LISFRANC (MIDFOOT) FRACTURE

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. 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 most common symptoms of Lisfranc injury include:

1. The top of foot may be swollen and painful.
2. There may be bruising on both the top and bottom of the foot. Bruising on the bottom of the foot is highly suggestive of a Lisfranc injury.
3. Pain that worsens with standing or walking. The pain can be so severe that crutches may be required.

The discoloration on the bottom of the foot is very suggestive of a Lisfranc injury. Imaging Tests X-rays Broken bones (fractures) and the position of the bones can be seen in an x-ray picture. An x-ray also can show the alignment of the Lisfranc joint. Any change in the normal joint may suggest injury to the ligaments. Weight bearing stress x-ray, showing a widening of the joint.
Magnetic resonance imaging (MRI) scans. These studies can create better images of soft tissues like the tendons. This test is not required to diagnose a Lisfranc injury. It may be ordered in cases where the diagnosis may be in doubt.
Computerized tomography scan (CT) scan. These scans are more detailed than x-rays and can create cross-section images of the foot. This test is not required to diagnose a Lisfranc injury. Because a CT scan will help evaluate the exact extent of the injury and the number of joints that have been injured, may order this test to help plan surgery.

Treatment
Treatment for a Lisfranc injury depends on how severe the injury is.

Nonsurgical Treatment
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-weight bearing cast for 6 weeks. You must be very strict about not putting weight on your injured foot during this period. This then progresses to weight bearing in a removable cast boot or an orthotic. Regularly follow up 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.

Surgical Treatment
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.

Rehabilitation.
After either surgery (reduction or fusion), a period of non weight bearing for 6 to 8 weeks is recommended in a cast or cast boot. Weight bearing is started while the patient is in the boot if the x-rays look appropriate after 6 to 8 weeks. The amount of weight a patient can put on their foot, as well as the distance the patient is allowed to walk, is at the surgeon’s discretion. Impact activities, such as running and jumping, should be avoided until the hardware has been removed. Despite excellent surgical reduction and fixation, arthritis may occur from the damage to the cartilage. This may result in chronic pain and may require fusion in the future.