Lisfranc's injury is a dislocation or fracture in the midfoot area. It occurs in the joint where the short metatarsal bones meet the long bones in the foot. Swelling on the top of the foot and pain when weight is placed on the foot are the main symptoms. This foot injury is very rare but it is vital that it is not missed as long-term damage can occur.
Lisfranc's injury symptoms
Symptoms of Lisfranc's injury include pain in the midfoot area with difficulty putting any weight on the foot. There may be some bone deformity visible but this is not always the case. Swelling is likely on the top of the foot and there will be tenderness over the joint area. Pain will be increased when pushing up onto the toes or performing a calf raise exercise.
What is a Lisfranc injury?
The term Lisfranc's joint refers to the tarsometatarsal joints where the short tarsal bones in the midfoot meet the long bones or metatarsals in the foot. 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 it can have very severe consequences. If a 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.
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.
Treatment of Lisfranc's injury
If you suspect a Lisfranc's injury, or even a midtarsal joint sprain, then seek medical advice immediately. Delaying treatment of Lisfranc's injury can cause long term or permanent damage.
A doctor will X-ray the foot with the athlete in a weight-bearing position. However, 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 Lisfranc's injury is 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.