What is a Lisfranc injury?
The Lisfranc joint is the grouping of bones and ligaments in the midfoot, where the five metatarsal bones meet up with the smaller cuboid bone and the medial, middle, and lateral cuneiform bones. Ligaments hold these bones in place. The Lisfranc joint stabilizes the foot's arch and helps transfer loads from the lower leg through the foot, all the way to the toes when walking or running.
Lisfranc injuries, while not highly common, occur when any of the bones or ligaments in the Lisfranc joint break or tear. A Lisfranc or midfoot injury typically results from a sudden trauma. It can take months to heal fully.
Lisfranc injury treatment depends on the type and severity of the damage. In some cases, rest can help heal a sprain. Lisfranc surgery is common for fractures, breaks, or dislocations.
Types of Lisfranc injuries
Lisfranc joint injuries can range from minor strains to multiple bone fractures.
- Lisfranc sprain: When any of the three Lisfranc ligaments stretch or partially tear
- Lisfranc fracture: When any of the bones in the Lisfranc joint break
- Lisfranc dislocation: When a bone is moved out of place in the joint
What are Lisfranc injury symptoms?
Often mistaken for some other form of injury, a Lisfranc injury causes pain and can be tender to the touch. You may experience swelling and bruising in the foot's arch or on the top of the foot. Pain typically increases when placing weight on the foot.
What are the causes and risk factors of Lisfranc injuries?
Lisfranc injuries are usually caused by a sudden trauma, which can happen in any sport where falls, hard contact, or twisting occur.
Lisfranc injuries result when an impact damages the bones—this could be contact from the hard ground or an opponent in sports—or when the foot twists forcefully and overstresses the ligaments or bones within the Lisfranc joint.
Lisfranc injuries are seen most often in football and soccer players. The more an athlete is involved in high-contact sports with constant movement, the greater the chance of suffering Lisfranc injuries.
Learn more about how athletes can reduce the risk of a foot injury.
How is a Lisfranc injury diagnosed?
A Lisfranc diagnosis includes a physical examination and imaging technology. It is crucial to differentiate between ankle and Lisfranc injuries, as the two are commonly confused.
A physical examination focused on diagnosing Lisfranc injuries often includes:
- Questions about the injury and extent of pain in the midfoot
- A visual inspection to check for tenderness, swelling, and bruising
- Movement testing to evaluate pain, range of motion, and stability when standing or walking
With Lisfranc injuries, additional imaging scans can help diagnose the severity of the injury. An X-ray will reveal a fracture or break of any of the bones in the Lisfranc joint. A computerized tomography (CT) scan may be ordered if more detailed bone information is needed. In some cases, a magnetic resonance imaging (MRI) scan can help reveal any damage to the soft tissue, such as ligaments or cartilage.
Request an appointment with a Mass General Brigham sports medicine specialist to learn more.
Lisfranc injury Treatment
The treatment path for Lisfranc injuries is based on the type and severity of the issue.
Nonsurgical Lisfranc injury treatments
Surgery is usually not required for Lisfranc ligament sprains when the ligaments aren't fully torn. Typically, an athlete is placed in a boot for six to eight weeks to take weight off the joint and rest the injury. Once the boot is removed, you can gradually add back weight-bearing exercises. Patients typically work with a physical therapist to not overstress the Lisfranc ligaments during recovery.
Surgical Lisfranc injury treatments
Lisfranc surgery is the preferred course of action for fractures, dislocations, and complete Lisfranc ligament tears. The procedure aims to properly align bones, potentially using metal plates or screws to reattach pieces. A joint fusion is done in extreme cases where the damage is beyond repair. Lisfranc surgery recovery time includes up to three months in a cast or boot followed by rehabilitation and physical therapy. It could take a year for a full recovery from surgery.
Living with Lisfranc injuries
If left untreated, Lisfranc injuries can grow in severity and increase the risk of arthritis developing in the joint. Proper rehabilitation of Lisfranc injuries is vital for an athlete to regain full mobility. Even after full recovery, pain can remain.
FAQs
If left untreated, a Lisfranc injury can seriously impair your ability to walk or run. Recovery times for Lisfranc injuries can range from a few months to a full year.
You may still be able to walk following a Lisfranc injury, but it will likely be extremely painful. You will probably be unable to bear weight on your foot or walk.
A minor Lisfranc injury, such as a strain, may heal in as little as eight weeks, but most surgical repairs require at least four months of healing, if not a full year.
Pain and tenderness in the midfoot and arch are common signs of a Lisfranc injury. The pain intensifies with standing and toe-off movements, such as walking or running.
If the Lisfranc injury is to the bones, an X-ray can show the damage, whether a fracture, break, or dislocation. An X-ray won't show the injury if a minor sprain of a Lisfranc ligament.
