A Lisfranc injury , also known as a midfoot injury, happens when the ligaments or bones in the middle of your foot are either fractured, sprained or dislocated (sometimes all three). A lisfranc injury can be simple or complex depending on how many of the bones or joints are affected. Treatment options vary depending on the severity. Here’s the lowdown on Lisfranc injuries, treatment and recovery:
A Lisfranc injury affects the bones or ligaments in the middle part of your foot. The Lisfranc joint is pretty complex – it’s where the metatarsal bones and the tarsal bones are connected by a tough band of tissue. It plays an important role, which is why it’s really important that this injury is diagnosed and treated correctly. The joint helps to both stabilize your arch and maintain proper alignment.
The three main types of Lisfranc injury are: sprain, fracture, and dislocation. In some cases it’s a combination of all three. It can affect one or many bones or ligaments in the foot and this will determine what type of treatment and recovery plan you’ll need.
The injury gets its name from the pioneering French surgeon Jacques Lisfranc de St. Martin. He noticed it was common among soldiers in Napoleon’s army who had fallen from their horse but got their foot stuck in the stirrup. .
Lisfranc injuries can happen while playing sport, particularly soccer or football, so they’re often regarded as a sporting injury. Many elite athletes have seen promising seasons end abruptly because of this injury. But they can also be the result of a simple twist or fall, a large object falling on your foot or a major trauma like a car accident.
Lisfranc injuries are rare and they’re often misdiagnosed as a simple sprain at first, which means that people try to “walk them off” and treat them at home. But it’s really important to get checked out by a doctor because this type of injury can be quite serious and may require surgery. It can take months to recover from a Lisfranc injury and the earlier you see a specialist, the greater the chance is that you’ll make a full recovery..
The most common symptoms of a Lisfranc injury are:
• Swelling of the foot.
• Pain throughout the foot, especially when pressure is applied.
• Being unable to bear any weight.
• Bruising or blistering on the arch of the foot.
• Bruising on the bottom of the foot (highly indicative of a Lisfranc injury).
• Abnormal widening of the foot.
These can be symptoms of other, less serious injuries too but it’s important to get your foot checked out if you have any concerns. If rest, ice, and elevation (commonly referred to as “RICE”) don’t reduce the pain or swelling within a day or two you may have a Lisfranc injury, so make sure you go see a doctor..
This really depends on the severity of your injury. Some people experience intense pain immediately and can’t put any weight on their foot at all. Others liken it to a sprain which doesn’t get better after a few days, prompting them to eventually seek medical advice. This is one of the reasons why it’s often misdiagnosed at first.
If your doctor suspects you have a fracture or tear in your Lisfranc joint, they will examine your foot and send you for X-rays. An X-ray will show a broken or dislocated bone in the midfoot but it may not show a ligament tear or rupture. If this is the case, then you may need an MRI or a CT scan. These can help to determine the seriousness of the injury and whether or not you’ll need surgery..
Your treatment plan will depend on how severe your injury is. Treatment for a minor Lisfranc injury (where you haven’t broken a bone or torn a ligament) is pretty similar to that for a sprained ankle – rest, ice and elevation. This will help to manage both the pain and swelling of your foot while it begins to heal. Over the counter non-steroidal anti-inflammatory medications (NSAIDs) such as Ibuprofen can help to reduce any pain and inflammation during this time.
You may also need a period of non-weight bearing, usually around six weeks. Your foot will be placed in a cast or walking boot during this time. This is a very important step in your recovery from a Lisfranc injury and shouldn’t be ignored.
If you need to be non-weight bearing for a few weeks, you’ll need crutches or a crutch alternative such as a knee scooter or iWALK2.0 (a hands free device allowing you to maintain day-to-day activity while keeping your foot elevated).
Once the swelling and pain has subsided and you’ve got the go-ahead from your doctor you’ll slowly be able to start bearing weight again until you can walk unaided. Physical therapy is usually the final phase of the Lisfranc injury treatment plan. Make sure you wear appropriate footwear (that means no stilettos!) to ensure that your arch is sufficiently supported as your foot slowly starts to become more stable.
