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 or move or even dislocate (the joints are no longer in place).
SYMPTOMS OF A LISFRANC INJURY
Lisfranc injuries can range from a minor sprain of a ligament to a lifechanging 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
DIAGNOSIS OF A LIS FRANC INJURY
Diagnosis of a Lisfranc injury include a medical practitioner taking a history, examining the foot and getting xrays.
Less severe injuries can have normal xrays, as the ligament is not visible on xrays. 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 weightbearing xrays, and it is often helpful to compare it to the ‘normal’ foot. In more severe injuries, xrays 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 xrays 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 require 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 weightbearing
- Pain relief
- Blood thinners to prevent DVT
Most Lisfranc injuries require surgery to stabilise the Lisfranc complex and prevent chronic pain and deformity of the foot (see Lisfranc Injury Surgery (ORIF)). Even after surgery, arthritis may develop in the middle of the foot and the foot may always feel different compared with prior to the injury. The surgery aims to stabilise the foot, prevent collapse of the foot and slow the progression of arthritis and pain.
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