Lisfranc Injury: An Overview

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.