LISFRANC INJURY
(BROKEN FOOT)
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related talks: broken foot (talus fracture, another type); broken foot (jones fracture); broken foot (heel bone fracture); broken ankle (classic type); low ankle sprain; high ankle sprain
What is a Lisfranc Injury?
A Lisfranc injury is a bone and/or ligament injury to the midfoot.
It usually occurs when someone accidentally twists their foot by stepping off a curb or into a pothole (a force is transmitted up the toes while the foot is flexed downward, "plantar-flexed").
There are strong ligaments (called Lisfranc ligaments) which connect the metatarsal bones (you have one for each toe) with the midfoot bones (called the cuneiform bones). The connection of these bones maintains the arch of our foot, and a sprain or tear to these ligaments disrupts the normal foot architecture. The foot is unstable. This instability is painful, prevents walking, and if not corrected will cause arthritis in the future.
How is a Lisfranc Injury diagnosed?
A Lisfranc injury is suspected when a patient complains of midfoot pain after a traumatic injury. The injured foot will be swollen, possibly bruised, and very tender in the midfoot region. Instability of the foot can be tested by stressing the metatarsal bones to look for excessive motion (which would normally be prevented by an intact ligament). X-rays are an important part of diagnosis. Sometimes there are fractures associated with a Lisfranc injury, however the x-ray is most useful for looking at the alignment of the metatarsal bones to see if the architecture is maintained with and without weight bearing. There are specific parameters that doctors can look at to determine if the ligament is intact. In general the space between the metatarsal bones widen as , and the metatarsal bones slide upward and to the outside (lateral). CT scans of the foot are often ordered to get a better view of the injury (a CT scan is many many x-ray slices of the foot, from three different angles, so it provides a lot more detail about the injury).
How is a Lisfranc Injury treated?
Treatment of a Lisfranc injury almost always requires surgery.
The only indication for nonsurgical treatments is if the metatarsal bones dont move during weight-bearing x-rays, which indicates that the ligaments were only sprained. In this case, the foot is placed into a fiberglass cast for 8 weeks to allow time for the ligaments to heal.
In most cases however, the bones will move out of alignment which indicates the midfoot is unstable and requires surgery to allow normal walking in the future.
Surgery consists of using plates and screws to hold the foot bones in their normal position, or to fuse the injured midfoot joints. Both surgeries have been successful in preventing pain and minimizing future arthritis.
What is the long term outcome?
The patients typically do ok. Although they are at increased risk for post traumatic arthritis in the midfoot.
There is debate whether its better to fuse the injured joints of the foot, or to repair them and try to maintain joint mobility. Arthrodesis appears to be as good if not better at restoring function to that foot, and it lowers the risk of repeat surgery (to remove painful screws). This is particularly true in Lisfranc injuries due to ligament injuries.
Reference
1) Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. JBJS 2006; 88: 514-20. full article. better postop fxn, fewer revision sx in arthrodesis.
2) Henning JA et al. Open reduction internal fixation versus primary arthrodesis for Lisfranc injuries: a prospective randomized study. Foot Ankle Int 2009; 30: 913-22. full article. equal fxn, fewer revisions with arthrodesis medial/middle column.
3) Kuo RS et al. Outcome after open reduction and internal fixation of Lisfranc joint injuries. JBJS 2000; 82: 1609-1618. full article. anatomic orif improves fxn, ligamenous injuries do worse.
4) Watson TS, Shurnas PS, Denker J. Treatment of Lisfranc joint injury: current concepts. JAAOS 2010; 18: 718-28. full article. review.
5) Komenda GA et al. Results of arthrodesis of the tarsometatarsal joints after traumatic injury. JBJS 1996; 78: 1665-76. full article. complications of surgery.
6) Thompson MC, Mormino MA. Injury to the tarsometatarsal joint complex. JAAOS 2003; 11: 260-67. full article. review.