Lisfranc Injury

A side on view of a hand clutching a foot and ankle, highlighted in red, signaling pain.

What is a Lisfranc injury?

A top down view of the foot bones with a shaded purple area showing where the Lisfranc joint is A Lisfranc injury is an injury to the midfoot joint (tarsometatarsal joints). If you're looking down at of your foot, you will feel the bony bumps in front of your ankle joint on top of your foot. The Lisfranc joint runs horizontal along those bony bumps and includes the total width of the foot. The Lisfranc joint is largely responsible for holding the height and shape of your arch, hence there are many joints (bones and ligaments) involved.  When a twisting motion is applied to this area (from a stumble or fall), it can break or dislocate these bones and/or sprain or tear the ligaments holding this joint together.

This is a very serious injury due to vital role the midfoot plays in any weight bearing activity. 

Causes & risk factors

As previously mentioned, the injury is caused by a twisting motion with a downwards or upwards movement of the midfoot. It is always acute and traumatic in nature, so you will most likely be able to pinpoint the particular event or accident when your injury occurred.

The 3 common types of Lisfranc injuries are: 

  • Sprains or rupture of ligament, which results in a marked instability of the midfoot.
  • Lisfranc fractures, which can be an avulsion fracture (small piece of bone is “pulled off") or break.
  • Dislocation, when the bones are forced out of their normal position.

It is not uncommon for these differing types of injuries to occur simultaneously. 

The common causes include:

  • Sports such as soccer, rugby league and union, wakeboarding, snowboarding etc.
  • Simple twist and fall as a person stumbles over their foot.
  • Direct trauma from a big fall or if a heavy object is dropped on your foot.

    Symptoms

    It's common for a Lisfranc injury to be mistaken for a minor sprain of the foot, especially since the injury can occur from a simple stumble and fall. However, this injury can not be walked off; it is a severe injury that can take months to heal and may require surgery. 

    Common signs and symptoms connected to the injury include:

    • Pain in your foot, particularly the midfoot. This may worsen when standing, walking or exercising.
    • Inability or marked difficulty in weight bearing.
    • Swelling on top of the foot that often spreads to toes and bottom of your foot.
    • Bruising may occur on the top and bottom of the foot in the arch area, however bruising does not always occur.
    • Numbness and tingling of midfoot and toes. 
    • Abnormal widening of the midfoot.

    Diagnosis

    This injury can be difficult to diagnose. Due to the severe nature, it's important to get an accurate diagnosis from one of our podiatrists so that we can get you started on an effective treatment pathway.

    We diagnose a Lisfranc injury by taking into account your signs and symptoms, the history of the injury, and by performing a physical assessment. If we suspect a Lisfranc injury, we will refer for an X-ray, CT imaging and MRI if required.

    Treatment

    Due to the location of the injury, most treatments require prolonged periods of time spent in a moon-boot, followed by a rehabilitation program, with the correct footwear and support from devices. Treatment periods can differ markedly and depend on the severity of your injury.

    The key to ensuring you recover effectively and as quickly as possible is early diagnosis and the correct treatment.

    For pain relief of your symptoms, we may also recommend the RICE protocol — rest, ice, compression & elevation. 

    Some severe Lisfranc injuries may require surgical management. 

    What can happen if I ignore a Lisfranc injury?

    • Compartment syndrome may occur where the pressure builds up within the tissues of the foot and immediate emergency surgery is required 
    • Post traumatic arthritis is likely to occur, this is an accelerated version of osteoarthritis.
    • Surgical intervention is required
    • Delayed return to sport and daily activities
    • Prolonged impact on lifestyle due to the prolonged healing time with this type of injury.

    FAQs

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