Lisfranc injuries

What is a Lisfranc injury?

Anatomy of the Lisfranc Joint

The Lisfranc joint is located in the middle of the foot and plays a crucial role in the stability and mobility of this area. It is not a single joint, but several tarsometatarsal joints collectively known as the Lisfranc joint line. The integrity of this joint is essential for transmitting forces during walking or running. A good understanding of foot anatomy is indispensable for understanding lesion impacts in this area. We can separate the Lisfranc into two parts with :

• The lateral Lisfranc, which is mobile, including the cuboid-metatarsal joints of the fourth and fifth metatarsals.
• The medial Lisfranc including the cuneo-metatarsal joints of the first, second, and third metatarsals.

Common Causes of Lisfranc Injuries

The causes of a Lisfranc injury are varied, but certain activities significantly increase the risk of injury. Among them, sports where the foot can twist or be crushed are particularly high-risk. Here are some examples :

• High-impact sports : Football, rugby, and American football, where the foot can become blocked while undergoing a twist, are high-risk activities.
• Fall accidents : A fall from a height where the foot lands improperly can cause a Lisfranc injury.
• Everyday activities : A misstep or a poorly landed jump can also be the cause of this injury.
• Road accidents : Road accidents are a major cause of complex Lisfranc injuries, especially in two-wheeler accidents.

Symptoms and diagnosis of Lisfranc injuries

Identify the symptoms of a Lisfranc injury

Lisfranc injuries are osteoarticular and ligamentous injuries, which clinically present as a swollen, painful foot. The presence of a swollen, painful post-traumatic foot with X-rays considered normal should lead to a CT scan to look for Lisfranc injuries. Early recognition is key for effective treatment and to avoid long-term complications. Here are the main symptoms to watch for :

• Severe pain in the middle of the foot, worsened by walking or pressure on the foot.
• Noticeable swelling in the same area, often accompanied by a large hematoma with significant skin tension.
• Difficulty walking or bearing weight on the injured foot, which may result in limping.
• In some cases, a visible deformity of the foot may occur if the fractures are displaced or if the joints are dislocated.

These symptoms can vary depending on the severity of the injury, ranging from mild pain to a complete inability to walk.

Diagnostic methods for Lisfranc injuries

The diagnosis process usually begins with a thorough physical examination, where the doctor evaluates foot pain, tenderness, swelling, and deformity. However, to confirm the diagnosis and determine the extent of the injuries, several imaging tests may be necessary :

• X-raysof the foot : They are essential for visualizing fractures or displacement of the foot bones. They allow an assessment of the extent of the injuries, fracture displacement, and dislocations. Foot X-rays considered normal in the emergency room do not rule out Lisfranc injuries, and additional imaging will then be needed.
• Magnetic resonance imaging (MRI) : It provides better assessment of ligament and soft tissue injuries, which are often not visible on X-rays. Subtle Lisfranc injuries may present as cartilage lesions visible on MRI. Bone edema can also be analyzed.
• Computed tomography (CT scan) : It is used to obtain detailed images of bone structures, particularly useful in complex cases or when results from other tests are inconclusive. The CT scan is prescribed when a Lisfranc injury is suspected, especially with normal foot X-rays. The CT scan allows analysis of the bone structure, and assessment of fracture displacement, particularly intra-articular displacement.

These diagnostic methods not only confirm the presence of a Lisfranc injury but also help plan the most appropriate treatment depending on the severity and specifics of each case.

Available treatments for Lisfranc injuries

Non-surgical treatments

Lisfranc injuries can vary in severity, ranging from so-called subtle injuries to fracture-dislocations with possible skin breach. Not all injuries require surgical intervention. For less severe cases, several non-surgical options may be effective :

• Immobilization : Wearing a walking boot or cast can help protect and stabilize the foot, thus promoting ligament healing and bone consolidation.
• Medication : Non-steroidal anti-inflammatory drugs may be prescribed to reduce inflammation and relieve pain.
• Rehabilitation : Foot rehabilitation is crucial to restore function and strength after a period of immobilization, especially following a Lisfranc injury which tends to significantly diminish foot muscle mass.

Surgical options for Lisfranc injuries

In cases where the injury results in significant joint instability or when non-surgical methods are insufficient, surgery may be necessary. Surgical options include :

• Reduction of joint displacements and dislocations : Surgery may involve repairing and realigning the bones and ligaments of the foot.
• Fixation or osteosynthesis : Screws or plates can be used to hold the foot's structures in the correct position.
• Fusion or foot arthrodesis : In certain cases, a fusion of the bones forming the Lisfranc joints is necessary to achieve sufficient stability.

For surgical intervention, it is essential to consult a surgeon specialized in foot surgery who has expertise in treating complex foot injuries, including those of the Lisfranc.

Prevention and long-term management

Prevention tips to avoid Lisfranc injuries

Preventing Lisfranc injuries starts with understanding high-risk activities and appropriate behaviors to protect your feet. Here are some practical tips:

• Choose the right shoes: Opt for shoes that offer adequate support, especially when engaging in sports activities.
• Protecting ankles and feet on two-wheelers: Even in summer and during periods of high heat, it is essential that two-wheeler riders have their ankles and feet protected by appropriate shoes or boots.
• Muscle strengthening: Incorporate exercises to strengthen the muscles of the foot and ankle into your training routine to improve stability and muscle endurance.

Long-term follow-up and rehabilitation

Once a Lisfranc injury has occurred, long-term follow-up is often necessary for optimal recovery. Foot rehabilitation plays a key role in this process. Here are some key steps:

• Regular consultation with a specialist: Follow your doctor's recommendations and schedule regular visits to monitor your progress.
• Personalized rehabilitation program: Work with physical therapists to develop a rehabilitation program tailored to your specific needs, aiming to restore function, joint mobility, and muscle strength.
• Patience and perseverance: Recovery can be lengthy. Respect the process and fully commit to your rehabilitation plan to achieve the best possible results.