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Lisfranc Injury: An Overview

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Lisfranc injury is a complex midfoot injury around the Lisfranc joint. It can be treated in surgical or non-surgical ways, depending on the severity.

Written by Dr. Varshini
Medically reviewed by Dr. Anuj Gupta
Published At October 30, 2023
Reviewed At October 30, 2023

Education:

Bachelor of Dental Surgery

Professional Bio:

Dr. Varshini is a BDS graduate from Chettinad Dental College and Research Institute (2022). She brings two years of clinical expertise to her practice. Passionate about oral health, she delivers compassionate care and skillful treatments, aiming to create healthy and confident smiles for her patients.

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Education:

MBBS

Professional Bio:

Dr. Anuj Gupta is an Orthopedic Surgeon who is specially trained in spine surgery. He completed his MBBS from The Sri Aurobindo Institute of Medical Sciences, Indore, and MS in Orthopedics at Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur. He did his DNB at Chatrapathi Shahu Ji Maharaj University. Currently, he is working in Triveni Ortho and Spine Center, Delhi, with work experience of 13 years. He has also done short training in spine surgery from the University of California, San Francisco, and Mount Sinai hospital, New York.

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Table of Contents

Introduction:

Lisfranc injury is a term used to describe a complex injury to the midfoot region involving the tendons, ligaments, and skeletal structures that link the front part of the foot to the middle part. It is named after Jacques Lisfranc de St. Martin, a French surgeon who first described this injury in the early 19th century. Lisfranc injuries can be from mild sprains to severe fractures, and they result from sports-related activities, falls, or high-energy trauma.

What Is the Lisfranc Joint?

The Lisfranc joint refers to the area where the metatarsal bones connect to the tarsal bones (midfoot bones). This complex joint is essential for maintaining stability and facilitating movement in the foot. It plays a significant role in weight-bearing activities and provides stability for routine activities.

What Are the Causes of Lisfranc Injury?

Lisfranc injuries often occur due to direct or indirect trauma to the midfoot. Common causes include:

  • Sports-related activities that involve sudden changes in direction or high-impact forces such as football, soccer, and skiing.

  • Trauma from falling from heights.

  • Road traffic accidents.

  • A history of ankle and other foot-bone injuries can make the Lisfranc joint susceptible to injury.

  • Anatomic variations like having a high arch foot.

What Are the Symptoms of Lisfranc Injury?

Common symptoms are:

  • Pain: This is a predominant indication of a Lisfranc injury. The pain may be localized to the midfoot or extend to the arch of the foot. It may also worsen with weight-bearing activities or movements that stress the midfoot area.

  • Swelling: Swelling around the midfoot is a common symptom of a Lisfranc injury. The injured area may appear swollen, tender, and inflamed. The swelling may develop rapidly following the injury or gradually over time.

  • Bruising: Bruising or discoloration of the foot is another sign of a Lisfranc injury. The bruising may occur on the top or bottom of the foot, and it may extend to the toes.

  • Difficulty Bearing Weight: A Lisfranc injury can cause difficulty or pain when attempting to bear weight on the affected foot. Walking or standing may be challenging, and there may be a sensation of instability or a feeling that the foot is giving way.

  • Abnormal Foot Alignment: In some cases of severe Lisfranc injuries, there may be a noticeable deformity or abnormal alignment of the foot. This can include a widened or splayed appearance of the forefoot, with the affected foot appearing wider than the unaffected foot.

  • Limited Range of Motion: Lisfranc injuries can restrict the mobility of the foot. People may experience stiffness or difficulty moving the foot, particularly when attempting to flex or extend the toes.

  • Numbness or Tingling: In more severe cases, there may be associated nerve damage, resulting in numbness or tingling sensations in the foot or toes. This can indicate nerve compression or injury.

How to Diagnose Lisfranc Injury?

  • Obtaining Medical History: Gathering information and history of the affected individual is the most important step in diagnosing the condition. This involves a history of any previous foot or ankle injuries, the mechanism of injury (such as a fall, sports-related activity, or trauma), and the onset and progression of symptoms.

