Lisfranc Injuries: Causes, Symptoms, and Treatment

What Is a Lisfranc Injury?

The Lisfranc joint complex consists of the bones and ligaments that connect the forefoot (the metatarsals) to the midfoot (the tarsal bones). A Lisfranc injury refers to damage to this region, which can include:

• Ligament sprains or tears

• Fractures of the metatarsal or tarsal bones

• Dislocations of the bones in the midfoot

Lisfranc injuries are often caused by trauma, such as a high-impact fall or motor vehicle accident, but they can also occur from a twisting or overloading motion, such as in sports like football or soccer.

Causes of Lisfranc Injuries

Trauma or Direct Impact

• High-Impact Falls: A sudden fall from a height or an accident can result in a direct blow to the midfoot.

• Motor Vehicle Accidents: In crashes, the force applied to the foot can cause the Lisfranc joint to become dislocated or fractured.

Sports Injuries

• Twisting Motions: Activities like football, soccer, or basketball, where athletes frequently pivot or change direction quickly, can lead to injuries in the Lisfranc joint.

• Falling with Force: In sports that require sudden stops or high impacts, such as skiing, runners may also be at risk of Lisfranc injuries.

Overuse and Repetitive Stress

• Long-Term Overload: Repetitive stress from certain sports or occupations can gradually weaken the ligaments and bones in the foot, increasing the risk of a Lisfranc injury.

• Improper Footwear: Wearing unsupportive shoes that lack proper arch support can contribute to foot strain, increasing the likelihood of an injury.

Symptoms of Lisfranc Injuries

• Pain in the Midfoot: A deep, aching pain in the midfoot area is one of the most common symptoms. The pain may be exacerbated by walking or standing.

• Swelling and Bruising: Swelling often occurs around the midfoot, and bruising may appear on the top or bottom of the foot.

• Inability to Bear Weight: Due to the severity of the injury, those with a Lisfranc injury often experience difficulty putting weight on the affected foot or walking.

• Deformity: In more severe cases, the bones of the foot may be misaligned, causing visible deformities in the foot’s appearance.

• Numbness or Tingling: If there is nerve involvement, patients may experience numbness or tingling in the foot or toes.

Diagnosing Lisfranc Injuries

Clinical Examination

• A healthcare provider will perform a physical exam to check for tenderness, deformity, and swelling in the foot. They will assess the range of motion and evaluate the patient's ability to bear weight.

Imaging Studies

• X-rays: Standard X-rays are the first diagnostic tool used to assess fractures, dislocations, and any misalignment in the Lisfranc joint.

• CT Scans: A CT scan may be recommended for a more detailed view of the bones and to assess the extent of the injury.

• MRI: MRI scans are used to evaluate soft tissue damage, such as ligament tears or cartilage injuries in the Lisfranc area.

Treatment for Lisfranc Injuries

Non-Surgical Treatment

1. Rest and Immobilization

   • Cast or Boot: A cast or walking boot is typically used to immobilize the foot and reduce movement during the healing process.

   • Crutches: Crutches or a walker may be used to help you avoid putting weight on the injured foot.

2. Ice and Elevation

   • Applying ice to the foot helps reduce swelling and pain, especially in the first 48 hours after the injury.

   • Keeping the foot elevated can also help reduce swelling and improve blood circulation.

3. Pain Management

   • NSAIDs: Over-the-counter anti-inflammatory medications like ibuprofen can help manage pain and swelling.

4. Physical Therapy

   • Once the injury begins to heal, physical therapy exercises may be recommended to restore strength, flexibility, and range of motion to the foot.

Surgical Treatment

In cases of severe Lisfranc injuries, surgery may be necessary to repair fractures, realign bones, or reconstruct ligaments. Surgical options include:

1. Open Reduction and Internal Fixation (ORIF): This procedure involves surgically realigning the fractured or displaced bones and securing them with plates, screws, or pins.

2. Ligament Repair or Reconstruction: If the ligaments in the Lisfranc joint are torn, surgery may be needed to repair or reconstruct the damaged ligaments.

3. Fusion: In some cases, the Lisfranc joint may need to be fused to provide stability to the foot.

Recovery Timeline

• Non-Surgical Recovery: The recovery time for non-surgical treatment typically ranges from 6 to 8 weeks, depending on the severity of the injury. The use of a walking boot or cast is often required during this period.

• Post-Surgical Recovery: Recovery from surgery may take 3 to 6 months, depending on the complexity of the injury and the surgery performed. Rehabilitation and physical therapy are crucial to restoring full function.

Preventing Lisfranc Injuries

• Wear Proper Footwear: Choose shoes with good arch support, cushioning, and a secure fit to help prevent foot injuries.

• Avoid Overuse: Gradually increase the intensity of physical activities to avoid overloading the foot, especially when engaging in high-impact sports.

• Strengthening Exercises: Strengthening the muscles and ligaments around the foot and ankle can improve stability and reduce the risk of injury.

If you suspect a Lisfranc injury, prompt evaluation and treatment are essential to prevent long-term damage. At Palms Physiotherapy & Allied Health, our team of experts is dedicated to providing effective care and rehabilitation for foot injuries, including Lisfranc injuries. Contact us today to schedule an appointment and begin your recovery journey!