What Is a Lisfranc Injury?
The Lisfranc joint complex is located in the midfoot, where the long bones
leading to the toes (metatarsals) connect to the bones in the arch (tarsals).
A Lisfranc injury involves damage to the bones and/or ligaments in this area,
ranging from a simple sprain to severe fracture-dislocation.
These injuries are named after Jacques Lisfranc, a surgeon in Napoleon's army
who described amputations through this joint. Today, proper treatment aims to
preserve the foot while restoring function.
Lisfranc injuries are frequently misdiagnosed as simple sprains because the
initial X-rays may appear normal. This is why expert evaluation is so important.
Types of Lisfranc Injuries
- Sprains: Ligaments are stretched but bones remain aligned (most commonly missed)
- Fractures: Bones in the midfoot are broken
- Dislocations: Bones are pushed out of their normal position
- Fracture-Dislocations: Combination of fractures and dislocations
How They Happen
- Low-Energy Injuries: Twisting the foot while it's planted, missing a step, falling with the foot pointed downward
- High-Energy Injuries: Motor vehicle accidents, falls from heights, crush injuries
- Sports: Football, soccer, and other sports with potential for foot twisting
Symptoms
- Pain and swelling on the top of the midfoot
- Bruising on the top and bottom of the foot (plantar ecchymosis is a key sign)
- Pain that worsens when standing or walking
- Inability to bear weight in severe cases
- Pain when twisting the midfoot
- Widening of the foot
Important: Bruising on the bottom of the foot is a red flag for
Lisfranc injury and warrants immediate evaluation.
Diagnosis
- Physical Examination: Tenderness over the Lisfranc joint, pain with midfoot stress testing
- Weight-Bearing X-rays: Critical for detecting subtle injuries that appear normal on non-weight-bearing films
- CT Scan: Provides detailed images of bone alignment and fracture patterns
- MRI: Evaluates ligament damage and subtle injuries
Treatment Options
Non-Surgical Treatment
Non-surgical treatment is only appropriate for stable injuries without
displacement:
- Immobilization: Non-weight-bearing cast or boot for 6-8 weeks
- Gradual Weight-Bearing: Slowly increasing activity as healing progresses
- Physical Therapy: Restoring strength and mobility
- Follow-up Imaging: To ensure bones remain properly aligned
Surgical Treatment
Most Lisfranc injuries with any displacement require surgery to restore
alignment. We use fixation systems from
Stryker
and Enovis.
Options include:
- Internal Fixation: Screws and/or plates to hold bones in proper position
- Fusion: Permanently joining bones together (may be recommended for severe injuries or failed fixation)
- Hardware Removal: Screws may need to be removed after healing
Recovery and Long-Term Outlook
Recovery from a Lisfranc injury takes time and patience:
- Non-weight-bearing period: 6-8 weeks typically
- Transition to weight-bearing: 8-12 weeks
- Return to normal activities: 4-6 months
- Full recovery: Up to 1 year
Even with proper treatment, some patients may develop post-traumatic arthritis
in the midfoot. This is why accurate diagnosis and appropriate treatment from
the start are so important.