)
6 months
Anticipated Return to WorkTrauma Sedentary Light Medium Heavy
Lisfranc fracture-dislocation
3-4 weeks 8-12 weeks 4-6 months ????
Talar/Cuboid fracture
3-4 weeks 8-12 weeks 4-6 months ????
Calcaneal fracture
3-4 weeks 8-12 weeks 4-6 months ????
Anticipated Treatment & MMI
Trauma Surgery P.T. Orthotics MMI
Ankle Sprain Only after conservative measures are
exhausted
YES Benefits from ankle brace
(ASO or Ritchie brace)
3 months
Ankle fracture No for a non-displaced fibular
fracture, otherwise YES
YES Benefits from ankle brace
(ASO or Ritchie brace)
3-6 months
?????
Tendon injuries Depends YES NO 2-3 months
Anticipated Return to Work
Trauma Sedentary Light Medium Heavy
Ankle Sprain 1-2 weeks 2-4 weeks 2-3 months 4-6 months with the possible use of a brace
Ankle fracture 1-2 weeks 3-4 months 4-6 months ????
Tendon injuries
1-2 weeks 4-6 weeks 3-4 months ????