If you have a severe injury – ie you’ve fractured, dislocated or torn ligaments – you may need surgery. The goal of surgery is to realign the joints or bones and/or repair any tears. There are two main types of Lisfranc injury surgery: internal fixation and fusion.
The surgeon will use plates, screws or other hardware to hold your bones in place. This may be temporary, which means you’ll need to have it removed a few months later. For other people, this stays in permanently unless it causes any problems.
With fusion surgery, the bones will be “welded” into place to form a single solid piece. Any fusing material will be left in the foot permanently.
Studies have been inconsistent on the benefits of open reduction and internal fixation (ORIF) versus fusion surgery. A study by University of Minnesota researchers found that fusion may provide better long-term pain relief. This was supported by Nicholas J. Bevilacqua, an orthopaedic specialist, who wrote in Podiatry Today that fusion offers more stable, predictable outcomes..
What to expect after Lisfranc surgery:
As always, following doctors’ orders post-surgery is an essential aspect of injury recovery, and it is important to understand the benefits behind the post-surgery regimen your doctor prescribes.
• Rest, ice, and elevation will help reduce any swelling, allowing the body to recover more quickly.
• Non-Weight Bearing: Staying off of your foot for an extended period of time (generally 6 to 8 weeks, depending on the severity of the injury) will also give the foot time to recover.
• Avoid high impact activities such as running or jumping until your doctor grants permission (generally for 3-5 months after surgery, depending on when the surgeon removes the hardware in the foot).
The most frustrating thing about Lisfranc injury rehabilitation is the long period of non-weight bearing that comes with it. If you’re used to being active this can be a tough pill to swallow but it’s essential that you stay off your feet if you want to make a full recovery.
To help you get around during this time, you’ll need a mobility device. There are a few to choose from, including traditional crutches, knee scooters and a hands-free crutch.
Crutches are used by millions of people worldwide each year. They’ve been around for thousands of years and most people assume that they’re the only option available. Our crutch resource center has more information about the pros and cons of crutches.
While crutches can be a useful, quick fix solution they can be quite restrictive as they limit the use of your hands and arms and are physically exhausting. If you’re used to being active and you’re dreading the thought of hobbling around for the next six weeks or more, you may want to consider another option.
Crutch alternatives such as knee scooters are becoming more popular. You kneel on a platform which means that you can whiz around happily without putting any weight on your injury. Knee scooters are great for flat surfaces but can’t be used on uneven ground or stairs. They are quite bulky, which makes them a bit more tricky to transport.
Another alternative is the iWALK2.0 hands-free crutch. It functions like a prosthetic leg which means that you can walk around unaided and with the full use of your hands and arms. Meanwhile your knee is resting safely on a padded platform. The iWALK2.0 is lightweight and can be used on uneven ground, stairs and even in the shower.
Compare the iWALK2.0 to other mobility devices.
A Lisfranc injury is rare, which means that it’s often misdiagnosed, But it’s something you want to take seriously. While it’s easy to miss, it’s hard to recover from and it can take months to make a full recovery. During this time, make sure that you rest up and listen to your doctor’s instructions. Understanding your injury, its severity, what treatment you need and your rehabilitation plan are your keys to the fastest possible recovery.
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Wedro, Benjamin, MD, and Melissa C. Stoppler, MD. “Lisfranc Fracture Causes, Symptoms – MedicineNet.com.” MedicineNet. N.p., n.d. Web. 8 Feb. 2014.
“Lisfranc (Mid foot) Injury-OrthoInfo – AAOS.” Lisfranc (Midfoot) Injury-OrthoInfo – AAOS. N.p., n.d. Web. 9 Feb. 2014.
” Lisfranc (Mid foot) Sprain/Fracture.” Lisfranc (Midfoot) Sprain/Fracture. N.p., n.d. Web. 9 Feb. 2014. https://www.aofas.org/footcaremd/conditions/ailments-of-the-midfoot/Pages/Lisfranc-Injury.aspx
“Foot Health Facts – Lisfranc Injuries.” American Colege of Foot and Ankle Surgeons. http://www.foothealthfacts.org/footankleinfo/lisfranc_injuries.htm