A Lisfranc injury, otherwise known as a midfoot injury, occurs when the bones in the midfoot are broken or fractured or if the ligaments supporting this area of the foot are torn. Read on to learn the following about Lisfranc injuries
Lisfranc Injury Background – What is it?
The Lisfranc injury was named after French surgeon James Lisfranc de St. Martin. He became interested in these injuries as a surgeon in Napoleon’s army, having treated a number of soldiers who injured the arch area on the top of the foot when they fell from their horse but their foot remained stuck in the stirrup.
The Lisfranc or midfoot region is the area in the middle of the foot where many small bones form the arch on the top of the foot. From this area, five long bones (metatarsals) extend to the toes. Each individual bone and ligament in this structure is very specialized, providing support and structure to both the joint and the foot. Injuries to this area of the foot can vary from torn ligaments to broken and/or dislocated bones, the severity of which depends on how many bones or ligaments are affected.
Causes of a Lisfranc Injury
The injuries to the midfoot region commonly occur during sports such as soccer or football. The foot becomes injured when someone simply stumbles over a foot, therefore imposing strain on the flexed Lisfranc joint. They can also occur as the result of stepping in a hole and falling forward. More traumatic injuries to this area can be the result of a large object falling on top of the foot or a car accident.
Lisfranc injuries are sometimes misdiagnosed as a simple sprain, but in fact, they can be quite serious and may require surgery and/or months to heal. Because many Lisfranc injuries are the result of a simple twist or fall, people who have them often try to “walk them off” as you would with a sprain.
Lisfranc Injury Symptoms And Diagnosis
Pain and/or swelling in the foot can be an indication of a simple sprain or a more severe Lisfranc injury. If rest, ice, and elevation (commonly referred to as “RICE”) do not reduce the pain or swelling in your foot within a day or two it is probable that you are suffering from a Lisfranc injury, which may include a fracture or ruptured Lisfranc ligament. If this is the case then it is very important to visit a doctor for an accurate diagnosis. Symptoms of Lisfranc injury include the following:
• Swelling or pain on the top of the foot.
• Bruising of the foot on both the top and bottom of the arch area. Bruising on the bottom of the foot is highly indicative of a Lisfranc injury.
• Sensitivity or pain when pressure is applied to the midfoot.
• Pain associated with movement of the toes or while standing and walking.
• Abnormal widening of the foot.
If your doctor suspects a fracture or tear in your Lisfranc joint, he/she will complete a foot exam as well as an x-ray. An x-ray will show a broken or dislocated bone in the midfoot but it may not show a ligament tear or rupture. If this is the case, then an MRI or CT scan will be ordered. Both will be used to determine the seriousness of the injury and to determine whether or not surgery is necessary.
Lisfranc injuries that do not result in a torn ligament or broken or dislocated bone in the midfoot often don’t require surgery. Treatment for a minor Lisfranc injury is very similar to that for a sprained ankle – rest, ice and, elevation. These steps will help manage both the pain and swelling of the foot.
A doctor may also recommend immobilization whereby the foot is placed in a cast or walking boot. In conjunction with the cast or boot, you will need to be non-weight bearing on the foot for approximately 6 weeks. This is a very important step in the rehabilitation of the foot and should not be taken lightly. If you are instructed to be non-weight bearing, then you will need crutches or a crutch alternative such as a knee scooter or iWALK2.0 (a hands free device allowing you to maintain day-to-day activity while keeping the foot elevated).
Once the swelling and pain has subsided, you will progress to weight bearing with a removable cast or boot. Physical therapy is generally the final phase of recovery. As your foot continues to become more stable, it is important to wear appropriate footwear, ensuring that your arch is sufficiently supported.
If the Lisfranc injury is more severe in nature, resulting in a fracture, dislocation, or torn ligaments, surgery may be the appropriate course of action. The goal of surgery is to realign the joints or bones and/or repair any tears. There are two primary types of surgery for this injury: internal fixation and fusion, both involving the realignment of bones or ligaments.
Internal fixation requires the bones to be held into place with plates, screws, or other hardware. The hardware may be temporary and will require removal at a later date, generally between 3 and 5 months, or permanent.
Fusion requires that the bones be “welded” into place to form a single solid piece. Any fusing material will be left in the foot permanently.
Lisfranc Surgery Recovery And Rehabilitation
As always, following doctors’ orders post-surgery is an essential aspect of injury recovery, and it is important to understand the benefits behind the post-surgery regimen your doctor prescribes.
• Rest, ice, and elevation will help reduce any swelling, allowing the body to recover more quickly.
• Non-Weight Bearing: Staying off of your foot for an extended period of time (generally 6 to 8 weeks, depending on the severity of the injury) will also give the foot time to recover.
• Avoid high impact activities such as running or jumping until your doctor grants permission (generally for 3-5 months after surgery, depending on when the surgeon removes the hardware in the foot).
As mentioned, following doctor’s orders during rehabilitations is the key to a full recovery. One of the most difficult rehabilitation scenarios is that of non-weight bearing. This can directly impede an active lifestyle, but you should take whatever steps necessary to get back to you optimum health. To help you on your way, you have several choices of mobility devices to help you adhere to a non-weight bearing restriction.
• Traditional Crutches: Crutches are a common device used to enable non-weight bearing activity. Although, common, traditional crutches are also among the most hated mobility devices as they can cause considerable pain to the user, and the physical limitations can out weigh the benefits. To operate crutches, the user puts strain on their underarms, arms, and wrists. Also, since both hands are needed to use crutches, doing simple tasks such as opening doors, going up stairs, carrying a glass of water , or manoeuvring in tight spaces becomes practically impossible. With this in mind, if you have a very active lifestyle and feel that the encumbrance of crutches will cause you to stray from the non-weight bearing mandate, then a crutch alternative may be appropriate.
• Knee Scooters: Crutch alternatives such as knee scooters are becoming increasingly popular. Knee scooters do allow the user to kneel on a platform which is preferred in rehabilitation, but the scooter itself is large, unwieldy and also requires the use of both hands to operate. Due to it’s size, the knee scooter can not be used in small spaces, on uneven ground, on stairs, and is difficult to transport.
• iWALK2.0: Another alternative, is the iWALK2.0 hands free and pain free crutch. The iWALK2.0 enables you to use your arms and hands while keeping your leg at a 90 degree angle on a padded platform, and weight off the injured foot, so that you can easily perform day to day tasks. This is important because lack of compliance (cheating through temporary or momentary weight bearing) can significantly increase recovery time or chance for re-injury. Unlike other mobility devices, the iWALK2.0 is also lightweight, making it easily manoeuvrable in tight spaces, up stairs, on uneven ground, and even in the shower. To learn more about the iWALK2.0, click here.
There isn’t a single injury that doesn’t cause some sort of temporary lifestyle change, but understanding the symptoms, treatment, and rehabilitation of a Lisfranc injury can be the key to a quick and hopefully permanent recovery. Seeking necessary medical advice and following your doctors orders can help you avoid unnecessary side effects, such as arthritis or extended downtime.
Often initially misdiagnosed, a Lisfranc injury is something you want to take seriously. Understanding your injury, its severity, and the course of action to take are your keys to the fastest possible recovery.