The midfoot has a complex structure of bones and soft tissue (ligaments) that is important for foot stability and walking. Lisfranc injuries are damage to the area of the foot where the metatarsal and tarsal bones connect.
They can be caused by direct trauma like something falling on the foot, or indirect trauma such as twisting the foot during a fall. X-rays can show the injury, but more detailed imaging is often needed.
Diagnosis
The Lisfranc joint on the top of your foot is important because it’s where many parts of your foot connect. You use it when you step down, jump and run. It’s also where the bones in your arch connect to the rest of your foot. If something heavy falls on the top of your foot, you might damage the joints and ligaments in the area.
Your healthcare provider might suspect a Lisfranc injury if you have pain and swelling in the middle of your foot. This might be because of a direct force, like a fall or car accident, or indirect force, such as twisting the foot. You might see bruising in the area or have trouble standing or walking.
To diagnose a Lisfranc injury, your doctor will ask you about your past health and symptoms. Then, he or she will examine your foot and ankle. You might have tenderness to touch in the middle of your foot or a widening of the space between the first and second metatarsal bones (a distance called the Lisfranc gap). Your doctor might also hear a snapping sound when putting pressure on the bottom of your foot.
A standard anteroposterior and lateral radiograph of your foot might not show any fractures or dislocations. However, your doctor might suggest getting a weight-bearing anteroposterior and lateral view of the foot, along with a 30-degree oblique radiograph. This will help your doctor find a problem, such as a widening of the space between your first and second metatarsal bone (the space is called the Lisfranc gap).
This injury can also be diagnosed with CT scans. This type of imaging shows more detail than X-rays or ultrasound.
You might need surgery to fix the injured area of your foot. During open reduction and internal fixation, your surgeon will put the bones back into place. They will use metal plates and screws to hold them in place. Your doctor might remove the hardware at a later date. Before surgery, you might need to ice your foot and elevate it. This will reduce swelling and help keep the bones in place while you recover from the injury.
Treatment
The foot and ankle surgeon can determine the severity of a Lisfranc injury with careful physical examination of the injured foot and by performing imaging studies. This may include x-rays and an MRI or CT scan. If you injure this area of your foot, you should see a doctor as soon as possible to avoid long-term problems with pain, stiffness and swelling.
A cluster of small bones forms an arch in the middle of the foot (midfoot). This group includes five long bones (the metatarsals) that extend from your heel to your toes and three smaller, curved bones called cuboid bones. Tight connective tissue bands hold these bones together and give the joint stability. The area can be injured by a fall or by jumping or running. If you injure the midfoot, you may experience a fracture or dislocation or both.
These injuries are often mistaken for sprains and are not treated as promptly as other lower leg injuries. As a result, up to 20% of low-energy Lisfranc complex injuries go unnoticed or are diagnosed late and can lead to serious complications such as posttraumatic arthritis in the foot and ankle.
We can use the following signs and symptoms to help identify a Lisfranc injury: pain with standing or pushing off on the affected foot; bruising on both sides of the bottom of the foot; and a visible gap between the first and second metatarsal bases.
The surgical treatment for a Lisfranc injury depends on the type of injury and your symptoms. For displaced fractures and dislocations, surgery is needed to realign the bones and return them to a normal position. In this procedure, we make an incision on the top of the foot and reduce the broken bones. We then secure the bones in place with plates or screws. Because these plates or screws span joints that normally have movement, it is likely that they will need to be removed at some time in the future.
For less severe injuries, we can treat these injuries by securing the bones with K-wires in association with vacuum sealing drainage. This method is simple, allows for a fast anatomical reduction, stabilises the bony structure and prevents infection.
Recovery
The Lisfranc joint is the point where the foot’s long bones (metatarsal) and short bones of the arch connect. It is held in place by tight ligaments that run across and down the foot. This area is very important in stabilizing the arch for pushing off during walking (gait). Injuries to this region most often occur as a result of direct trauma, such as automobile accidents or falls from heights. These high-energy injuries often involve multiple fractures and dislocations of the midfoot joints along with other bones of the foot, leg, knee, or back.
If the injury is not treated, it may lead to instability of the arch and flattening of the foot. This can cause pain in the ball of the foot and difficulty with walking, running, or sports. In some cases, the injury may be so severe that it requires surgery to put the bones and ligaments back into place.
For most cases of Lisfranc fracture-dislocation, your doctor will take x-rays of the foot while you are standing (weightbearing). This helps them identify the location and extent of the damage. They will also compare the x-rays of your uninjured foot to see if the injured foot is changing shape.
Treatment for Lisfranc injuries involves immobilizing the foot in a cast or specialized boot, along with physical therapy to regain strength and mobility. During the recovery process, you may be able to gradually increase how much weight you put on your foot. Depending on the severity of your injury, it can take up to a year for you to reach a full recovery.
If you are diagnosed with a displaced Lisfranc fracture, you will need surgery to realign the fractured bones and ligaments in your foot. In the surgical procedure, your doctor will remove the broken bone fragments and then use a plate and screws to hold the bones and ligaments in place. This X-ray shows a patient with a dislocated Lisfranc fracture and a dislocation of the second metatarsal. The patient’s foot has a metal plate with several screws to hold the bones and ligaments in position.
Complications
Whether it’s the result of missing a step on your basement stairs or a more serious injury in an auto accident or sport, any pain, swelling or bruising in the middle of your foot needs to be seen by a healthcare provider right away. That’s because if your midfoot gets injured, problems with the ligaments that support the bones in your arch could develop into a serious condition called a Lisfranc fracture dislocation — named after French surgeon Jacques Lisfranc de St. Martin who observed such injuries in Napoleonic cavalry soldiers in the 1800s.
The Lisfranc joint is where a cluster of five long bones (metatarsal) bridges the arch to your toes. It also connects the base of your foot to the rest of the lower body, so this is a key area of the foot. And it’s important for walking because this is where your weight is centered on each foot.
Injuries to this area are very common. They’re most often the result of a fall or sports injury, but they can also be the result of high-energy trauma, such as in motor vehicle accidents or industrial accidents. These injuries are very difficult to diagnose, even for experienced orthopaedic surgeons. They require a high index of suspicion for patients with midfoot pain, swelling and an inability to bear weight.
Most Lisfranc fractures are caused by indirect trauma. For example, the force of a fall may cause the metatarsal bones to shift and break or a twisting injury on a plantar-flexed foot can also lead to a fracture. Indirect trauma is more commonly missed than direct trauma, which makes these injuries more serious.
Several complications can occur from this type of injury, including non-union (a bone doesn’t heal), post-traumatic arthritis and nerve damage. Fortunately, these complications are rare in patients who have their fractures treated promptly with ORIF surgery and appropriate follow-up care. If your doctor uses screws or plates to stabilize the midfoot, these can fail for the same reason that a paperclip fails if bent repeatedly.