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Located in the middle of the foot, the Lisfranc joint is the point at which the metatarsal bones, which are the long bones that lead to the toes, attach to the tarsal bones (e.g., arch bones). Lisfranc injuries result if bones in the midfoot are broken or if 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 midfoot.
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 something that should be simply “walked off.” It is a severe injury that may take many months to heal and may require surgery to treat.
Lisfranc injuries can happen with a simple twist and fall. This is a low-energy injury. In fact, it is often seen when someone stumbles over the top of a foot that’s flexed downward.
More severe injuries occur from direct trauma, such as a high-impact fall. These high-energy injuries can result in multiple fractures and dislocations of the joints.
The most common symptoms of a Lisfranc injury include:
The diagnosis of a Lisfranc injury is made using several things: your symptoms, a foot exam, X-rays and other imaging tests. Your orthopaedic foot and ankle specialist will examine the middle part of your foot to identify the location of pain, and then perform tests to check the stability of this area. X-rays may show broken and/or shifted bones in the middle of the foot. An MRI scan may be helpful, too, to determine if the ligaments in the foot are damaged. A CT scan can help determine the extent of the bone injury, and is particularly useful when planning surgery.
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. In these instances, a Lisfranc injury may be treated with casting, followed by custom-molded orthotics. However, a majority of Lisfranc fractures are unstable and displaced, so they require surgery. Your doctor will carefully assess your injury to determine the precise type and severity of fracture. If you require surgery, your foot and ankle surgeon will reposition the joints and realign fractured bone fragments. Once bones are in their proper place, screws and metal plates are used to stabilize the joint and allow injured tissues to heal. In cases of severely ruptured ligaments and irreparable bone damage, your surgeon may even recommend fusion to “weld” together the joints as a single piece.