Diagnosis of a Lisfranc fracture requires a thorough examination and imaging tests. Surgery is needed in some cases, and the injury may take a long time to heal.
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The Lisfranc joint complex
The foot is a complex part of the body. It is separated into three areas to make discussion about the individual parts easier.
The hindfoot is composed of the heel and ankle, which support the leg bones. The midfoot is a collection of bones that form the arches in the feet. The forefoot is made up of the five toes and their supporting bones, which are called the metatarsals.
The Lisfranc joint complex is in the midfoot. It is made up of the bones and ligaments that connect the metatarsals to the midfoot.
The bones in the complex give the foot its arch. The bones are held in place by ligaments that stretch both across and down the foot.
Causes
A Lisfranc fracture can often be confused with a simple sprain, as both injuries occur in similar ways.
Lisfranc fractures can happen through simple low-energy injuries, such as twisting the foot when falling. It is commonly seen in football players who stumble over their flexed feet while running.
Lisfranc fractures can also be caused by more serious trauma. Falling from a great height can cause an extensive Lisfranc injury.
Dropping something on the foot while it is flexed may also cause fractures or dislocations in the joints. Being involved in an automobile or motorcycle accident is another cause of Lisfranc injuries.
Symptoms
A Lisfranc injury can occur in the bones, joints, or ligaments of the Lisfranc joint complex in the middle foot. This type of injury is relatively rare and can sometimes be misdiagnosed.
A Lisfranc fracture can cause serious complications if it does not heal properly.
Symptoms of Lisfranc fractures may appear similar to many other foot injuries. This is why it is very important to have any foot injury properly diagnosed.
Common symptoms of Lisfranc injuries include:
- a swollen and painful foot, especially on the top
- pain that worsens when standing or walking
- inability to walk without an aid, such as crutches
- bruising on the top or bottom of the foot
Bruising on the bottom of the foot is an indication of a Lisfranc injury, but bruising does not occur in every case.
A Lisfranc fracture can range from simple to extremely complex, and the symptoms may vary from mild to severe. Lisfranc fractures also tend to damage the cartilage between the midfoot joints.
If the injury is not treated properly, it can lead to increased damage to the cartilage and excessive stress on the other midfoot joints.
Diagnosis
Doctors are likely to take their time to diagnose Lisfranc injuries, as they can easily be misdiagnosed. Diagnosis usually involves both physical examinations and imaging tests.
Physical examination
After discussing the injury and how it happened, a doctor will often do a physical examination of the injured foot.
First, a doctor may look for signs of bruising. Bruising can help indicate where on the foot the injury has occurred. Bruising can be a sign of a ligament tear, blunt trauma, sprain, or fracture.
Doctors may also gently squeeze different areas in the midfoot. A Lisfranc injury will cause tenderness and pain surrounding the area that has been damaged. The doctor will probably also gently bend and twist the front of the foot to check if a person feels pain in their midfoot.
In simple cases, doctors may ask the person to stand on the tiptoes of their injured foot. Doing so puts significant stress on the midfoot. A person may notice pain from even a slight injury here, which can help doctors know what to look for in imaging tests.
A doctor may also check for midfoot injury by holding the toes and moving them up and down, to check for pain. This manipulation puts pressure on the midfoot and will produce pain if there is an injury in the area.
Imaging tests
Imaging tests are the best way to confirm a diagnosis of a Lisfranc injury. Doctors will use one or more imaging tests to look at the bones and tissues in the foot before deciding treatment.
X-rays will show any broken bones, as well as the alignment of the Lisfranc joint complex. If it is out of alignment, it may suggest that there is injury to the ligaments in the area.
Doctors may also position the foot in specific ways to look for ligament damage. They may take X-ray images of the uninjured foot for comparison.
In some cases, CT scans or MRIs will be used. These tests provide a more detailed image of the foot than an X-rays, and are better for looking at softer tissues. They may be more common in cases that could involve surgery.
Treatment
Basic treatment for a foot injury immediately after the injury has occurred is rest, ice, and elevation. Walking on the injured foot should be avoided. A doctor should examine the foot as soon as possible.
The quicker treatment is initiated, the easier it is to reduce the fractures and sometimes an open surgical procedure can be avoided.
Non-surgical treatment
In some simpler cases of Lisfranc injury, where the ligaments are not completely torn and there are no fractures or dislocations, treatment may include wearing a cast for as little as 6 weeks. During this period, no weight can be put on the injured foot. Afterward, the person will need to wear a weight-bearing cast and have regular follow-ups.
Additional X-rays may be needed to ensure the foot is healing properly. If it is not healing correctly, surgery may still be required.
Surgical treatment
Midfoot injuries that include a bone fracture, joint dislocation or abnormal positioning, or torn ligaments may need surgery. The surgery will vary based on the type and severity of the injury.
Internal fixation surgery is the most common treatment. This type of surgical procedure involves positioning the injured bones correctly and then holding them in place with wires, screws or plates. The plates stay in place until the bones or joints heal, and they are then often surgically removed.
Fusion is another method that may be recommended in cases of severe injury. This involves fusing damaged bones together so 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.
Treatment for a Lisfranc fracture also involves a period of rehabilitation and physical therapy. This is done under supervision from surgeons and therapists to help the person heal at the proper pace. Rehabilitation may take several months overall.
Recovery and outlook
Recovery from a Lisfranc injury depends on its severity and the success of the surgery. Most surgeries will require 6-12 weeks of wearing casts and special walking boots.
Physical therapy and rehabilitation will also take time. Full recovery may occur after a year, but this can vary greatly. It may take longer than a year for athletes to regain their full strength and mobility. It is important to work closely with doctors and refrain from physical activity unless it is approved first.
Lisfranc fractures are serious, and even successful treatments may produce undesired side effects. These problems can include a reduced range of motion or strength, despite a period of rehabilitation.
Arthritis and chronic pain may also occur from damage to the cartilage in the joints.
In view of the seriousness of a Lisfranc injury, it is best to have any foot injury inspected by a doctor and to begin treatment quickly.
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