Lisfranc Injuries
When most athletes think about major injuries, they usually gravitate towards knee and shoulder injuries. Rarely do foot injuries come up in these conversations.
However, foot injuries can be equally debilitating and possibly season-ending because of the crucial physical role the foot plays. One such injury is a Lisfranc injury, a fracture that causes the displacement of the metatarsals. You may be wondering, what is a Lisfranc injury?
Foot Anatomy
The foot has 26 bones. For this case, we’re going to focus on the five metatarsals which are located just proximal to the phalanges (toes) and distal to the tarsal bones. Normally, the metatarsals are connected to these other structures and each other through a variety of ligaments, thereby providing stability to the arch and body. However, with a Lisfranc injury, those ligaments rupture, causing the metatarsals to shift and displace.
What is a Lisfranc Injury?
A Lisfranc injury is the displacement of the metatarsals in relation to the tarsal bones of the foot. Due to various potential causes, the tarsometatarsal ligaments rupture, causing the metatarsals to slide laterally.
Typically, Lisfrancs are treated as foot fractures because of their treatment method and major impact on daily life. The metatarsals and the respective ligaments play a major role in everyday actions: walking, jumping, and running.
The foot also contains cartilage that, without treatment, can be permanently and severely damaging and may lead to conditions such as arthritis. While not life-threatening, Lisfranc injuries still need to be taken seriously and treated properly to avoid any long-term consequences.
Causes
Lisfranc injuries have a variety of causes. However, the root movements that cause this injury are:
Rotation of the tarsometatarsal joints
Forced hyper-plantarflexion
Forced toe extension and dorsiflexion
Things that can cause these movements include…
Great falls from height
Overloading the foot
Running
Diabetes or nerve damage
Repetitive microtrauma
Symptoms
As you can probably imagine, breaking your foot is no fun. Here are some symptoms of Lisfranc injuries:
Severe pain and swelling
Popping or tearing sound
Inability to fully bear weight
Bruising especially at the top of the foot near the metatarsals
Treatment
While most Lisfranc injuries require surgery, there are several operative and nonoperative treatment methods. Usually, the latter are more conservative and don’t always work, prompting the need for surgical alternatives.
Nonsurgical Option
Cast immobilization (or boot): 8 weeks long, usually used in nondisplaced fractures and patients with stable weight bearing. Typically for non-ambulatory patients with serious vascular disease or severe peripheral neuropathy. While nonsurgical, this treatment usually means that the patient will have less functional ability in their foot.
Surgical Options
Surgical options are recommended for all bone fractures, severe joint/bone displacements, and misaligned bones. The following two options are the most commonly used.
Open reduction internal fixation (ORIF): Incision is made at the top of the foot, bones are reduced to their normal positions, screws and plates are used to secure the bones, and later on the surgical hardware may need to be removed to allow for more movement once healed. Recovery time spans 3-5 months.
Midfoot fusion: Goal is to realign the joints and then have them heal together so the joint between the bones is nonexistent. Can be appropriate to treat pain and restore midfoot function. Cartilage is removed, and screws and plates are used to fuse the bones. Hardware is often not removed.
Rehab
Post-surgery for 6-8 weeks patients will be in boots for the non-weight-bearing phase
Only after X-rays and imaging confirm healing is occurring will weight bearing continue
Overall full RTP process can take 6-12 months
Can be career-ending as some players never fully return to their previous level of play
Conclusion
While debilitating, Lisfranc injuries can be conquered through careful management and treatment. It is ultimately up to the athlete to treat their rehab seriously and pursue the best course of treatment, whether surgical or nonsurgical, to get the best results. As always, keep stepping through the pain.
Sources
“Lisfranc (Midfoot) Injury - Orthoinfo - Aaos.” OrthoInfo, orthoinfo.aaos.org/en/diseases--conditions/lisfranc-midfoot-injury/#:~:text=Lisfranc%20(midfoot)%20injuries%20result%20if,midfoot%20joints%20and%20broken%20bones. Accessed 25 Feb. 2024.
“Lisfranc Injury.” Orthobullets, www.orthobullets.com/foot-and-ankle/7030/lisfranc-injury. Accessed 25 Feb. 2024.
professional, Cleveland Clinic medical. “Lisfranc (Midfoot) Fracture: Symptoms, Treatment & Recovery.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/22237-lisfranc-fracture. Accessed 25 Feb. 2024.
