How is a Lisfranc injury different from a sprain, and which is the more serious injury?
Foot and ankle injuries are very common, especially among athletes and those involved in other types of rigorous activities. Injuries to the foot are classified based on whether there is damage to bone, ligament or tendon. If a bone is broken, it’s called a fracture. Muscles and tendons are injured in strains and damage to a ligament is a sprain.
In the foot, the most common issues are sprains and fractures. A somewhat rare injury to the midfoot region of the foot can combine damage to both bone and ligament. This is what is known as a Lisfranc injury and, while basically unknown to the general public, it has affected the careers of more than a few professional athletes.
The Lisfranc joint complex lies approximately halfway between the heel and the toes. The name originated during the Napoleonic Wars. A soldier had injured his foot by falling from his horse and getting his foot caught in the stirrup. The French surgeon, Jacques Lisfranc de St. Martin, was forced to amputate part of the foot due to gangrene having set in. The cut was made at the tarsometatarsal joint and, after that, damage to the ligaments and bones in this spot are called Lisfranc injuries.
A Lisfranc injury is often misdiagnosed as a simple sprain but it can be far more serious. Without proper treatment, a severe Lisfranc injury can result in the collapse of the arch and debilitating arthritis, possibly requiring complex surgery.
Lisfranc Injury: Causes and Symptoms
Lisfranc injuries can be the result of a variety of causes. In sports, another player stepping or falling on a foot that is already flexed or in motion or a planted foot getting caught by a cleat or some other reason as the player exerts force on it can cause the ligaments to tear, a bone to fracture or both. Similar situations in other sports, activities and occupations, such as violent twisting or landing wrong on a foot can create the same damage. The same is possible during a fall, car crash or if something heavy is dropped on the foot.
Recognizing the symptoms of a Lisfranc injury is especially important due to the tendency to believe that it is merely a simple sprain. Some of the most common symptoms of a Lisfranc injury are:
- Swelling: especially swelling on the top of the foot.
- Extreme pain: any standing will be painful and motion that involves pushing off with the injured foot will be worse. Lisfranc injuries can be so painful that walking or placing any weight on that foot is impossible without crutches.
- Bruising: one of the signature signs of a Lisfranc injury is the bruising on the arch and on the bottom of the foot.
Treatment
Treatment for a Lisfranc injury will depend upon the severity. Less serious cases in which the ligaments are not totally severed or there no dislocated or displaced fractures will likely respond to conservative methods. These will include rest, ice, pain and anti-inflammatory medications and bracing of some sort. Physical therapy may be recommended.
Surgery may be necessary to repair more damaged ligaments and broken bones. For athletes, a Lisfranc injury is often the end of their season and it is possible that, even with surgery, they may not regain the same level of playing as before the injury.
The earlier medical care is sought, the better the chances for a more successful outcome.
If you have questions about an injury or about any foot or ankle concerns, Dr. Christopher Hubbard is a board-certified Orthopedic Surgeon and is the former Chief of the Foot and Ankle Service at Mount Sinai Beth Israel in NYC. To schedule an appointment, or if you just have questions, please use our convenient online contact form by clicking here.