Lisfranc’s Injury

A Lisfranc’s injury is becoming a common term among football fans with Indianapolis Colts defensive end, Dwight Freeney, sidelined by this injury.lisfranc’s joint

The Lisfranc joint is actually a group of joints where the long bones in the foot (metatarsals) meet the midfoot (tarsal bones). These joints are held together by a series of ligaments on the top and bottom of the foot. The lisfranc’s ligament connects the base of the 2nd metatarsal to the 1st cuneiform and is the strongest ligament of the group.

A Lisfranc’s injury is the rupture of the lisfranc’s ligament and the associated dislocation of the lisfranc’s joint. The rupture of the ligament may be accompanied by metatarsal base fractures (breaks in the long bones in the foot). This injury is called a Lisfancs fracture-dislocation. The injury is often misdiagnosed as a simple foot sprain because the changes on X-ray can be very subtle.

lisfrancs injury on X-ray

Lisfranc’s injuries are not common, with an incidence of 1 in every 55,000 people. Only 0.02% of all fractures are lisfranc’s fractures. Yet, many speculate that this incidence is so low because these injuries are commonly misdiagnosed. The changes on X-ray can be very subtle and many times it’s necessary to X-ray both feet for comparison or do stress views. Since the bases of the metatarsal bones overlap on X-ray, it can be difficult to see fractures in this area. In many cases a CT scan is ordered to better visualize the metatarsal bones.

This injury was originally known to occur when an individual fell off a horse and the forefoot was caught in the stirrup, causing a separation between the front of the foot and the midfoot. The injury can also occur in car accidents when the ball of the foot is on the pedal and the impact of the crash forces the front of the foot up, rupturing the lisfranc’s ligament. Other mechanisms include a crush injury – a direct force to the foot – and in football, being tackled from behind while the foot is planted. The force from the tackle puts a tremendous force through the midfoot, causing rupture of the ligament, dislocation of the forefoot on the midfoot and possible breaks in the metatarsal bones.

closeup of lisfranc’s injury

Diagnosis is important because injuries which go without treatment can result in chronic midfoot instability and future arthritis. Even with treatment, there are chances for post-traumatic arthritis in the midfoot. The treatment depends on the severity of the injury, either with casting and crutches for minor Lisfranc’s injuries or surgical treatment involving screw placement and a long rehabilitation period, for more severe Lisfranc’s injuries.


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7 Responses to “Lisfranc’s Injury”

  1. on 29 Nov 2007 at 4:14 pm smokeybear

    The foot is a lot more complex than I would have thought…. and Seinfeld made fun of podiatrists.

    The way it’s described, it’s amazing that anyone could actually ever recover from this. The human body is pretty amazing… as well as the accompanying surgery and treatment.

  2. on 26 Aug 2008 at 1:43 pm Laura Sellers

    I think I may have one of these fractures. It started with a “freak” accident of dropping a board on top of my foot over a year ago. I wore a surgical boot several months to help the injury, a hairline fracture, heal. About 3 months ago, I noticed a bony bump on the bottom/right side of my right foot. I went back to the podiatrist/surgeon who had done plantar fasciotomy on that foot and the other foot, as well, and had x-rays & MRI done. He said it looked like a dislocated bone and referred me to another orthopedic doctor. I go to him tomorrow. Since it is so unusual and atypical of the places in the foot to have this kind of injury, I am wondering if this might be a Lisfranc injury. Fortunately, I have not had any major pain, which the podiatrist thought unusual, also. After reading up on this, and if it turns out to be the diagnosis, I wonder what the treatment will be. The podiatrist thought the bone could be shaved, but he thought it would be a shame to have to do that to a perfectly good bone. I will try to update on my new doctor’s findings.

  3. on 20 Feb 2010 at 6:56 am Deb

    I am 2 years from surgical reduction. Still…alot of pain…all of the time. Staying off the foot makes no difference, pain is the same.

    Offered fusion of bones..reseaarch indicates this often does little to reduce daily pain.

    This is not an injury you ever recover from. My limitations grow more each month.

    In the process of selling my two story home, no stairs for me!

    Lot of time and money spent on medical NOTHING!

    Just done..could not be more done!

    Do not let a doctor give you the illusion that you will recover from a lisfranc fracture…you do not. They will make alot of money. You will miss alot of work and your life with no effective
    treatment.

  4. on 31 May 2010 at 10:15 am dana

    i injured my rt foot about 7 years ago i first went to a hostpital they told me i spained my anckle put me in a air cast said keep walking ,and use ice i did what the doctor ordered .well i never experianced so much pain and swelling to make a long story short. with in a nine month span i visited 9 doctor, all but one misdionosed me. they told me i had arthritis, gout, badly spained anckle,bone cancer, after romoving some bone and tested that was false,one orthapedic said he was baffled finaly one doctor said lisfrancs he did surgury and fused part of my foot but the original pain never went away . to this day i still have severe pain and bad swelling he should have fused all five bones at the time of the second surgury.my life has totaly changed ive been totaly disabled and i live with bad pain and swelling daily im seeking a specialist interested in helping me with this problem. a week ago i saw a doctor that took a bone scan a gave me a shot in my foot and said he want fuse the rest of my foot but i would probley be in as much pain and swelling if any one has a new procedure please contact .

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