Lisfranc Joint Injury
What is a Lisfranc joint injury?
A Lisfranc joint injury is a type of injury to the bones or ligaments, or both, in the middle part of your foot. In a Lisfranc joint injury, there is usually damage to the cartilage covering these bones.
In the middle region of your foot (midfoot), a cluster of small bones form an arch. Five of these long bones (the metatarsals) extend to the toes. The group also includes smaller bones: the cuboid bone and the medial, middle, and lateral cuneiform bones. Tight connective tissue bands hold these bones in place and give the joint its stability. This area of the foot is important in stabilizing your arch and transferring the force from your calves to the front of your feet.
A twisting fall may break one or more of these bones or shift the bones out of place, causing a Lisfranc injury (tarsometatarsal joint injury). There are different categories of Lisfranc injuries, depending on the direction of the displaced metatarsals and their degree of displacement. The injury gets its name from a French surgeon, Jacque Lisfranc de St. Martin.
Lisfranc joint injuries are somewhat uncommon. These injuries can vary from simple to complex, depending on the number of bones involved and the degree of disruption.
What causes a Lisfranc joint injury?
Lisfranc joint injuries occur from trauma to the foot. This may happen with a simple twist and fall on top of a foot that is pointing downward. It is common in football and soccer players. Lisfranc injuries can also happen from direct trauma, like a fall or a motor vehicle accident. Such an injury is more likely to result in a more severe injury with multiple fractures and dislocations of the bones of the middle foot.
What are the symptoms of a Lisfranc joint injury?
A Lisfranc joint injury might cause symptoms like the following:
- Pain in your midfoot, especially tenderness to the touch
- Swelling or deformity in the middle region of your foot
- Inability to put weight on your foot
- Bruising in the middle of your foot
The intensity of these symptoms may vary according to the severity of your injury and how long ago it happened.
How is a Lisfranc joint injury diagnosed?
Your doctor will begin with a medical history, asking questions about your recent symptoms and your past medical problems. Your doctor will also do an exam of your foot, looking for tenderness, deformity, bruising, and swelling. Your doctor may grasp your toes and move them up and down, seeing whether this causes pain.
To definitively diagnose your Lisfranc injury, you doctor will probably order X-rays as well. Your doctor might need to order special views of the foot, because these injuries sometimes don’t show up on standard X-rays.
In some cases, your doctor might order more detailed imaging to get more information about your foot. Magnetic resonance imaging (MRI) gives more information about damage to the soft tissues in your foot, and CT scans give more detailed information about damage to your bones. These techniques may pick up injuries that an X-ray alone might miss. It is important to have your injury diagnosed correctly because the treatment for a simple ankle sprain (a common misdiagnosis) is quite different. An emergency room physician typically makes the diagnosis, but an orthopedic doctor might help treat you.
How is a Lisfranc joint injury treated?
Your treatment may vary according to the severity of your injury. You may only need nonsurgical treatment for your injury if you don’t have any bone breaks, if your bones are still in alignment, and if your ligaments are not completely torn. For these types of injuries, your treatment might include:
- Pain medicines
- Wearing a non-weight-bearing cast or boot for 6 weeks
- Wearing a weight-bearing cast or a special foot support after the first 6 weeks
- Serial X-rays to determine how your foot is healing
It is very important not to put weight on your foot during the initial healing period.
If your injury was more severe than this, you probably will need surgery as well. Your doctor may do a surgery called open reduction and internal fixation. During this surgery, your doctor puts your bones back in the correct alignment. Using special metal plates and screws, your doctor physically reattaches the pieces of your bones back together. Your doctor might remove some or all of this hardware at a later date. Your doctor might also repair other ligament injuries.
Less commonly, surgeons does a joint fusion as the initial procedure. Surgeons usually only do this if the damage is very severe and they cannot repair it. This surgery permanently fuses one or more of the bones in the region together, so they heal into a single, solid piece.
After either type of surgery, you would need to use a cast for several weeks and avoid putting weight on your foot during this time.
What are the complications of a Lisfranc joint injury?
Lisfranc joint injuries often cause arthritis in the injured bones of your foot. This might cause chronic pain in the region. You are more likely to develop arthritis if you had a severe Lisfranc joint injury that damaged much of the cartilage in the region. This arthritis might develop even if your initial surgery was successful. Some people need to have joint fusion surgery to relieve these symptoms if their arthritis is severe.
There is also a risk that your bones will fail to heal properly, which might require a follow-up surgery. These risks may be higher if you smoke and if you have certain medical conditions, like osteoporosis.
When should I call my healthcare provider?
Call your healthcare provider if you have a high fever, if the pain is increasing, or if your foot feels numb.
A Lisfranc joint injury is a type of injury to the bones or ligaments in the middle part of your foot, the tarsometatarsal joint. It can range from mild to severe.
- Your Lisfranc joint injury might cause bruising, deformity, swelling, or pain in the middle of your foot. Your foot will also be unable to bear weight.
- Your doctor can diagnose your injury with a medical history, a physical exam, and the use of imaging techniques.
- If your injury is mild, you might only need treatment with casts and pain medicines.
- If your injury is more severe, you will probably need surgery.
- Sometimes, Lisfranc joint injuries result in long-term arthritis of the bones of your foot.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
March 22, 2017
Joseph, Thomas N., MD,Moloney, Amanda Jane (johns)., PA-C, MPAS, BBA