What Is a Lisfranc Injury?
The Lisfranc joint is a meeting of five other joints on the top of the midfoot. It was named for Jacques Lisfranc de Saint-Martin, a surgeon in Napoleon’s army who discovered the area was a good place to amputate when a soldier’s foot had frostbite and gangrene.
A Lisfranc injury can be anything from a ligament sprain to a fracture of all the bones in the midfoot. Because the Lisfranc joint is important in walking and bearing weight, Lisfranc injuries are usually severe and complex, and have the potential for lasting disability.
Causes and Symptoms
A Lisfranc injury is usually caused by either a low-energy event, like a sports injury or a trip and fall, or a high-energy event such as a car crash.
Symptoms of a Lisfranc injury include:
- Bruising on both the top and bottom of the foot
- Pain—sometimes severe—especially when walking or standing
- Swelling on the top of the foot
Diagnosis
A doctor will perform a physical examination of the foot and will take a medical history, paying special attention to any event that may have caused the injury.
An X-ray can be used to further clarify the diagnosis. The X-ray will show broken bones and can also show if any of the individual joints in the Lisfranc area are out of place, which could be indicative of a ligament injury.
A magnetic resonance imaging (MRI) scan can show soft tissue damage, such as damage to a ligament. A computed tomography (CT) scan can show fracture lines.
Treatment
Treatment for a Lisfranc injury varies depending on the severity of the injury. A simple sprain may be able to be treated with conservative measures—no surgery necessary. Nonsurgical treatment usually involves wearing a cast or boot for six to eight weeks.
A Lisfranc injury may be treated surgically in one of two ways. The first is internal fixation, which involves repositioning the bones of the Lisfranc joint and holding them in place with plates or screws.
The second type of surgery is fusion, which connects the damaged bones, allowing them to heal as a single piece of bone. Injuries to bones that have significant joint damage or severely damaged ligaments will likely require fusion.
After either surgery, use of a cast or boot is recommended for six to eight weeks, after which time weight can begin to be placed on the injured foot again.
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