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Lisfranc Injury

If you suspect you have a Lisfranc injury, seek medical attention promptly for an accurate diagnosis and treatment plan. It's important not to ignore any symptoms and to avoid putting weight on the affected foot until they receive guidance from a healthcare professional. Prioritizing foot health and following medical advice will help you with proper healing and recovery.

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What Is Lisfranc Injury

A Lisfranc injury is an injury to the Lisfranc joint in your foot. This joint connects the metatarsal bones (long bones that lead up to the toes) to the tarsal bones (bones in the arch of the foot). The Lisfranc ligament, a tough band of tissue that joins these bones, helps to maintain proper alignment and strength of the Lisfranc joint.

Types of Lisfranc injuries

  • Sprains – A sprain of the Lisfranc ligament occurs when there is damage to it caused by trauma or stretching of the ligament. The Lisfranc ligament and other ligaments on the bottom of the midfoot are stronger than those on the top. Therefore, when they are weakened through a sprain, patients experience instability of the Lisfranc joint.
  • Fractures – Fractures of the Lisfranc joint can be either avulsion fractures, in which a small piece of bone breaks off, or complete fractures, in which a bone or several bones of the midfoot are fully broken.
  • Dislocations – Dislocations occur when the bones of the Lisfranc joint are forced from their normal positions.

What are the causes and risk factors for Lisfranc injury?

Lisfranc injuries occur as a result of direct or indirect forces or stress on the foot. Direct forces often involve a heavy object falling on the foot, while indirect forces involve twisting or stretching the foot. While an injury such as this can occur from an action as simple as missing a step on a staircase, if you are one of the following, you may be especially at risk of sustaining a Lisfranc injury:

  • Contact sport player
  • Horseback rider
  • Military personnel
  • Runner

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What Are the Symptoms of Lisfranc Injury?

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)

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How Do You Diagnose Lisfranc Injury?

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.

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How Do You Treat Lisfranc Injury?

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.

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