Lisfranc Injuries – what are they and what can you do about them?

side and aerial views of foot bones showing where lisfranc injuries can occur

Lisfranc injuries are common in sports such as AFL, NRL and soccer.

Because of this, they are often spoken about in the media.

It is referred to as a ‘dreaded’ injury as it takes a while to recover.

Today, we’re going to tell you exactly what a Lisfranc injury injury is and how we can treat it.

What is a Lisfranc injury?

A Lisfranc injury occurs when there is a dislocation or fracture between the 1st and 2nd toes and the midfoot.

It can result in tearing of the ligaments that connect the bones, which can also affect the cartilage between bones.

Lisfranc injuries are also referred to as midfoot sprains and tarsometatarsal (TMT) injuries.

There are 3 stages of Lisfranc injuries:

  • STAGE 1: Classed as a sprain of the Lisfranc ligament with no separation between the 1st and 2nd digits.
  • STAGE 2: Classed by a rupture of the Lisfranc ligament, as well as some separation between the 1st and 2nd digits.
  • STAGE 3: Classed by a rupture of the Lisfranc ligament and separation between the 1st and 2nd digits of more than 5mm.

 

What does a Lisfranc injury feel like?

Symptoms of a Lisfranc injury include swelling, bruising, and pain through the top of the foot at the forefoot.

The pain often worsens when weight bearing and can be quite severe.

Pain is generally at its worst during the propulsion/toe off phase of the gait – when the joint in question is under the most amount of pressure.

The pain can continue to worsen if not treated properly.

 

What can cause a Lisfranc injury?

A Lisfranc injury can occur with a simple injury involving twisting of the feet and falling or through impact when the toes are flexed.

It can also be caused by a direct force placed on the area, such as in a crush injury.

 

Who does it affect?

Lisfranc injuries are most common in athletes and rarely affect the general population.

 

How are Lisfranc injuries diagnosed?

Proper diagnosis of a Lisfranc injury is crucial in order to avoid a delay in treatment.

If you have been experiencing pain for more than 5 consecutive days in the area, it is important to consult a podiatrist as soon as possible.

If pain is present on the palpation of the site, as well as with simple range of motion tests, we may suspect a Lisfranc injury.

We will send you for an X-ray or MRI to confirm the diagnosis and determine the extent of the injury.

 

How is a Lisfranc injury treated?

Immediate and proper treatment is crucial to assist with the healing of a Lisfranc injury.

How the injury is treated is dependent on the severity of the injury, and can include:

  • The use of a CAM boot/Moon boot – This will help to completely offload the area and allow the structures to heal, whilst also keeping you mobile.
  • A strengthening program – This will involve simple exercises to help increase the strength of the muscles within the feet. It will also target muscles in the lower leg, such as the calves.
  • Orthotics therapyOrthotics can assist with redistributing pressure through the feet and allowing the feet to function efficiently in proper alignment.
  • Padding and strapping – Offloading the injured site with the help of padding and strapping can assist with pain relief.

 

Is surgery a treatment option for a Lisfranc injury?

In some cases, a referral for surgery is necessary if the injury to the Lisfranc joint is severe.

It is often indicated when there is significant damage to both the Lisfranc ligament and the adjoining bones, including the medial cuneiform and 2nd metatarsal.

The goal of surgery is to realign the joint and restore its function to as close to its pre-injury state as possible.

Surgery is typically only required when there is instability within the Lisfranc joint, meaning that some Lisfranc injuries can heal with conservative treatments rather than surgery.

 

How is the Lisfranc joint surgically repaired?

There are 2 surgical options to treat a Lisfranc injury:

Open reduction and internal fixation (ORIF)

This involves the use of wires, plates and screws to realign and restore the structural integrity of the joint.

It requires an incision on the top of the foot between the 1st and 2nd metatarsals to access the Lisfranc joint easily.

Depending on the severity of the injury, a second incision may be required closer to the 3rd or 4th metatarsals. The number of screws and plates that are used will depend on the extent of the injury. There is typically a screw known as the “home run screw”, which runs between the medial cuneiform bone and the 2nd metatarsal which mimics the orientation of the Lisfranc ligament.

Fusion

This involves the medial cuneiform and the 2nd metatarsal being fused together.

This type of surgery is used when the joints cannot be repaired under ORIF and it causes them to heal as a single structure.

How quickly will I have surgery to repair the Lisfranc joint?

Surgery is typically performed 1-2 weeks post injury. This allows for the reduction of swelling and inflammation to essentially make the surgery easier to perform. Therefore, it is important that if you suspect you have sustained a Lisfranc injury that you immediately follow the RICE principle of rest, ice, elevation and compression. Spending as little time on your feet and reducing the amount of pressure on the area to protect it from further injury can also help the surgery to run as smoothly as possible.

 

Risks of Lisfranc surgery

As with any surgery, there are risks associated. These can be discussed with your surgeon prior to surgery. These risks can include:

  • Reaction to anaesthesia,
  • Infections
  • Damage to surrounding nerves and blood vessels
  • Hardware failure
  • The development of osteoarthritis in the joint, particular in fusion surgeries.

 

Will the screws and plates be removed?

In the case of an open reduction and internal fixation procedure (ORIF), the hardware is typically removed 3-6 months after surgery. It is not usually removed when there has been a fusion, unless it is causing pain or discomfort.

 

What does rehabilitation after Lisfranc surgery involve?

Rehabilitation after a Lisfranc surgery takes longer to heal on average when compared to other structures. This is due to its location and the amount of force it must withstand, even in day to day activities.

Some studies suggest that recovery post surgery can be anywhere between 3-5 months, potentially longer if it was a particularly severe injury.

After surgery, you will be placed in a cast or moon boot for at least 6-8 weeks with minimal weight bearing allowed. For some other surgeries, weight bearing can begin much earlier, with the research suggesting that there needs to be more studies conducted to assess if this is an option for those following Lisfranc surgery.

Once you come out of the moon boot, it is best to wear rigid shoes that provide support to the Lisfranc joint and reduce the amount of pressure that is placed on the joint. In most cases, the use of orthotics is essential to allow the joint to heal and function properly.

A strengthening program is typically begun even whilst in the moon, involving simple range of motion exercises when seated, slowly progressing to weight bearing exercises. The program will also take into account your activities or sports and eventually involve specific exercises for these.

 

If you’re experiencing pain similar to what we’ve discussed today, or any pain or discomfort in your feet and/or lower limbs, come see us at Watsonia Podiatry. You can book an appointment with us by calling us on (03) 9432 3689 or online here.