A Lisfranc injury (named after a French surgeon serving in the Napoleonic war) is a specific injury of the mid-foot. This type of injury occurs when there is a tear or trauma to the ligaments that help stabilise the long bones of your feet (metatarsals) to the other, smaller bones of your mid-foot.
A Lisfranc injury may be suspected if a patient complains of pain in the mid-foot following trauma. The pain in the mid-foot may be accompanied by difficulty walking and some visual changes to the appearance of the foot. There may be bruising and swelling around the midfoot, particularly in the hours or days after the initial injury.
A Lisfranc injury can occur after a high-energy trauma to the mid-foot, particularly if the patient land’s forcefully on their flexed toes. This may occur in a sporting setting, such as rugby or gymnastics, but may also occur following a road traffic accident. The injury causes disruption in the ligaments that stabilise the mid-foot, leading to injury. This is more commonly seen in men, with two to four times as many cases seen in males.
These types of injury are quite rare, accounting for approximately 0.2% of all fractures, although in 20% of cases they are misdiagnosed or missed altogether.
A Lisfranc injury will be diagnosed following a thorough history, a physical examination and with a weight-bearing x-ray. The x-ray may be followed by another type of scan, called a CT scan, which may be used to assess the severity of damage to the ligaments of the midfoot (otherwise known as the degree of instability or displacement). The sooner diagnosis can be established, the quicker the most appropriate and effective treatment can be implemented. You will be given information on the injury and the extent of the damage so that you can make an informed decision on your care. By having you at the forefront of the treatment decisions, your Physio will work with you to create personal goals for you to aim for and this will help direct your management further.
In mild-moderate cases, the patient will usually need to spend some time (usually around 6 weeks) in a non-weightbearing walking boot or a stiff walking cast to allow time for healing to take place. Whilst healing, your Physio will educate you on the injury and suggest methods of facilitating the healing process such as the RICE protocol – rest, ice, compression and elevation.
Once you have completed the recommended period of immobilisation, your Physio will discuss how you can gradually help yourself return to full function. You will be supported throughout your recovery so that your progress can be monitored and necessary adjustments in your treatment plan can be made.
A good Physiotherapy assessment will help the design of a personalised and progressive rehabilitation to produce the best possible outcomes, helping you to fully return to the activities important to you. Your Physio may also use hands on treatment techniques such as manual therapy and acupuncture to reduce pain, restore movement and support the healing processes taking place. Ongoing advice and support, coupled with advancement of your exercise plan will ensure you can continue to manage and minimise the likelihood of re-injury in the future.
In severe cases where there is structural instability, surgery is needed for those patients with displaced or unstable Lisfranc joint injuries in order to repair and stabilise this part of the midfoot. The surgeon may use small screws or a metal plate to help fix and stabilise the midfoot joints affected.
It is important to ensure that any suspected Lisfranc injury is appropriately investigated. It may be easier to identify a possible Lisfranc injury from high-speed trauma, but it may be more difficult to spot a possible Lisfranc injury after relatively low-level trauma. If not diagnosed and managed appropriately, an undiagnosed Lisfranc injury may lead to further complications. This may include earlier onset osteoarthritis of the midfoot, instability of the midfoot or difficulty with walking.
Despite this, research has shown that if identified and managed surgically, patients with Lisfranc injury can return to high level sport and activity, although time frames for a full return can range from 8 – 12 months.