Making Sense of the Lisfranc Injury

Lisfranc injury occurs in the midfoot, in the Lisfranc joint, also known as the tarsometatarsal articulation of the foot.

This joint is named after a field surgeon in Napoleon’s army, Jacques Lisfranc. Dr. Lisfranc, while serving on the Russian front, discovered that amputation at the tarsometatarsal articulation was an expedient treatment for gangrene of the forefoot, as it did not require cutting through bone.

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Many patients have heard of this injury, but few know much about it. And in fact, this condition is frequently misdiagnosed (and thus treated incorrectly).

What Is the Lisfranc Joint?

In the center of the foot lies a cluster of small bones — the tarsals and metatarsals —  that fit together like jigsaw puzzle pieces to form the foot’s arch. The five metatarsal bones extend downward, connecting to the bones of the toes (phalanges). The junction of the five tarsal bones and the five metatarsals is the nexus of the Lisfranc joint.

The Lisfranc bones are held in place by ligaments that extend both across and up and down the foot.

This structure is what allows your foot to stabilize the body and to bend and flex as you move. If you’ve ever watched someone on a balance beam, you notice the tiny flexions the foot makes as it works to keep the gymnast upright. That is the magic of the Lisfranc joint.

What Is a Lisfranc Injury?

linsfrancBecause this complex structure involves multiple bones and ligaments, it is susceptible to sprains, fractures and dislocations.

One notable area of vulnerability involves the first and second metatarsals. No ligaments connect the first and second metatarsals together, making them especially prone to dislocation.

The most common causes of high-velocity tarsometatarsal injury are car accidents, twisting falls, industrial accidents and falls from high places. However, low-velocity injuries can occur from something as benign as stepping off a curb incorrectly.

Athletes are especially prone to midfoot sprain, which occurs when they move the foot while their cleated shoe remains stuck in the ground. This injury affects almost 5 percent of football players (professional and amateur) every year.

The classic symptoms typically include severe pain and swelling in the midfoot, bruising and the inability to bear weight.

Treatment of Lisfranc Injuries

A large percentage of Lisfranc injuries are missed or misdiagnosed in an initial evaluation. This occurs primarily because they are difficult or impossible to detect on X-rays. An experienced physician with a high level of suspicion is the best way to catch this injury. Sometimes, advanced imaging techniques such as CT or MRI provide doctors with a clearer view of any potential damage.

If the injury goes undetected, serious complications can develop. For example, an undetected midfoot sprain can progress quickly to osteoarthritis and a flattened arch, both of which require surgery to correct.

Fractures, dislocations and significant ligament tears almost always require surgery to correct. Surgery might include reduction (relocation), fixation with screws, or fusion.

The Center of Orthopedic & Rehabilitation Excellence (CORE) has foot specialists in our locations in Riverton, West Valley City and West Jordan, Utah. Our orthopedic surgeons and sports medicine specialists can provide diagnostics and treatment for a variety of orthopedic injuries, including tarsometatarsal or Lisfranc injury.

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