Lisfranc Fractures

In recent years there have been a significant number of professional and collegiate athletes that are sidelined for a significant amount of time, often for the remainder of the season, due to a foot injury. This injury is called a Lisfranc injury at occurs in the midfoot. Players that have experienced this injury over the last two years include Matt Schaub quarterback for the Houston Texans, Brandon Jenkins defensive end for the Florida State Seminoles, Dewight Freeney

The midfoot is the middle region of the foot, where small bones form the arch of your foot. From these bones, the metatarsals extend to the toes. The bones are held in place by ligaments that stretch both across and down the foot. However, there is no connective tissue holding the first metatarsal to the second metatarsal. A twisting fall can break or shift (dislocate) these bones out of place.

Lisfranc (midfoot) injuries result if bones in the midfoot 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 Lisfranc injury is often mistaken for a simple sprain, especially if the injury is a result of a straightforward twist and fall. However, injury to the Lisfranc joint is not a simple sprain that should be simply “walked off.” It is a severe injury that may take many months to heal and may require surgery to treat.

The midfoot is critical in stabilizing the arch and in walking (gait). During walking, the midfoot transfers the forces generated by the calf muscles to the front of the foot.

The Lisfranc joint complex has a specialized bony and ligamentous structure, providing stability to this joint.

These injuries can happen with a simple twist and fall. This is a low-energy injury. It is commonly seen in football and soccer players. It is often seen when someone stumbles over the top of a foot flexed downwards.

More severe injuries occur from direct trauma, such as a fall from a height. These high-energy injuries can result in multiple fractures and dislocations of the joints.

The treatment of a Lisfranc injury is dependent on the severity of the injury and whether fracture has occurred or just a sprain. If there are no fractures or dislocations in the joint and the ligaments are not completely torn, nonsurgical treatment may be all that is necessary for healing. A nonsurgical treatment plan includes wearing a non-weightbearing cast for 6 weeks. You must be very strict about not putting weight on your injured foot during this period. This then progresses to weightbearing in a removable cast boot or an orthotic. Your doctor will want to follow up with you regularly and take additional x-rays to make sure your foot is healing well. In the course of follow up, if there is any evidence that the bones in the injured joint have moved, then surgery will be needed to put the bones back in place.

Surgery is recommended for all injuries with a fracture in the joints of the midfoot or with abnormal positioning (subluxation) of the joints. The goal of surgical treatment is to realign the joints and return the broken (fractured) bone fragments to a normal position. In most cases the bones then need to be held together were screws or other forms of internal fixation. Occasionally the screws may need to be removed on the later date.

If you injure your foot it’s important to have it evaluated as soon as possible. Delay and treatment can result in arthritis and other long-term painful conditions.