Lisfranc Injuries
![Lisfranc]()
The
Lisfranc Joint
The
Lisfranc joint is the point at which the metatarsal bones (long bones that lead
up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc
ligament is a tough band of tissue that joins two of these bones. This is
important for maintaining proper alignment and strength of the joint.
How Do
Lisfranc Injuries Occur?
Injuries to the Lisfranc joint most commonly occur in automobile accident
victims, military personnel, runners, horseback riders, football players and
participants of other contact sports, or something as simple as missing a step
on a staircase.
Lisfranc injuries occur as a result of direct or indirect
forces to the foot. A direct force often involves something heavy falling on
the foot. Indirect force commonly involves twisting the foot.
Types of
Lisfranc Injuries
There are three types of Lisfranc injuries, which sometimes occur together:
- Sprains.
The Lisfranc ligament and other ligaments on the bottom of the midfoot are
stronger than those on the top of the midfoot. Therefore, when they are
weakened through a sprain (a stretching of the ligament), patients
experience instability of the joint in the middle of the foot.
- Fractures.
A break in a bone in the Lisfranc joint can be either an avulsion fracture
(a small piece of bone is pulled off) or a break through the bone or bones
of the midfoot.
- Dislocations.
The bones of the Lisfranc joint may be forced from their normal positions.
Symptoms
The symptoms of a Lisfranc injury may include:
- Swelling
of the foot
- Pain
throughout the midfoot when standing or when pressure is applied
- Inability
to bear weight (in severe injuries)
- Bruising
or blistering on the arch are important signs of a Lisfranc injury.
Bruising may also occur on the top of the foot.
- Abnormal
widening of the foot.
Diagnosis
Lisfranc injuries are sometimes mistaken for ankle sprains, making the
diagnostic process very important. To arrive at a diagnosis, the foot and ankle
surgeon will ask questions about how the injury occurred and will examine the
foot to determine the severity of the injury.
X-rays and other imaging studies may be necessary to fully
evaluate the extent of the injury. The surgeon may also perform an additional
examination while the patient is under anesthesia to further evaluate a
fracture or weakening of the joint and surrounding bones.
Non-surgical
Treatment
Anyone who has symptoms of a Lisfranc injury should see a foot and ankle
surgeon right away. If unable to do so immediately, it is important to stay off
the injured foot, keep it elevated (at or slightly above hip level), and apply
a bag of ice wrapped in a thin towel to the area every 20 minutes of each
waking hour. These steps will help keep the swelling and pain under control.
Treatment by the foot and ankle surgeon may include one or more of the
following, depending on the type and severity of the Lisfranc injury:
- Immobilization.
Sometimes the foot is placed in a cast to keep it immobile, and crutches
are used to avoid putting weight on the injured foot.
- Oral
medications. Nonsteroidal anti-inflammatory medications (NSAIDs),
such as ibuprofen, help reduce the pain and inflammation.
- Ice
and elevation. Swelling is reduced by icing the affected area and
keeping the foot elevated, as described above.
- Physical
therapy. After the swelling and pain have subsided, physical
therapy may be prescribed.
When is
Surgery Needed?
Certain types of Lisfranc injuries require surgery. The foot and ankle
surgeon will determine the type of procedure that is best suited to the
individual patient. Some injuries of this type may require emergency surgery.
Complications
of Lisfranc Injuries
Complications can and often do arise following Lisfranc injuries. A
possible early complication following the injury is compartment syndrome, in
which pressure builds up within the tissues of the foot, requiring immediate
surgery to prevent tissue damage. A build-up of pressure could damage the
nerves, blood vessels, and muscles in the foot.
Arthritis and problems with foot alignment are very likely
to develop. In most cases, arthritis develops several months or longer
following a Lisfranc injury, requiring additional treatment.
Information provided by The American College of Foot and Ankle Surgeons