Lisfranc Injuries

A Lisfranc injury is a traumatic injury to the midfoot at the location of the Lisfranc, or tarsometatarsal joint, which is where the bases of the metatarsals meet the bones of the midfoot. This type of injury often varies in severity. Such an injury may involve a sprain or tearing of a ligament, a fracture, and/or a dislocation. Lisfranc injuries generally involve some sort of twisting of the foot or crushing blow to the foot, such as from a sport injury or motor vehicle accident.

Although these injuries are relatively rare, they are often misdiagnosed as simple sprains or are overlooked. Common symptoms of a Lisfranc injury include pain, swelling and bruising as well as difficulty standing or walking. When such symptoms occur, it is important to seek immediate medical care because of the potential difficulty in diagnosing the condition and the possibility that, without prompt treatment, proper healing may not take place. Treatment for a Lisfranc injury depends on the severity of the condition, but may include conservative measures such as immobilization by splinting or casting. If the joints of the midfoot are misaligned, surgery may be necessary. The primary goal of Lisfranc injury surgery is to anatomically realign the joints of the midfoot.

Diagnosis of a Lisfranc injury starts with a comprehensive history and physical examination, but will always then include a set of x-rays. Advanced imaging, such as MRI or CT, are often necessary to fully evaluate the extent of the injury.

Symptoms

  • Pain and swelling to the midfoot region
  • Difficulty standing or walking
  • Inability to bear weight on the affected side
  • Bruising to the top of the foot or the arch of the foot
  • Increase in size of the foot (abnormal widening)

Treatment

  • Immobilization with or without crutches
  • Anti-inflammatory medications
  • Ice therapy
  • Elevation of the affected extremity
  • Physical therapy
  • Surgery

Whether a Lisfranc injury can be treated conservatively or surgically depends upon the specific type of injury and the extent of the injury. If surgery is necessary, this usually involves internal fixation, such as plates and screws, to keep the bones and joints properly aligned during healing. The hardware may be removed a few months after the procedure or it may remain in the foot permanently.

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