What is a Lisfranc injury?

A Lisfranc injury, also known as a Lisfranc fracture, is a somewhat uncommon foot injury involving one or more of the five metatarsal bones in the midfoot region. A cluster of small bones forms an arch, which connects to the metatarsals and extends to the toes. Tight connective tissue bands hold these bones in the correct place and give the joint stability. This stability helps the transferring of force from your calves to the front of your feet.

How do Lisfranc injuries occur?

Lisfranc (midfoot) injuries result if bones in the midfoot are broken or ligaments that support the midfoot are torn. The severity of the injury can vary from simple to complex, involving many joints and bones in the midfoot.

 Low-energy injuries can happen when the back of the foot twists or presses down with the ball of the foot planted on the ground. This can happen during athletic activities such as football but also can occur from a misstep or even missing a stair and stumbling over the top of the foot. High-energy injuries occur from direct trauma such as a car accident or a fall from a height.

Who is at higher risk of a Lisfranc injury?

These injuries commonly occur in sports such as football, soccer, or lacrosse. Localized trauma, including both direct and indirect injury, can cause this condition. Participants in extreme sports, including windsurfing, wakeboarding, or snowboarding may also commonly experience this type of injury.

What are the symptoms of a Lisfranc injury?

A Lisfranc injury is often mistaken for a simple sprain, especially if the injury is a result of astraightforward twist and fall. However, injury to the Lisfranc joint is not a simple sprain that should be simply “walked off.” It is a severe injury that may take many months to heal and may require surgery to treat. 

• The top of the foot may be swollen and sore to the touch
• There may be bruising on both the top and bottom of the foot. Bruising on the bottom of the foot is highly suggestive of a Lisfranc injury.
• Pain that worsens with standing, walking or attempting to push off on the affected foot. The pain can be so severe that crutches may be required.

The intensity of these symptoms will vary depending on how severe the Lisfranc injury is and how long ago it occurred. 

How are Lisfranc injuries diagnosed?

Several variations of a Lisfranc injury may occur. A proper diagnosis will involve an examination by a foot and ankle doctor and X-ray images. Your provider will examine your foot, and look for tenderness, any deformities, bruising and swelling. They may also move your toes up and down to see if this causes you any pain. The diagnosis will confirm whether all five metatarsal bones are displaced in a similar direction, one or two are displaced from the others, or a divergent classification that might also include a navicular fracture.

In some cases, your provider may order MRI or CT scans to see more detailed imaging of the soft tissues and bones in your foot. These tests pick up injuries that an X-ray alone cannot, and are an important step in having your injury properly diagnosed. 

How is a Lisfranc injury treated?

For less serious dislocation of the affected bones, your physician may prescribe casting or bracing for several weeks.  For severe cases, surgery is necessary to perform an open reduction of internal fixation. 

Non-surgical treatments

If there are no fractures or dislocations in the joint and the ligaments are not completely torn, nonsurgical treatment may be all that is necessary for healing. A nonsurgical treatment plan includes wearing a non-weight-bearing cast or boot for 6 weeks. You must be very strict about not putting weight on your injured foot during this period. This then progresses to weight-bearing in a removable cast boot or an orthotic.

Your doctor will want to follow up with you regularly and take additional x-rays to make sure your foot is healing well. In the course of follow-up, if there is any evidence that the bones in the injured joint have moved, then surgery will be needed to put the bones back in place.

Surgical treatments                

A foot and ankle orthopedic surgeon will recommend surgery for all injuries with a fracture in the joints of the midfoot or with abnormal positioning (subluxation) of the joints. The goal of surgical treatment is to realign the joints and return the broken (fractured) bone fragments to a normal position.

Internal fixation – In this procedure, the bones are positioned correctly (reduced) and held in place with plates or screws.

Fusion – If the injury is severe and has damage that cannot be repaired, fusion may be recommended as the initial surgical procedure. A fusion is essentially a “welding” process. The basic idea is to fuse together the damaged bones so that they heal into a single, solid piece.

Recovery and return to activity after Lisfranc injury

After either surgical procedure (reduction or fusion), a period of non-weight bearing for 6 to 8 weeks is recommended in a cast or cast boot. Weight Bearing is started while the patient is in the boot if the x-rays look appropriate after 6 to 8 weeks. The amount of weight a patient can put on their foot, as well as the distance the patient is allowed to walk, is at the surgeon’s discretion. If the patient has had internal fixation, impact activities such as running and jumping should be avoided until the hardware has been removed.

It’s important to note that some athletes never return to their pre-injury levels in the sport after these injuries. Despite excellent surgical reduction and fixation, arthritis may occur from the damage to the cartilage. This may result in chronic pain and may require fusion in the future. There is also a chance that the bones will fail to heal properly, and it may require follow-up surgery. 

Contact Campbell Clinic

Call Campbell Clinic immediately if you are experiencing symptoms that resemble those of a Lisfranc injury. With 24/7 appointment scheduling, you can make an appointment as soon as possible from anywhere. We know that accidents don’t just happen 9-5, so we also offer walk-ins and after-hours examinations at both our Germantown and Southaven locations.