Lisfranc Injury: Causes, Symptoms, Treatment and Recovery

Lisfranc injury, also commonly known as a midfoot injury, takes place when one of the bones of the mid foot are fractured or broken due to a trauma. It also involves damage to the ligaments, muscles and tissues supporting the midfoot. The severity of damage caused in these injuries range from mild to complex and may involve more than one bone and joint of the mid-foot area.

Lisfranc Injury – An Overview

Lisfranc injuries are named after Dr. Jacques Lisfranc, who worked on the dislocations, sprains and fractures of the mid-foot--the place at the junction of the upper and lower foot bones. To be precise, Lisfranc injury is caused when there is a damage to the joints where the thin metatarsals meet the tarsal bones, making up the midfoot. The midfoot region is the area where the metatarsals extend to the toes. Each joint and bone in the midfoot has a specialized job and provides support to the foot while walking, running and standing. Injuries to the midfoot can range from dislocated and broken bones to torn ligaments.

Lisfranc injuries are often thought to be foot sprains, especially when the injury occurs due to some obvious causes like falling from a height or twisting the foot. It is important to keep in mind that a Lisfranc injury is not the same as an ankle or foot sprain. It can also not be walked off to reduce the pain, swelling and other symptoms. It can take several months for the Lisfranc injury to heal and may even require a surgical procedure if the injury to the foot is severe.

Causes of a Lisfranc Injury

Lisfranc injuries mostly occur from falling from heights or twisting the foot. It is most common among football and soccer players and happens when the player stumbles over and cause the foot to flex in a downward motion. It can also be caused by falling forward or stepping into a hole. A direct trauma to the foot can also cause Lisfranc injuries. It can also be caused by a heavy object falling on the foot or as a result of a car accident.

Lisfranc injuries are quite serious and may also require surgery in case there are multiple fractures or an associated injury to the surrounding tissues, joints, muscles and ligaments.

Common Signs and Symptoms of a Lisfranc Injury

The main indication of a Lisfranc injury is swelling or/and pain in the injured foot. These symptoms are also common for sprains, hence a Lisfranc injury is often mistaken for a simple sprain. If you have applied the rest, ice, compression and elevation method on the injured foot but the pain and swelling does not subside even after two days, it is likely that you are suffering from a Lisfranc injury which may include a ruptured Lisfranc ligament or a fracture in one of the bones or joints of the midfoot. It is important to visit a doctor at your earliest if you experience the following symptoms.

• Pain and swelling on the top of the injured foot
• Bruising of the foot
• Pain, sensitivity and tenderness of the injured area in the midfoot
• Not being able to put weight on the injured foot and therefore, not being able to walk or stand
• Pain in toes when the foot is moved
• A visible abnormal widening of the foot

If the standard techniques to reduce pain and swelling do not work, it is important to visit a doctor to check if there is a damage to the Lisfranc joint or ligament.

Diagnosis and Tests

Your doctor will conduct a physical examination of the injured foot and perform some test to check if there is a Lisfranc injury or not. Here are the physical findings that the doctor will look for when examining the injured foot.

• If there is bruising of the injured foot along the bottom, there may be a fracture or a complete tear in the midfoot ligaments
• Palpation, tenderness upon touch, along the midfoot
• There is pain when stress and pressure is applied to the midfoot
• The doctor may also conduct a piano key test which involves moving the toes of the injured foot up and down to see whether there is any pain caused
• Limb heel rise test may also be performed where you will be asked to stand on one foot and try rising on your toes. Since this puts pressure on the midfoot, any pain caused by this can be an indication of a Lisfranc injury

In addition to the tests and physical examination mentioned above, your doctor will also conduct an X-Ray or an MRI to check where the fracture is and how much damage is caused to the surrounding tissues, ligaments and muscles. This will point out the seriousness of the injury and also what kind of treatment will work best on each individual case.

Treatment Options for a Lisfranc Injury

Minor Lisfranc injuries can be treated using non-surgical methods, but most of the time, a surgery is needed to cure a Lisfranc injury.

Non-Surgical Options

R.I.C.E. Method: Rest, ice, compression and elevate effective in reducing swelling and pain of the midfoot. If there are some minor fractures or broken ligaments in the midfoot, they can heal through this method. If the symptoms do not subside, your doctor will advise you to go for a surgical treatment.

Walking Boot or Brace: Your doctor may recommend you to wear one of these to make sure the healing process continues smoothly and there is no additional damage to the already injured midfoot region.

Immobilization: Your doctor may also recommend immobilization to give the injured foot much needed rest. You will have to make sure that you do not put any weight on the injured leg and make use of mobility devices like a knee scooter by KneeRover as a traditional crutch alternative to keep the leg non-weight bearing. Knee scooters are the ideal crutch alternative as they provide ease of mobility while keeping weight off your injured foot.

Surgical Options

In case of a severe Lisfranc injury, you will have to go through a surgical procedure. It is the case when there is a severe injury resulting in a dislocation, torn ligaments or fractures. The aim of surgery is to realign the bones and joints and to repair any tears in the midfoot region. Following are the two types of surgeries performed for a Lisfranc Injury.

Internal Fixation: This procedure makes use of screws, plates and other hardware to keep the foot into place. The hardware can be permanent to temporary. Temporary hardware will be removed at a later date between 3-5 months after surgery.

Fusion: This procedure will weld the bones back into place so that it forms a single solid piece. The material used to fuse will stay in the foot permanently.

Recovery and Rehabilitation

Recovery from a Lisfranc injury depends on the severity of the break, the health of the patient the and treatment method used. The healing time may be increased in case of a severe injury.

It is important to keep the foot non-weight bearing for the recovery to take place smoothly and to reduce the chances of the Lisfranc injury occurring again. You can choose a mobility device to keep weight off the injured foot.

Here are some options you can choose from:

Traditional Crutches

Crutches allow you to keep your weight off your injured leg. These might be readily available and inexpensive, yet there are many disadvantages associated with it that you should be aware of. The number one complaint from people using these crutches is pain in wrists, under your arms, elbows and hand. It becomes difficult to do every day work such as walking through a door, going to work, pushing a shopping cart. All this leads to occasional weight bearing on the affected leg which can cause the injury again or increase the recovery time.

Knee Walkers or Knee Scooters

These are becoming common to make the rehabilitation process easy. Knee scooters from KneeRover let the user bend their knee at an angle of 90-degrees and kneel on the platform on a frame attached to four wheels. It works like a bicycle and the user can steer it easily using the handles.

Knee scooters are a great improvement for long distance mobility and provides the user freedom to move as soon as the doctor allows mobility after the surgery. It provides comfort and keeps your weight off your affected foot.

Lisfranc injuries, commonly mistaken from sprains, are serious injuries of the midfoot. You can make a fast recovery if you understand the severity, the causes and the course of action that needs to be taken in case you suffer from a Lisfranc injury.

This is for informational purposes only, please remember to consult your doctor.  

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