Lisfranc Injury Overview
Lisfranc injuries can be either an injury to the ligament or in some cases the bone within the midfoot. Many injuries to the midfoot are referred to as Lisfranc injures, but the ligament runs from the medial cuniform bone to the base of the second metatarsal. This area if the foot does not have an intermetatarsal ligament so the Lisfranc ligament is very important to the stability of the midfoot.
Injuries to the Lisfranc area often occur from a twisting mechanism or a loading of the foot with the toes pointed. There is a spectrum of injuries from a sprain to a full disruption of the ligament. In severe injuries there can be fracture of the involved bones or dislocation of the tarsometatarsal joints. Unfortunately, recovery following a Lisfranc injury is often long and difficult.
Lisfranc Injury Symptoms
The primary symptom associated with a Lisfranc injury is pain in the middle of the foot. The foot may appear to be bruised, swollen, and inflamed. The bruising may affect both the top and bottom of the foot. Depending on the severity, it can be difficult to walk with this type of injury. In cases where ligaments are torn and a dislocation or fracture has occurred, medical treatment will be needed in order to resolve the problem.
How to Diagnose a Lisfranc Injury
Our physicians will perform an extensive physical exam including x-rays of the foot. Typically, weight bearing x-rays will be performed as this helps identify the degree of injury. In some cases, we will order an CT or MRI to confirm a Lisfranc injury and understand the degree of the ligament damage and/or further evaluate fractures.
Treatment for Lisfranc Injury
Non-Surgical Treatment for Lisfranc Injury
In cases where there is no fracture and ligament damage is minimal, non-surgical/conservative treatment measures are often effective in healing the injury. We will most likely prescribe a cast or boot to wear on the injured foot for a few weeks to allow the injury to heal. Additional X-rays will be taken during follow-up appointments to evaluate how the injury is healing. Following a period of immobilization weight is reintroduced to the foot in a gradual fashion (Weight Progression Instructions). Following this transition patients typically work back into regular shoes. Physical therapy may help with returning to higher function.
Surgical Treatment for Lisfranc Injury
If a displaced fracture the midfoot region or if subluxation/dislocation of the midfoot joints has occurred, then surgery may be recommended. The goal is to realign the joints and return the bones to their normal, functioning position.
Through incisions on the top of the foot, the Lisfranc region will be visualized. To correct the damaged area internal fixation involving hardware such as plates, screws, or heavy suture are often used.
For fractures, the bone is directly manipulated into a normal position and fixation applied. For ligamentous injury, the bones are reduced and held in place with sutures, screws or a plate over the joint. Rigid fixation (plates or screws) are often removed about 4 months after injury.
In more complex injuries where fixation will not be enough to correct the damage, a fusion of the affected joints may be indicated. With a fusion the bones involved will grow together, eliminating the joint but providing a stable and pain free midfoot.
Recovery Following Lisfranc Treatment
It is essential that patients follow the post-operative protocol for recovery as set forth by the surgeon as it remains a crucial part of the healing process. Regardless of the surgery that has been performed to correct a Lisfranc injury, the healing process can be lengthy. A cast or boot will be required for four to eight weeks following surgery. While most will recover fully from this injury, it is important to note that some athletes will not be able to return to their pre-injury level of competition. Each case is different and our goal is always to obtain the best possible outcome for each patient.