Lisfranc Injuries

By Justin Delicato, PTA, Site Coordinator

What is a Lisfranc Injury?

Lisfranc injuries occur in the midfoot when the supporting structures (bones or ligaments) are damaged. The Lisfranc joint is the area of the foot where the metatarsals and tarsal bones connect. This joint is supported by a band of tissue known as the Lisfranc ligament. These injuries can vary in complexity and are oftentimes misdiagnosed for simple sprains. However, the midfoot (arch of the foot) plays a crucial role in functional stability and gait.

 

Graphic showing the bones of the foot.

Diagram of the anatomy of the foot.

What causes a Lisfranc Injury?

This injury most commonly occurs from a fall, when the ankle suddenly twists. However, they can also happen after forceful twist while in a plantar-flexed position (when the foot is pointed away from the body). A direct blow to the mid-foot (during sports, car accidents, fall from a height, etc.) can also injure this area of the foot.

Types 

There are three main types of Lisfranc injuries: sprains, fractures, and dislocations.

  • Sprains: Create instability of the midfoot, as the weakened ligament is unable to adequately support the arch of the foot after an injury.
  • Fractures: Breaks can occur in the associated midfoot bones – tarsals and metatarsals. Sometimes, a small piece of bone is pulled away creating an “avulsion” fracture at this location.
  • Dislocations: The supporting midfoot bones may shift out of place.

Symptoms of Lisfranc Injuries

The following symptoms can be present during a Lisfranc injury:

  • Tenderness at site of injury/top of foot.
  • Swelling.
  • Bruising in the midfoot (either top or bottom).
  • Pain in the midfoot that increases when weight-bearing (or inability to stand/weight-bear).

Diagnosing Lisfranc Injuries

In order the make the proper diagnosis for the injury, your physician may:

  • Take a thorough history.
  • Perform a physical exam.
  • Take x-rays (to determine fractures and position of the bones), sometimes standing.
  • Suggest further diagnostic imaging, including: MRI or CT Scan to determine associated soft tissue injury, which may be beneficial if surgery is required.

Treatment

There are two main approaches to treat a Lisfranc Injury:  Conservative (non-surgical) or Surgical.

  • Conservative treatment may be considered for mild sprains. These do not involve significant tears, fractures, or dislocations. Such injuries may be treated with the use of a walker boot or cast (non weightbearing only) to allow the injury to heal. The RICE technique is recommended:
    • Rest
    • Ice
    • Compression (when appropriate)
    • Elevation (lifting limb above height to decrease swelling).
  • Surgical treatment is typically performed for fractures or dislocations that occur at the Lisfranc Joint. During such a procedure, bones would be realigned to encourage appropriate healing and functional ability.  Sometimes, an ORIF (open reduction internal fixation) must be performed. This operation uses hardware (plates, screws, etc.) to ensure the integrity of the repair. In the case of severe injuries which are unable to be repaired, a fusion of the involved bony structures may be performed.

 Rehabilitation/Recovery

Individuals with Lisfranc injuries may benefit from physical therapy services, as advised by their MD.  After proper healing, rehab efforts encourage foot mobility and strengthening required for everyday function and a possible return to sport.

Author: Justin Delicato, PTA, Site Coordinator

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