Lis Franc Injury
What is a Lis Franc Injury?
A Lis Franc injury involves the displacement or fracture at the tarsometatarsal (Lisfranc) joint, where the metatarsals connect with the midfoot bones.
- Often due to high-impact trauma, twisting, or crush injuries
- Can be missed in initial examinations
Overview of the Condition
This injury may include ligament tears and bone fractures at the midfoot. Proper alignment is essential for foot stability and to prevent long-term complications.
Symptoms
- Midfoot pain and swelling
- Inability to bear weight or severe pain when doing so
- Bruising on the bottom of the foot is characteristic
Causes
High-energy injuries (car accidents, falls) or low-energy twists (sports) can disrupt the Lisfranc ligaments. Axial loading on a plantarflexed foot is a common mechanism.
Diagnosis
Weight-bearing X-rays often reveal misalignment at the tarsometatarsal joints. CT or MRI may be necessary for subtle injuries or to assess ligament damage.
Treatment Options
- NWB casting or boot for minor, non-displaced injuries
- Surgical fixation (screws, plates) if joints are displaced
- Long-term rehabilitation to restore foot function
- Possible fusion if severe damage or chronic instability
Conservative Management
Nondisplaced or stable injuries may heal with strict non-weight-bearing immobilization for 6-8 weeks, followed by gradual weight-bearing.
Rehabilitation Exercises
- Gentle range-of-motion exercises after immobilization
- Progressive strength training of foot and ankle muscles
- Balance and proprioception activities to stabilize the midfoot
When is Surgery Needed?
Any displacement or ligament disruption typically requires surgical fixation to restore the normal alignment of the tarsometatarsal joints and preserve foot function.
Surgical Procedures
- Open reduction and internal fixation (ORIF)
- Temporary or permanent fusion in severe cases
- Prolonged non-weight-bearing period post-operation
Anatomy Overview
The Lisfranc joint complex includes the articulation between the metatarsals and the cuneiforms/cuboid. The Lisfranc ligament is key to midfoot stability.
Affected Areas
- Tarsometatarsal joints of the midfoot
- Lisfranc ligament connecting medial cuneiform to base of the 2nd metatarsal
- Associated fractures of the metatarsals or cuneiforms
Frequently Asked Questions
| Question | Answer |
|---|---|
| Why is a Lisfranc injury often missed? | Subtle misalignment can be difficult to spot on standard X-rays. Weight-bearing views or advanced imaging are crucial for diagnosis. |
| How long does recovery take? | Recovery can range from 3-6 months or longer, depending on severity and whether surgery was performed. |
Prevention Strategies
- Wear appropriate footwear during sports
- Strengthen foot and ankle muscles
- Avoid high-risk impacts when possible