LisFranc Injuries – No it is not my French Cousin. Dr Sullivan Explains

LisFranc injuries are talked about in all sports as a season progresses, but what exactly is a LisFranc injury? The LisFranc joint complex are the bones and ligaments that form the arch in the human foot.

It is a series of bones, joints, ligaments and tendons that provide stability to the arch of the foot and bridge the region between the ankle/heel and the toes.  It is important in providing stability to to structure of the foot and stabilizing the foot during the strenuous activity of walking, running and jumping.

The LisFranc region and therefore the injuries associated with this region are named after Jacques Lisfranc de St. Martin – a surgeon in the Napoleonic army in the 1800’s who first described this particular injury.

Most people assume this injury is related to a fracture; however, it is a complex continuum of damage that is rated by the severity of the injury.  Simple strain of the ligaments to full displaced fracture of the 1st and or 2nd metatarsals.  The interesting thing about this injury is not the injury itself, but the damage that occurs to the cartilage at the ends of the midfoot bones.

This damage results in restrictions in movement of the joint and persistent pain. Cartilage is the smooth surface in each joint which allows for ease of movement of the joint region.  When this region gets injured, the joint is like a ball bearing with a nick in it.  The bearing doesn’t move smoothly and this results in binding and restrictions in the normal smooth movement.

If the injury goes untreated, or inadequately treated, the entire joint can fail which results in both collapse of the arch but early onset arthritis in the midfoot which is both painful and persistent even in the world class athlete.

How do lisFranc injuries occur?

They can occur from both non contact and direct contact stressors.  Simple twist and fall non contact injuries are common in football and soccer where a player “steps wrong” or the foot gets twisted in the turf or with other players’ legs and feet.  It commonly occurs when one player “trips” over another player’s extended foot. More severe injuries occur when a player “lands wrong” after jumping to catch a ball resulting in the full weight of the body being absorbed by the tiny region in the foot.

Direct trauma generally results in fracture of the 1st and or 2nd metatarsal and partial or full dislocation of the resulting bone fragments.  This type of injury can occur in any sport where a player is asked to jump and then land on a hard surface including football, baseball, basketball and track & field.  Without proper stabilization and treatment of this injury, excessive scar tissue as well as early arthritis can occur in the injury site resulting in persistent pain and swelling when stress is placed on this region of the foot.

The most common symptoms of Lisfranc injury include:

  • The top of foot may be swollen and painful resulting in difficulty bearing ny weight on the affected foot.
  • There may be bruising on both the top and bottom of the foot. Bruising on the bottom of the foot is highly suggestive of a Lisfranc injury.  This bruising occurs right behind the great toe and severe pain is experienced when a shoe with a high or firm arch is attempted to be worn.
  • Pain that worsens with standing, walking or attempting to push off on the affected foot. The pain can be so severe that crutches may be required to prevent further injury.

Regardless of the mechanism of injury, early diagnosis and initiation of treatment is imperative to maximize recovery from this type of injury.  The greater the amount of displacement that occurs in the joint as a result of injury, the greater the need for more aggressive  treatment including surgery to stabilize the joint.

These types of injuries are difficult to identify on regular x-rays and treatment maybe delayed as a result.  Simple strains (no fractures) are treated with none to minimal toe weight bearing for 6-12 weeks and then a gradual return to full weight bearing in a custom shoe which is molded to the persons foot to maximize stability of the affected area of the foot.

If surgery is needed to stabilize the LisFranc joint, it is commonly done 7-10  days post injury to allow time for swelling to go down.  The surgery is usually done to insert screws and or wires to hold the bones in place, to remove any bone fragments occuring when the ligament is torn off the bone and hold the bones and ligaments in place to give the body time to heal the area.

Generally 4-6 months or more after the initial surgery a minimal procedure is done to remove the screws and or wires. This is done for 2 reasons: pain, and to prevent breakage of the screws from the forces applied when the athlete returns to the practice and playing field.

Recovery from this injury can be difficult to predict.

Simple injuries that do not require surgery may have the athlete out of commision for 2-3 months minimum to allow time for adequate healing.  They will miss a significant time, but if all goes well they may be able to return during the same season in which the injury occured.  If surgery is required, generally the athlete is placed on injured reserve for the remainder of the season.  If all goes according to plan without setbacks, they should be able to  return to the playing field 6-12 months after the injury.

Trying to rush the athlete back too soon can often result in irreparable damage to the athletes performance and their career.  LisFranc injuries are not something to play around with.  The athlete needs to follow the instructions regarding immobilization and weight bearing to the letter and stop immediately if they experience any pain or swelling in the repaired foot.  Many athletes return from these injuries without detriment, but there are also many who never returned to their pre injury form.

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