What Is a Lisfranc Injury?

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The midfoot is made up of a row of four small bones (the cuboid and the medial, middle, and lateral cuneiforms), five longer bones (the metatarsals), and many small, thick ligaments that run between them. These structures form the arch of the foot and provide critical stability when you walk, run, or negotiate uneven surfaces.

Occasionally, one or more of the ligaments or bones in this region can be sprained or fractured, resulting in a Lisfranc injury. This type of midfoot issue, while relatively uncommon, can cause high amounts of pain and varying degrees of disability based on the severity.

This article will review how this injury occurs, common symptoms, and treatment options.

Anupong Thongchan / EyeEm / Getty Images

How a Lisfranc Injury Occurs

Many different mechanisms or situations can cause a Lisfranc injury. Among the most common are high-impact traumas like a car crash, a crush injury, or a fall from an elevated surface. These types of accidents typically lead to more severe versions of the condition and can cause significant
deformities in the foot. 

In addition, sprains and fractures to the midfoot are also sometimes seen in athletes who participate in sports like soccer or football.

In these situations, the foot is in usually a plantar flexed position (high heel position) when a force outside the body causes the foot to pronate (roll inward) or supinate (roll outward) excessively. This can cause the bones in the midfoot to dislocate out of the joint.

Similar issues can also happen when an opponent or teammate lands on the top of your foot, causing damage to the midfoot structures.

What Are the Symptoms?

Individuals with a Lisfranc injury can experience a wide array of symptoms that may vary depending on how severe the condition is. Some of the most commonly seen complaints include:

  • Pain, swelling, and tenderness over the middle portion of the foot
  • Difficulty pushing off the foot while walking or inability to bear weight at all
  • Ecchymosis or bruising, particularly on the bottom surface of the foot
  • Visible deformity of the foot or toes (seen in more severe cases)

While more significant Lisfranc injuries are usually easily identifiable, milder cases may be more challenging to diagnose. They may also be confused with other, more common musculoskeletal issues.

If left untreated, milder Lifranc injuries can worsen and lead to mobility impairment or other complications, so it is crucial to be evaluated by your healthcare provider if you are experiencing any of the symptoms outlined above. Getting an accurate diagnosis will help you start treatment promptly.

How a Lisfranc Injury Is Diagnosed

Following trauma or sports-related injury to the foot, a comprehensive evaluation by an emergency medicine physician or orthopedic specialist is usually performed.

During this exam, your healthcare provider may apply manual pressure to the bones in the midfoot region to assess for any instability. They may also move the foot and ankle in several different directions that can elicit pain when a Lisfranc injury is present.

Imaging scans also play a key role in properly diagnosing any damage that has occurred. X-rays are usually taken while foot is weight bearing to assess for any increased distance or abnormal positioning between the bones in this region, which can indicate a Lisfranc injury. These images scans can also help identify any fractures that are present.

In some cases, a computer tomography(CT) scan may also be needed. For this test, a computer compiles multiple x-rays to create a three-dimensional image. This allows your healthcare team to assess for more subtle damage to the bones.

In addition, magnetic resonance imaging (MRI) is also frequently utilized. This test shows detailed views of tissues, which can be used to diagnose any sprains or tears to the ligaments of the midfoot.

In rarer cases, an ultrasound may also be performed to assess the integrity of these structures, though the accuracy of this diagnostic test is still in question.

Treatment Options Vary Depending on Severity

The treatment you receive after a Lisfranc injury will depend on the structures that were affected and the severity of the damage.

Less severe sprains that do not result in midfoot instability or boney displacement are typically treated conservatively, while injuries that do frequently need surgical correction.

Non-Operative Treatment

After a mild Lisfranc injury, you are normally required to use an immobilizing boot and keep weight completely off your foot. This usually occurs for 6 weeks to allow for healing, though it can extend for up to 3 to 4 months depending on the damage.

You are also commonly referred to physical therapy for several months (or longer). While in rehab, your therapist will focus on the following goals:

  • Regaining a normal walking pattern and weaning from using crutches when appropriate
  • Reducing any pain or swelling in the affected area
  • Improving your range of motion, while protecting the area of injury
  • Increasing the strength in your lower leg and foot muscles
  • Focusing on balance to improve your stability
  • Re-introducing sport-specific movements like cutting, running, and jumping when allowed

Operative Treatment

More severe injuries that result in boney displacement (also known as diastasis) or instability commonly require surgical fixation. This usually involves an open reduction and internal fixation (ORIF) procedure that restores the normal position of your bones by placing screws into them.

Other techniques that utilize fiber tape (a strong, collagen-based stringlike material) or plates to stabilize the midfoot may also be performed.

Following any version of the surgery, you are typically placed in a cast or boot and told to remain non-weight bearing for 3 weeks or longer.  Physical therapy is also normally initiated, focusing on the same goals that were detailed above.

A second surgery to remove the screws or fiber tape may be needed, especially if you plan to return to more demanding activities. Depending on the specifics of the injury, it can take 5 months or longer to resume higher-level sports or exercises after a surgically corrected Lisfranc injury.

Summary

A Lisfranc injury is an injury of the midfoot that can cause pain and impair your ability to walk. This injury most commonly occurs via high-impact trauma (such as a car accident or fall) or sports-related situations. This injury is diagnosed with a physical exam and various imaging scans. Depending on the severity of the damage, treatment may include physical therapy and/or surgery.

A Word From Verywell

Whether it’s a mild ligament sprain or a severe diastasis at the midfoot, Lisfranc injuries can significantly impact your daily life. Not only can they make athletic activities temporarily impossible, but they can hamper your ability to stand, walk, and care for yourself.

Fortunately, regardless of the severity, many effective treatment options exist for this condition. Working closely with your healthcare provider can help you regain your independence and speed up your return to normal function.

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