What is a Lisfranc Injury?
A Lisfranc injury is an injury to the mid-foot. It can be referred to as a Lisfranc fracture, Lisfranc injury, Lisfranc dislocation, Tarsometatarsal injury or simply midfoot injury. The injury is named after Jacques Lisfranc De St. Martin, a French surgeon who first described the injury in the year 1815.
The foot can be divided into three parts: the forefoot area which contains toes, the midfoot area consisting the small bones called navicular, cuboid and cuneiform. Third part is the hindfoot consisting of the talus (lower ankle) and the calcaneus (heel). These bones are held in place by connective tissues (ligaments) that stretch both across and down the foot. This cluster of bones and ligaments is known as the Lisfranc Joint Complex. A twisting fall can break or dislocate these bones out of place.
A Lisfranc injury is often mistaken for a simple sprain, especially if the injury is a result of a straightforward twist and fall. However, injury to the Lisfranc joint complex is not a simple sprain, it is a severe injury that may take months to heal and may require surgery in worse cases. Lisfranc injuries include ligament tears, fractures and dislocations of the bones and ligaments in the complex joint structure.
What Causes a Lisfranc Injury?
This is an injury that can be caused by an indirect or direct trauma. An example of a direct trauma is falling from a height or a forced hyperextension of the midfoot with a stable forefoot such as a someone stepping on the front of the foot while running. An indirect trauma is caused when a twisting of the foot happens after it gets caught on something.
What Are the Signs and Symptoms?
Whenever your foot gets injured due to varied reasons, check for the following signs and symptoms to know if you are suffering from Lisfranc injury:
- There may be bruising on both the top and bottom of the foot
- Bruising on the bottom of the foot is highly suggestive
- The top of the foot may be swollen and painful
- Pain may not decrease with the usual RICE treatment
- Pain worsens while standing or walking
How Can a Lisfranc Injury be Diagnosed?
The most appropriate scan is a comparison weight bearing X-ray and an MRI, if your physiotherapist suspects that you have a Lisfranc injury. Your physiotherapist is best equipped to assess and diagnose the condition.
How Can Physiotherapy Help?
Most common treatment is to secure the fractured and dislocated bones with either internal (screws) or external (pins) fixation. After immobilization, rehabilitation exercises will be prescribed. Physical therapy intervention begins shortly after immobilizing in both operative and conservative treatment. Interventions include strengthening to address post immobilizing atrophy, flexibility exercises, gait training and designing foot orthoses to help support the tarsometatarsal articulations. Other exercises are running on stairs, swimming, etc.
If you have experienced any direct or indirect trauma to your midfoot, please contact us for an examination and professional physical therapy sessions for better and faster recovery from Lisfranc injury.
