Lisfranc Fracture

A Lisfranc injury refers to damage to the tarsometatarsal (TMT) joint complex — where the metatarsal bones meet the tarsal bones (mainly the cuneiforms and cuboid) in the midfoot. It can involve:

1. Ligament injury (Lisfranc ligament between the medial cuneiform and 2nd metatarsal base),
2. Fracture,
3. or a fracture–dislocation of the midfoot.

These injuries are serious but often missed, leading to chronic pain and deformity if untreated.


Causes:

1. Direct Causes:
    (a.) Crush injury: Heavy object falling on the foot.
    (b.) Motor vehicle accidents: Foot trapped on pedal during impact.
2. Indirect Causes (more common):
     Axial load on a plantarflexed (pointed-down) foot, e.g.:
         - Twisting the foot while stepping down stairs or off a curb.
         -Sports injuries (football, horseback riding, windsurfing).
         -Falls from height.
         -Essentially, a force that twists or compresses the midfoot while the forefoot is fixed can disrupt the Lisfranc joint.

Symptoms

  • Midfoot pain and swelling, especially on the top of the foot.
  • Pain worsens when standing or walking, especially pushing off the foot.
  • Bruising on the sole of the foot (plantar ecchymosis) — a key diagnostic sign.
  • Inability to bear weight on the affected foot.
  • Visible deformity (if dislocation present).
  • Tenderness over the tarsometatarsal joints on palpation.
3. Treatment:
    (a.) Non-Surgical (Conservative):
         Used for stable, non-displaced injuries (no gap between metatarsals).
         -Immobilization: Cast or CAM (controlled ankle motion) boot for 6–8 weeks.
         -Non-weight-bearing for 6 weeks → gradual return to weight-bearing.
         -Follow-up X-rays to ensure no displacement develops.
         -Physical therapy for range of motion and strengthening after immobilization.

    (b.) Surgical Treatment:
         Indicated for:
         -Displaced fractures/dislocations.
         -Instability (2 mm gap between 1st and 2nd metatarsals).
         -Fracture–dislocations with midfoot collapse.

    (c.) Procedures include:
         1. Open Reduction and Internal Fixation (ORIF):
         -Screws or plates realign and stabilize the Lisfranc joint complex.
         -Hardware usually removed after 3–6 months.

         2. Primary Arthrodesis (fusion):
         -Fuses affected joints, often for purely ligamentous injuries or severe damage.
         -Provides long-term stability and reduces post-traumatic arthritis risk.