The middle area of the foot, the midfoot, consists of a collection of small bones that create the arch on top of the foot. The midfoot plays an important role in the movement of the foot, especially walking, through its function of transferring the forces produced in the muscles of the calf to the forefoot. The tarsometatarsal joint, also known as the Lisfranc joint, connects the midfoot to the forefoot.
Injuries to the foot and ankle are very common. They typically fall into the categories of sprains, strains or fractures. Broken bones are fractures. Sprains refer to damage to a ligament and strains involve muscles or tendons. A Lisfranc injury, which is far less common, can include damage to the bones and ligaments of the midfoot joint as the result of some sort of trauma to that area of the foot.
A Lisfranc injury may be unfamiliar to most, but it can be very serious, especially if misdiagnosed as a simple sprain. If not treated correctly, a Lisfranc injury can result in chronic and potentially debilitating pain. Professional athletes are more aware of this injury, as it has proven to be the cause of lost playing time and even ending entire seasons for more than a few of them.
Even with treatment for a Lisfranc injury, there is a chance of later developing posttraumatic arthritis in the affected joint, but without immediate and adequate intervention, the probability is even higher.
Who was Lisfranc?
Jacques Lisfranc de St. Martin was a French surgeon in Napoleon’s army, treating battlefield injuries at the Russian front. A common injury at that time occurred when soldiers would fall from their horses with a foot remaining trapped in the stirrup, causing a severe twisting injury in the ligaments of the midfoot joint. Since this pre-dated the availability of antibiotics, gangrene would often set in, and amputation would be necessary in order to save the soldier’s life.
Lisfranc became known for the surgery that amputated the foot at the tarsometatarsal joint following this particular type of injury. Thereafter, injuries to this joint became known as Lisfranc injuries.
Lisfranc Injury Symptoms and Causes
Lisfranc injuries vary in location and severity, ranging from torn or sprained ligaments to dislocations or fractures in bones. They result from a variety of causes and often involve a blow or twisting of the foot. This type of injury is found in many different sporting activities, like football and soccer, where another player may step or fall on a flexed foot or the individual may land wrong or over-twist a foot. Other common causes include falling from a height or being in an automobile accident.
Because of the consequences that can result from an inaccurate diagnosis of what is actually a Lisfranc injury, it is important to recognize the symptoms. Some of the more common of those symptoms include:
- Pain – the pain from a Lisfranc injury can be extreme. Present while merely standing, the increase in pain while engaged in any type of “pushing off” motion will be considerable. In fact, this injury can make it too painful to place weight on the injured foot or try to walk without using crutches.
- Swelling – the swelling that accompanies a Lisfranc injury will typically be noticeable on the top of the foot.
- Bruising – the pattern of bruising with a Lisfranc injury is considered a signature sign because it is often visible on the bottom arch part of the foot.
When these symptoms are present it is important to consult your healthcare professional in order to promptly begin treatment and optimize the potential for successful healing.
Lisfranc Injury Fixation
Lisfranc injuries are diagnosed based on symptoms and a physical examination. X-rays or CT scans will then be used to determine the exact nature of the injury, its location and degree of severity.
If the tests reveal that the ligaments have not been completely severed and there are no displaced or dislocated bone fractures, conservative measures, such as rest, icing and anti-inflammatory medications will usually be the prescribed course of treatment. This may be followed with bracing and physical therapy.
In the more extreme cases, like those that involve a serious bone fracture, fragments breaking off of a bone or when there is malalignment within the joint, surgery will usually be recommended.
The main goal of Lisfranc injury fixation is the realignment of the joint and restoration of broken bones or fragments of bones to their proper positions. This surgery may require the use of plates or screws to secure the alignment and add stability to the foot until it is back to normal. Some or all of the hardware supports may need to be removed several months post-surgery.
Recovery and Results of a Lisfranc Injury Fixation
The recovery period following Lisfranc injury fixation is typically six to eight weeks in a cast or boot until the patient can put weight on the injured foot. Physical therapy will be recommended to help the patient increase strength in the foot and restore normal functioning as soon as safely possible. It may be necessary to wear an arch support for the first year following surgery.
Results will vary following this surgery. Most people will be able to return to their previous level of activity or close to it. This is not always true for athletes. Some return to pre-injury performance levels, after sitting out most or all of a season. Others may not have the same degree of success.
Contact Dr. Christopher Hubbard Today to Make an Appointment
If you have suffered a Lisfranc injury and require a Lisfranc injury fixation, it is essential to consult with a knowledgeable health professional as soon as possible. Dr. Christopher Hubbard has the necessary experience and training to provide the treatment you need. Contact our office today to schedule an appointment.