Lisfranc’s Fracture Dislocation Injury
Lisfranc’s joint is the name given to the junction between the heel of the foot and the mid foot. It consists of five small joints formed between the bones of the heel (tarsal bones) and the five metatarsal bones of the midfoot. Injury to this joint is quite rare and is referred to as Lisfranc’s injury. It can be a simple sprain, a fracture, or even a dislocation of the joint (Lisfranc fracture-dislocation).
Lisfranc’s injuries or Lisfranc’s fracture-dislocations account for less than 1% of total fracture injuries. These injuries are either sports-related or caused by industrial or motor vehicle accidents. In the case of the former, the impact is low and results in less damage, but in the case of accidents often there is significant damage to both the bones and soft tissue structures.
These injuries can result from direct trauma to the foot, such as a heavy substance falling on the mid foot or the foot hitting with high force against a hard substance or due to indirect trauma, i.e., twisting the foot, such as falling from horseback with the foot caught in the stirrups.
Symptoms are the same as that of any sprain or fracture.
There is pain in the mid foot region, especially when standing or when pressure is applied
If the injury is severe, it becomes very painful to put weight on the affected foot
There is swelling in the area which makes the foot appear abnormally wide
A bruise forms at the site – it may appear below in the arch or on the upper surface of the mid foot. This bruise is quite diagnostic of Lisfranc’s injury.
Rarely, when there is dislocation of the joint, there would be some visible bone deformity
Lisfranc’s injuries are often misdiagnosed. The swelling of the foot and the bruise are important hints for its diagnosis.
There is pain when the area of the Lisfranc’s joint is touched or pressed.
The person is unable to stand on his or her toes.
Bending the foot upward, while keeping the heel fixed, aggravates pain.
Radiographs are taken in the weight-bearing position, i.e. while a person is standing. In some cases, radiographs may appear normal, so in some cases an MRI or a bone scan is advised.
When there is a sprain or a non-dislocated or stable fracture (in which the fractured bone holds its place), the treatment involves immobilizing the foot and using painkillers.
For immobilization, a non-weight-bearing leg cast is applied for about four to six weeks or until the symptoms subside. This protects the joint from getting destabilised by any pressure or weight.
Once the cast is discarded, it is advisable to put pressure on the foot gradually. It is better to shift to a well-contoured cast that allows gradual weight bearing. If there is any pain, one has to revert to immobilization.
Later on, the use of an insole device to support the midfoot region is advised.
If there is a dislocated or an unstable fracture, surgery is the best option. The fractured bones or dislocated joints are aligned and stabilized using bone screws.
Lisfranc injuries occur rarely but, if not treated properly, they may result in chronic disability. Success of the treatment lies in early diagnosis and proper treatment.