What Is It?
A Lisfranc fracture describes a fracture of the midfoot that can range from mild to very serious. Sometimes an injury can occur at the midfoot that does not break any bones. This is known as a Lisfranc injury. The midfoot is comprised of many tiny bones that are held together by ligaments, a type of connective tissue. Ligaments connect the two ends of bones together to form a joint. The ligaments that cross the midfoot connect the midfoot bones to the metatarsals (the long bones that connect to the toe bones). These joints form what is known as the Lisfranc joint complex and spans across the entire midfoot. It is essential for maintaining the shape of the foot and providing it with stability.
Unfortunately, with so many little pieces it makes the foot prone to injury. Lisfranc injuries can be caused by low-energy impacts, resulting from something as simple as a twist in the foot. The injury therefore, can result in fractures, tears in the ligaments, or both. This can cause the bones to displace and the joints to be dislocated. If left untreated, a flat foot deformity can develop as well as arthritis and other medical conditions.
The first symptoms that appear are usually bruising and swelling at the site of injury. Bruising along the bottom aspect of the midfoot is highly indicative of a Lisfranc injury. Pain might be so extreme that the patient may have difficulty weight bearing. The only real way to diagnosis a Lisfranc injury is through clinical evolution. Your doctor will most likely perform a series of test to identify a Lisfranc injury. One such test called the piano key test places stress along the midfoot by pulling the toes up and down. Sharp pain is a positive sign of injury. Radiographic assessment is the most surefire way to confirm an injury. An MRI might be required to confirm if there is any damage to the soft tissues. It’s important to identify the number of joints that are afflicted and the extent of their damage. Some injuries can be so severe that it causes displacement of the toes. Surgical intervention will be required to realign them in their normal anatomical position.
If there is no displacement and only minor damages to the soft tissues, then conservative treatment is the most likely course of outcome. Casting and/or splinting will be used to immobilize the bones. Patients will be non-weight bearing for about 6 weeks. During this period it is critical not place any weight on the foot. Since the midfoot is comprised of many small bones any type of pressure can cause them to shift around and prevent healing. Even worse, bone displacement can occur. When you progress to partial weight-bearing, some sort of orthotic or shoe/boot will be provided to ease you into activity. If there is any evidence that the bones have been shifted during recovery, surgery will be needed.
If it is apparent right when you present with your injury that you have displaced bone and torn ligaments, then surgical intervention is a must. Your surgeon will set the bones in place using internal fixation such as a plate or screws. This will not only realign them, but also fix them in place to prevent movement. If the joints and cartilage are badly damaged, they might need to be fused to eliminate pain (known as an arthrodesis). Fusion might also be an option down the road if midfoot arthritis occurs as a result of the injury. Post-operative recovery is similar to conservative treatment. The patient will experience 4 to 6 weeks of non-weight bearing in a cast or splint followed by a transition into a boot/shoe or orthotic when the patient returns to weight bearing. Again, it cannot be greater emphasized how critical it is to remain non-weight bearing when instructed. Once weight bearing is established, you might be instructed to wear your protective footwear for a further 4 to 8 weeks. This is followed by transitioning into a stiff shoe for a further few weeks. The recovery time from a Lisfranc injury can be long and some individuals may not retain their pre-injury levels of activity.
Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.