  • Physical Examination: A comprehensive assessment and examination of the foot and ankle are conducted to assess for signs of a Lisfranc injury. The healthcare provider will look for swelling, bruising, deformities, and tenderness in the midfoot area. They may also evaluate the range of motion of the foot and perform specific tests to assess the stability of the Lisfranc joint.

  • Radiographic Investigations: X-rays are typically the initial imaging modality used to evaluate a suspected Lisfranc injury. Weight-bearing views may be taken to assess joint stability during standing. X-rays from different angles can help in identifying subtle injuries or joint space widening.

  • CT Scans: They provide cross-sectional images of the Lisfranc joint, allowing for a detailed assessment of bony anatomy, fractures, and joint alignment. CT scans are particularly useful for complex or severe Lisfranc injuries.

  • MRI: It can be used to assess the level of soft tissue damage surrounding the Lisfranc joint.

An accurate and timely diagnosis of a Lisfranc injury is crucial for determining the most suitable treatment approach.

How Is Lisfranc Injury Treated?

Treatment of Lisfranc injury can be done through surgical and non-surgical methods. This includes:

Non-Surgical:

  • For stable Lisfranc injuries with minimal or no displacement, non-surgical treatment may be considered. This involves immobilizing the foot with a cast, splint, or walking boot to allow the injured ligaments and bones to heal. Assistive aids can be used to prevent exerting pressure on the affected foot during the initial healing phase.

  • Resting and applying ice packs to the inflamed Lisfranc joint can provide relief to pain and swelling.

  • Medications like Paracetamol, Ibuprofen, or Naproxen may be recommended to help alleviate pain and reduce inflammation.

Surgical:

  • Open Reduction and Internal Fixation (ORIF): Severe or unstable Lisfranc injuries require surgical intervention. ORIF involves realigning the displaced bones and using screws, plates, or wires to stabilize the joint. This technique allows for anatomical restoration of the joint and provides stability for proper healing.

  • Fusion: In cases of extensive joint damage or chronic instability, a fusion of the affected bones may be necessary. Fusion involves permanently joining the bones to eliminate movement at the Lisfranc joint. This procedure sacrifices motion but provides stability and pain relief.

Rehabilitation is necessary following surgical or non-surgical treatment. This includes:

  • Physical therapy to improve the mobility, stability, and improving other functions of the Lisfranc joint.

  • Weight-bearing activities are reintroduced gradually under the guidance of a healthcare professional. Initially, partial weight-bearing with the aid of crutches or a walker may be recommended, followed by a progressive increase in weight-bearing as tolerated.

  • Customized orthotic inserts or supportive shoes may be prescribed to provide stability, enhance foot alignment, and reduce the risk of re-injury.

Conclusion:

While it may not be possible to prevent all Lisfranc injuries, certain precautions can minimize the risk. These include wearing appropriate footwear, using proper technique during physical activities, gradually increasing exercise intensity, and maintaining overall foot and ankle strength and flexibility. The prognosis for Lisfranc injuries varies depending on the severity of the injury and the timeliness of treatment. With early diagnosis, proper treatment, and diligent rehabilitation, many individuals can recover and return to their normal activities.

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Frequently Asked Questions

What Is the Difference Between a Lisfranc Injury and a Sprained Ankle?

A sprained ankle is a common injury to the ligament (the strong bands of connective tissue) that holds the ankle joint together. In contrast, a Lisfranc injury is rare and occurs when the midfoot bones are broken, or the ligament that supports the midfoot is torn. Lisfranc injuries can range from simple strains to multiple bone fractures and are characterized by swelling and bruising on the sole.

Do Lisfranc Injuries Heal Without Surgery?

Surgery is mostly not necessary for a partial Lisfranc ligament injury or sprain. A cast or a boot is given for the injured foot for around six to eight weeks to support the joint recovery. However, surgery is the preferred choice for Lisfranc fractures, complete ligament tears, and dislocations to align the bones properly, and the foot is repaired back to its normal anatomy with the help of metal plates and screws.

