Lisfranc Injury

Lisfranc Injury Symptoms and Diagnosis

The key sign of a Lisfranc injury is bruising or blistering on the arch or top of the foot.

Lisfranc injury symptoms

Other symptoms of a Lisfranc injury may include:

• Swelling of the foot, especially on the top
• Pain in the midfoot that worsens when standing/walking or when pressure is applied
• Abnormal widening of the foot
• Inability to bear weight/walk without an aid, such as crutches (in severe injuries)

Lisfranc injury diagnosis

Lisfranc injuries are known for being easily misdiagnosed. They often present as ankle sprains or other foot/ankle injuries. This makes the diagnosis especially important for these injuries.

To arrive at a diagnosis, both physical examinations and imaging tests are necessary. The sports medicine physician or 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 can assist in fully evaluating the extent of the injury. The physician or 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.

The physical examination may include exercises like standing on the tiptoes of the injured foot or holding the toes and moving them up and down. Standing on the tiptoes puts significant stress on the midfoot, and the patient should notice pain from even a slight Lisfranc injury. Meanwhile, moving the toes up and down puts pressure on the midfoot, which will also produce pain if there in an injury there.

Imaging for a Lisfranc injury may include X-rays to show any broken bones and the alignment of the Lisfranc joint complex. If it is out of alignment, it may suggest that there is injury to the ligaments in that area of the foot. X-rays of the undamaged foot may help for comparison. In some cases, CT scans or MRIs will also be used. These tests provide more detailed imaging of the foot than X-rays and allow doctors to view soft tissues.

Lifranc Injury Treatments at UPMC Sports Medicine

Nonsurgical treatments for Lisfranc injuries include the following:

• Immobilization – The injured foot may be placed in a cast to keep it immobile, and crutches may be used to avoid putting weight on it.
• Ice and elevation – Ice and elevation work side-by-side to reduce swelling in the affected area.
• Oral medications – Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, may be prescribed to help reduce pain and inflammation.
• Physical therapy – After swelling and pain have subsided, physical therapy may be prescribed to rehabilitate the injured foot.

Lisfranc injuries that include a bone fracture, joint dislocation or abnormal positioning, or torn ligaments may require surgery. Surgical treatments for Lisfranc injuries include the following:

• Internal fixation surgery (most common) – This surgery involves positioning the injured bones correctly and holding them in place with wires, screws, or plates. The plates stay in place until the bones or joints heal and are then surgically removed.
• Fusion (severe injury) – This surgery involves fusing damaged bones together so that they heal as a single bone. Fusion may reduce motion in the foot, but it can be the best course of action in cases where internal fixation is impractical.
• Rehabilitation and physical therapy – This treatment will often follow surgical procedures and the 6-12 weeks of wearing a cast/special walking boot. Physical therapy is done under the supervision of surgeons and physical therapists to help the patient heal at the proper pace. This process may take several months, and patients may not experience a full recovery until a year has passed, but this can vary greatly. It may take longer than a year for athletes to regain their full strength and mobility, depending on the severity of the injury.