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Lisfrancs Injury
Lisfranc's ligament connects the medial cuneiform bone (one of the tarsals) to the base of the 2nd metatarsal. The injury may consist of a dislocation where there is only ligament damage, or a fracture of one of the two bones may also occur.
Symptoms of Lisfranc's Injury
- Midfoot pain with difficulty placing weight on the foot.
- Some bone deformity, although this is not always the case.
- Swelling on the top of the foot.
- Tenderness on the joints.
- Weight bearing on the front of the foot, pushing off and calf raises cause pain.
What is a Lisfranc Injury?
The term Lisfranc's joint refers to the tarsometatarsal joints where the long bones (tarsals) in the foot meet the smaller bones (metatarsals) of the toes. Jaques Lisfranc was a surgeon in Napoleon's Army who described an operation for an amputation through this joint.
Lisfranc's injury or Lisfranc's fracture-dislocation is rare in sport, but, if left untreated, can have very severe consequences. If a case of midfoot sprain is suspected then Lisfranc's injury should also be considered.
The most common cause of this injury is stepping into a small hole, which causes a strong twisting force with a lot of body weight on top. It can also happen in car accidents.
Treatment
What can the athlete do?
- Go and see a doctor or sports medical professional
What can a doctor or medical professional do?
- X-ray is required with the athlete in a weight bearing position.
- This injury is often missed even with an x-ray, so if the therapist suspects Lisfranc's injury and it is not obvious through X-ray then MRI or bone scan is required to confirm the diagnosis.
- If confirmed a plaster cast with a toe plate extending under the toes is applied below the knee to immobilize the joint. Sometimes the bones require fixing with pins or wires.
- Treatment will then depend on the severity of the injury. Precise anatomic reduction of the bones is required. If this is the case then the cast is usually on for 4 to 6 weeks. After this time general foot and lower leg rehabilitation exercises are done to restore mobility, strength and proprioception.
