The Lisfranc Injury

You may not have heard much about the the Lisfranc complex in the foot or a Lisfranc joint injury. This is because they are often missed or misdiagnosed. However, this should be one of the first injuries ruled out when the midfoot is involved.

The Lisfranc joint complex involved the bones and ligaments that connect the midfoot and forefoot. There is no connective tissue however that holds the first and second metatarsals together. A twisting fall can break or shift these bones out of place. The midfoot is critical in stabilising the arch and during walking, so without the stability that the Lisfranc joint provides, it can be a serious issue.

Lisfranc injuries can vary from simple injuries with no separation (diastasis) between the bones to a complex injury that disrupts multiple joints, includes multiple fractures and has a large diastasis.

h47tw-9875i (1).png

Figure 1: Foot Pain - Lisfranc Injuries - Physio Frenchs Forest, Physio Macquarie Park

What causes a lisfranc injury?

Low energy injuries tend to happen in soccer or rugby where a player twists or falls over the top of their already flexed foot. High energy injuries from direct trauma such as a fall from a height.

Signs and symptoms of a lisfranc injury:

  • Mid-foot swelling and pain (as opposed to the side of an ankle with a classic ankle sprain)

  • Bruising on the bottom of the foot (highly suggestive of a severe Lisfranc injury) Unable to calf raise

  • Tender over the base of the 2nd metacarpal

 

How is a lisfranc injury diagnosed?

Can be made with a WEIGHTBEARING Xray. A non weight bearing Xray will not show any diastasis of the midfoot. MRI can also determine the extent of the soft tissue damage

 

What is the treatment of a lisfranc injury?

 Treatment can range from a period of non-weightbearing in a cast/moon boot up to a midfoot fusion whereby the bones are welded together so they can heal.

After a period of immobilisation or surgery, physiotherapy is required to regain strength, range of motion, strength and normal gait. Unfortunately, after a Lisfranc injury, athletes have been shown to reduce their performance by 20% in the first year following injury and never fully return to their top end speed.

Fun Fact: The Lisfranc joint is named after French surgeon Jacques Lisfranc who served in the Napoleonic army in the 1800s. When soldiers feet were stuck in the stirrups of their horses and dragged along, they would injure the joint and would need to be amputated along the Lisfranc joint.

See our expert Physiotherapy team at Frenchs Forest and Macquarie Park!

Reece Joneslisfranc injury, lisfranc physio, foot injury, physio