Lisfranc Injuries
What are Lisfranc Injuries?
The Lisfranc complex is a group of bones and strong ligaments in the middle of the foot that are critical for push-off of the foot during gait. A fall on a foot pointing down can rupture the strong ligament (the ‘Lisfranc ligament’). If the ligament is injured, the bones can break, move, or even dislocate (the joints are no longer in place).
Impact of Lisfranc Injuries on Anatomy and Health
- Anatomy: The Lisfranc joint is crucial for maintaining the arch and stability of the foot. Injuries disrupt this stability, potentially leading to deformity, chronic pain, and impaired mobility.
- Health Impacts:
- Acute Pain: Severe pain and swelling in the midfoot area.
- Mobility Issues: Difficulty walking, running, or bearing weight.
- Long-term Complications: If untreated, Lisfranc injuries can result in arthritis, chronic pain, and decreased range of motion in the foot.
Risk Factors for Lisfranc Injuries
- Athletes: Particularly those in high-impact sports like football, soccer, and gymnastics.
- Accident Victims: Individuals involved in motor vehicle accidents or falls from heights.
- Military Personnel: Due to rigorous physical demands and load-bearing activities.
- Obese Individuals: Excess weight can increase stress on the midfoot.
Causes of Lisfranc Injuries
- Trauma: Direct trauma to the foot, such as being struck by a heavy object.
- Twisting Injuries: Sudden twisting or pivoting of the foot, often occurring during sports.
- Falls: Landing awkwardly from a jump or fall.
- Stress Injuries: Repeated stress on the midfoot over time, common in athletes or military personnel.
Symptoms of a Lisfranc Injury
Lisfranc injuries can range from a minor sprain of a ligament to a life-changing fracture dislocation of all of the bones. Most commonly, after a fall, the following symptoms are:
- Pain and swelling over the middle of the foot after an injury or fall on the foot with the foot pointing down (i.e. push off position)
- Bruising and swelling at the top and bottom of the foot
- Worsening pain with standing, walking, or trying to push off
Prevention of Lisfranc Injuries
- Wear Proper Footwear: Ensure shoes provide adequate support, especially during sports.
- Strengthen Foot Muscles: Exercise to improve foot and ankle strength and stability.
- Avoid Overloading: Gradually increase the intensity of physical activities to avoid stress injuries.
- Be Cautious: Avoid risky movements, such as abrupt pivots or jumps, without proper training.
- Use Protective Equipment: In high-risk sports, use protective gear to reduce the risk of trauma.
- Seek Early Treatment: Address minor foot injuries promptly to prevent complications.
Types of Lisfranc Injuries
- Sprains: Damage or tears to the ligaments in the Lisfranc joint without fractures or dislocations.
- Fractures: Breaks in the bones of the Lisfranc joint complex, often involving the metatarsals or cuneiforms.
- Dislocations: Misalignment or displacement of the bones in the midfoot joint.
- Combined Injuries: Both fractures and dislocations often seen in severe trauma cases.
Stages of Lisfranc Injuries
- Stage 1: Ligament Sprain or Minimal Damage
- Ligaments are stretched or slightly torn.
- No displacement or significant instability.
- Stage 2: Partial Displacement
- Ligaments are more damaged, leading to mild bone displacement (<2mm).
- Pain and swelling increase.
- Stage 3: Severe Displacement
- Complete tear of the ligaments with significant bone displacement (>2mm).
- Often involves fractures, deformity, and severe pain.
Diagnosis of a Lisfranc Injury
A Lisfranc injury is diagnosed by having a medical practitioner take a history, examine the foot, and take X-rays.
Less severe injuries can have normal X-rays, as the ligament is not visible. The only clue may be a tiny bony fleck indicating the ligament has pulled off a small area of bone. The instability may be revealed on weight-bearing X-rays, and comparing it to the ‘normal’ foot is often helpful. In more severe injuries, X-rays can show associated fractures and displacement of the bones. Other injuries may need to be identified and treated.
If there is a clinical concern of a Lisfranc injury and the x-rays are normal, Dr Graff may request an MRI or a weight-bearing CT of both feet (or both) to diagnose a Lisfranc injury.
Management and Treatment of Lisfranc Injuries
Management of Lisfranc injuries often requires surgery. Only very mild ‘sprains’ of the Lisfranc ligament can be managed non operatively. Non-operative measures include:
- Rest
- Elevation
- Compression with a Tubigrip or bandage
- Ice
- Camboot
- Non-weight bearing
- Pain relief
- Blood thinners to prevent DVT
Most Lisfranc injuries require surgery to stabilise the Lisfranc complex and prevent chronic pain and foot deformity (see Lisfranc Injury Surgery (ORIF)). Even after surgery, arthritis may develop in the middle of the foot, and the foot may always feel different from before the injury. The surgery aims to stabilise the foot, prevent its collapse, and slow the progression of arthritis and pain.
What if Lisfranc Injuries are Untreated?
- Chronic Pain: Persistent pain in the midfoot due to instability or improper healing.
- Arthritis: Early onset of osteoarthritis in the Lisfranc joint.
- Deformity: Collapsed arch or visible deformity of the foot.
- Mobility Loss: Reduced ability to walk, run, or engage in physical activities.
- Permanent Disability: Severe cases may require lifelong orthotics or assistive devices.
Timely diagnosis and treatment are critical to prevent these long-term complications and ensure a full recovery.
