Lisfranc Fracture

Lisfranc fractures are serious injuries in the midfoot area. They affect the tarsometatarsal joint. This joint links the midfoot and forefoot bones. A fracture or dislocation here can cause a lot of foot pain and make it hard to walk.

Lisfranc fractures are not common but can really affect your life. They often happen from big accidents like car crashes or falls. Sports and work accidents can also cause these injuries.

It’s important to know the signs of a Lisfranc fracture to get help fast. Waiting too long can lead to long-term pain and problems. We’ll look at what causes these fractures, their symptoms, how they’re diagnosed, and treatment options. We’ll also talk about how to prevent and recover from them.

What is a Lisfranc Fracture?

A Lisfranc fracture is a serious injury to the Lisfranc joint in the midfoot. This joint is key for midfoot stability and helps distribute weight when walking or standing.

The injury is named after Jacques Lisfranc de St. Martin, a French surgeon from the 1800s. Lisfranc fractures can cause bone fractures, ligament damage, or both. This leads to a lot of pain and makes it hard to move.

Anatomy of the Lisfranc Joint

Knowing the anatomy of the Lisfranc joint helps us understand the injury’s impact. The joint includes:

The bones and ligaments work together to keep the midfoot stable. This is important for activities that involve weight-bearing.

Types of Lisfranc Fractures

Lisfranc fractures are divided into three main types:

1. Fracture-dislocation: This is the most severe injury. It involves both bone fractures and ligament damage, causing the joint to become unstable and misaligned.
2. Ligamentous injury: Damage to the Lisfranc ligament and other ligaments can happen without bone fractures. This also affects the joint’s stability.
3. Bony fracture: Fractures of the metatarsals or cuneiforms can occur without significant ligament damage. Even so, they can disrupt the joint’s integrity.

It’s important to know the type of Lisfranc fracture to choose the right treatment and estimate recovery time.

Common Causes of Lisfranc Fractures

Lisfranc fractures often happen due to trauma from car accidents or falls from high places. The impact can break or dislocate the midfoot bones, causing a Lisfranc injury.

Sports-related injuries also lead to Lisfranc fractures, mainly in football and soccer. Players might get hurt when someone steps on their foot with their toes bent down. Or, when their foot twists hard during a tackle or fall.

High-Impact Trauma

Car accidents and falls from heights are common causes of Lisfranc fractures. The sudden force can break or tear the midfoot bones and ligaments. This results in a painful and serious injury.

Sports-Related Injuries

Athletes in high-impact sports like football and soccer face a higher risk of Lisfranc fractures. These injuries often happen when someone steps on the back of the foot with toes bent down. Or, when the foot twists hard during play.

Workplace Accidents

Industrial accidents involving heavy machinery, falling objects, or crush injuries can also cause Lisfranc fractures. Workers in construction, manufacturing, and other demanding jobs are more likely to get these injuries at work.

Symptoms of a Lisfranc Fracture

It’s important to know the signs of a Lisfranc fracture to get help quickly. The main symptom is foot pain in the midfoot area. You might also see swelling and bruising on the top of your foot.

People with this injury often find it hard to walk or put weight on their foot. They might feel tenderness when they press on the midfoot. Sometimes, you can see a midfoot deformity, which means the bone is out of place.

The severity of these symptoms can change based on the fracture. Here’s a table that shows the common symptoms and what they mean:

If you have any of these symptoms after a foot injury, get medical help right away. Quick diagnosis and treatment can prevent serious problems and help you recover better.

Diagnosing Lisfranc Fractures

Getting a Lisfranc fracture diagnosed right is key to the best treatment. Doctors use a mix of physical checks and high-tech scans to see how bad the injury is.

Physical Examination

Your doctor will look closely at your foot and ankle during the exam. They’ll check for swelling, bruises, or sore spots in the midfoot. They’ll also check how your foot lines up and if it looks or feels off.

They might move your foot and ankle gently to see if it hurts or if you can move it well. This helps them find out if there’s any problem with how your foot moves.

Imaging Tests

To make sure they know what’s going on, your doctor will probably ask for some scans. These might include:

By looking at what the physical exam and scans show, your doctor can figure out what’s wrong. Then, they can make a treatment plan that’s just right for you to heal well.

Treatment Options for Lisfranc Fractures

The treatment for Lisfranc fractures depends on how severe the injury is and how stable the joint is. There are both non-surgical and surgical options to help the joint heal and get back to normal.