What Is the Recovery Time Following a Lisfranc Injury?

The recovery period after a Lisfranc injury depends on the severity of the injury and the patient’s general health. A minor Lisfranc injury can heal within eight weeks, but severe Lisfranc injuries with surgical repair usually require at least three months and up to a year for complete recovery. Physical therapy is recommended after surgical or nonsurgical treatment.

How Is a Lisfranc Injury Managed?

The treatment of a Lisfranc injury depends on its severity. If there is no dislocation, fracture, or injury to the ligaments, a boot or a non-weight-bearing cast is recommended for approximately six to eight weeks. However, surgical intervention such as an open reduction internal fixation (ORIF) or midfoot fusion may be preferred if there is a fracture or instability of the joint.

What Are the Complications of Lisfranc Injury?

Healthcare specialists can diagnose Lisfranc injuries, but they can sometimes be overlooked in cases of multiple traumas. Lisfranc injuries are relatively rare, and missed or untreated injuries can cause significant complications such as chronic pain, compartment syndrome, arthritis, damage to the nerves and muscles, bone infection, and arch collapse.

Can a Person With a Lisfranc Injury Walk?

A person’s ability to walk after a Lisfranc injury depends on the severity of the trauma and may be associated with extreme pain and discomfort. The individual may be unable to bear weight on the injured foot and can slip or fall. The foot may appear normal in mild Lisfranc injuries, but it is better to consult a doctor immediately if any sprain or fracture is suspected.

Is Lisfranc Injury Common in Athletes?

Lisfranc injuries are relatively rare in athletes and contribute to approximately one to three percent of foot injuries. They comprise a small proportion of tarsometatarsal injuries and are unique in various ways. Lisfranc injuries mostly occur in high-energy sports such as basketball, football, or soccer, wherein the athletes push their toes and apply pressure on their midfoot. When the foot is flexed forward, it gets stuck or twists in an abnormal position.

How Soon Is Medical Attention Required for a Suspected Lisfranc Injury?

Medical assistance is immediately required if a Lisfranc injury is suspected. It can be overlooked in many cases if the foot appears normal or during multiple trauma. However, suppose there is pain, discomfort, swelling, bruising, difficulty walking, or the individual cannot bear weight on the foot. In that case, a healthcare professional must be consulted immediately to avoid future complications.

What Are the Risk Factors for Lisfranc Injuries?

Lisfranc injuries can occur due to a low-energy fall or a simple twist, or sometimes, they can be caused by repetitive movements. They mostly occur due to sudden trauma, especially in athletes or sportspersons during high-impact activities such as basketball, football, other contact sports, and horseback riding.

What Exercises Can Help in the Recovery of a Lisfranc Injury?

Some of the exercises that help in the recovery of Lisfranc injuries include:


- Ankle and foot stretching exercises.


- Calf stretching exercises.


- Range of motion exercises.


- Hamstring stretches, hip flexors, and quadriceps.


- Lunges and step-up exercises.

Is Physical Therapy Required Following a Lisfranc Injury?

Physical therapy is necessary following the treatment of a Lisfranc injury, either surgically or non-surgically, and must be done under the guidance of a physical trainer or therapist. Physical therapy helps reduce pain and swelling, enhances muscle strength, and improves mobility and range of motion. Gradually, it also helps restore normal walking ability in the patients.

What Are the Alternative Treatments for Lisfranc Injuries?

Some of the alternative treatments that provide relief during mild Lisfranc injuries include:


- Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, Acetaminophen, Naproxen, etc.


- Taking adequate rest by wearing a boot for six to eight weeks.


- Physical therapy under the guidance of an expert trainer.

Do Lisfranc Injuries Occur in Children?

Lisfranc injuries can occur in children, as they are mostly involved in jumping and other physical activities. However, they can be rare or easily overlooked. If a sprain or fracture is suspected, a thorough physical examination and an early diagnosis are highly necessary. Weight-bearing radiographs may be recommended in such cases to evaluate subtle injuries.

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Dr. Anuj Gupta

Spine Surgery

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