Lisfranc Injuries

Lisfranc (midfoot) injuries occur when bones in the midfoot (middle region of the foot) 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.

A general work-up involves x-rays of both feet to evaluate for widening of the interval between the 1st and 2nd metatarsals. A CT or MRI scan may also be done.

Anatomy

In the midfoot, there is a group of small bones, which form an arch on the top of the foot. From this group, five long bones (metatarsals) extend to the toes. The bones are held in place by ligaments that stretch across and down the foot. But there is no connective tissue holding the first metatarsal to the second metatarsal, and a twisting fall can break or shift these bones out of place.

Treatment

Treatment for a Lisfranc injury depends on how severe the injury is.

Nonoperative Treatment
Nonoperative treatment involves cast immobilization. Nonoperative treatment is elected if there is no instability or displacement confirmed on imaging, or other comorbidities that inhibit surgery are present.

Surgical Treatment
Surgical treatment is elected in athletes if instability is present. Surgery involves repositioning the bones in there anatomic positions and fixing them generally with screws. Various methods of internal fixation can be used to fix Lisfranc injuries.

Recovery

Recovery with or without surgery generally requires a period of non-weightbearing in a cast, followed by progressive weightbearing in an aircast boot and a physical therapy program.