Lisfranc Fractures

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Fractures-1.jpgLisfranc (midfoot) injuries result if bones in the mid-foot are broken or ligaments that support the midfoot are torn. The severity of the injury can vary from simple to complex, involving many joints and bones in the mid-foot.

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 is not a simple sprain that should be simply "walked off."

It is a severe injury that may take many months to heal and may require surgery to treat.

CAUSES

Lisfranc fractures often occur after a fall with a rotating, or twisting motion. Athletes who are on their toes a great deal can have this injury.  It doesn’t take a lot of force to have a Lisfranc fracture, so they can occur with people of all ages.

DIAGNOSIS

The doctor will perform an examination and probably order an x-ray.  Symptoms that indicate a Lisfranc fracture include:

• Bruising along the bottom of your foot suggesting a ligament tear.
• Tenderness to pressure (palpation) along the midfoot
• Pain with a stress examination of the midfoot
• Pain with a "piano key" test: grasping or plunking the toes
• Single limb heel rise or rising to “tippy toes”

SYMPTOMS

Patients often notice that the top of the foot can be swollen and painful.  Bruising can occur on the top and the bottom of the foot. Bruising on the bottom of the foot - in the arch area - is highly indicative of a Lisfranc injury. Because of the bruising and swelling, it can be very painful to put weight on the foot.

TREATMENT

Treatment for a Lisfranc fracture depends on how severe the injury is.

NONSURGICAL TREATMENT

If there are no fractures or dislocations in the joint and the ligaments are not completely torn, nonsurgical treatment may be all that is necessary for healing. A nonsurgical treatment plan includes wearing a non-weight bearing cast for 6 weeks. We will then order weight bearing in a removable cast boot or an orthotic.

SURGICAL TREATMENT

The goal of surgical treatment is to realign the joints and return the broken bone fragments to a normal position. The bones are positioned correctly and held in place with plates or screws. Because the plates or screws will be placed across joints that normally have some motion, some or all of this hardware may be removed at a later date. This can vary from 3 to 5 months after surgery, and is at the surgeon's discretion.