Non-Surgical Treatment

For stable, non-displaced Lisfranc fractures, non-surgical treatment might be enough. This usually means wearing a cast or boot to protect the foot. It also means not putting weight on the foot to help it heal.

The time needed for this treatment can be anywhere from 6 to 12 weeks. It depends on how bad the injury is.

Surgical Interventions

For unstable or displaced Lisfranc fractures, surgery is often needed. This is to fix the bones and make the joint stable again. The most common surgeries are:

• Open reduction and internal fixation (ORIF): This surgery lets doctors directly fix the bones. They use screws, plates, or wires to hold the bones in place. ORIF helps the joint heal correctly.
• Arthrodesis: This is for severe cases where the joint needs to be fused. It removes damaged cartilage and joins the bones together. This stops the joint from moving but helps with pain and stability.

Choosing between ORIF and arthrodesis depends on the fracture’s pattern, cartilage damage, and the patient’s health and activity level. After surgery, the foot needs time to heal. This means wearing a cast or boot and not putting weight on it.

Recovery and Rehabilitation

After treating a Lisfranc fracture, whether it’s non-surgical or surgical, the recovery is key. It helps you get your foot working right again and get back to doing things you love. This journey starts with rest, then moving to weight-bearing and physical therapy.

Immobilization and Weight-Bearing Restrictions

First, your foot is put in a cast or boot to heal safely. You’ll need to stay off your foot, or be non-weight bearing. To move around, you might use assistive devices like crutches or a walker.

When you can start putting weight on your foot, it’s a big step. Your doctor will help you slowly get back to walking normally. How fast you can do this depends on your injury and treatment.

Physical Therapy

Physical therapy is a big part of getting better after a Lisfranc fracture. A physical therapist will create a plan just for you. They’ll help you move better, get stronger, and use your foot right again. They might do things like:

How long you’ll be in physical therapy and what exercises you’ll do depends on how you’re doing. Sticking to your plan is important. It helps you heal well and avoid future problems.

Complications and Long-Term Prognosis

Many people with Lisfranc fractures recover fully. Yet, some face long-term issues. Post-traumatic arthritis is a common problem. It leads to chronic pain and stiffness in the foot.

Damage to the cartilage in the Lisfranc joint causes this. It results in bone rubbing against bone.

Foot deformity is another complication. If the bones don’t heal right, the arch may collapse. Or the toes might point down. This makes wearing shoes hard and might need more surgery.

Lisfranc fractures can also lead to loss of mobility. This is more likely with severe injuries or healing issues. Patients might need a cane or walker to walk.

Several things affect long-term outcomes after a Lisfranc fracture:

To avoid complications and get the best outcome, it’s vital to follow doctor’s advice. Attend all follow-ups and stick to the rehab plan. Most people can get back to normal after a Lisfranc fracture. But, some might have lasting symptoms.

Preventing Lisfranc Fractures

Accidents can happen, but there are ways to lower your risk of Lisfranc fractures. Focus on wearing the right supportive shoes and doing exercises to boost ankle stability. This helps your foot and lower leg work better.

Proper Footwear

Wearing the right shoes is key to protecting your feet and avoiding injuries like Lisfranc fractures. Look for shoes that offer good support, cushioning, and stability. This is important, whether you’re into sports or high-impact activities.

Don’t forget to use the right protective equipment for your activities. This includes cleats, skates, or work boots. Make sure they fit well and are of good quality to keep you safe.

Strength and Flexibility Training

Adding strength and flexibility exercises to your routine can help prevent Lisfranc fractures. Focus on lower leg exercises that strengthen the muscles and ligaments around the midfoot. Some good exercises include:

• Calf raises
• Toe pulls and curls
• Ankle circles and alphabet tracing
• Balance training on uneven surfaces or wobble boards

Strengthening your muscles and improving flexibility can help your body better handle impacts. This reduces the risk of Lisfranc fractures and other foot injuries.

When to Seek Medical Attention for Foot Injuries

Foot injuries can vary from mild sprains to serious fractures like Lisfranc fractures. Knowing when to see a doctor is key. Severe pain in your foot or ankle, after an injury or accident, is a clear sign. Pain tells your body something is wrong and needs help.

Being unable to bear weight on your foot is a warning sign. If putting weight on your foot hurts a lot, it might be a Lisfranc fracture. Also, if your foot looks different, like it’s swollen or bruised, get it checked right away.

Numbness or tingling in your foot is another red flag. These could mean nerve damage or compression, common with Lisfranc fractures. If you feel numb or tingly, see a doctor fast. Early treatment can stop more harm and help you heal better.