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Lis Franc Injury

What is it?

A Lisfranc injury refers to a specific type of injury affecting the Lisfranc joint complex in the midfoot. This area consists of the bones and ligaments connecting the metatarsals (the long bones in the foot) to the tarsal bones (the bones in the rear and midfoot).

Types of Lisfranc Injuries

  • Lisfranc Fracture: This involves fractures of one or more of the metatarsal bones.
  • Lisfranc Dislocation: This occurs when the bones in the midfoot are displaced from their normal alignment.
  • Lisfranc Sprain: This involves damage to the ligaments without significant bone injury.

What causes it?

Tibialis posterior tendon dysfunction (TPTD) can be caused by several factors, including:

Overuse and Repetitive Strain

Engaging in activities that place repetitive stress on the tendon, such as running, jumping, or sports that involve a lot of footwork, can lead to inflammation and degeneration.

Injury or Trauma

Acute injuries, such as a sprain or strain, can damage the tendon, leading to dysfunction.

Age-Related Degeneration

As people age, the tendon can weaken or degenerate, making it more susceptible to injury.

Foot Structure and Biomechanics

Abnormal foot mechanics, such as flat feet (pes planus) or high arches (pes cavus), can increase the strain on the tibialis posterior tendon.

Obesity

Excess body weight can place additional stress on the foot and ankle, contributing to tendon dysfunction.

Medical Conditions

Conditions such as diabetes, rheumatoid arthritis, and hyperthyroidism can affect tendon health and contribute to dysfunction.

Poor Footwear

Wearing inappropriate or poorly fitted shoes that lack support can exacerbate strain on the tibialis posterior tendon.

Addressing these risk factors can help in the prevention and management of TPTD. If you suspect you have this condition,
consulting a healthcare professional is advisable for proper evaluation and treatment.

How is it diagnosed?

Diagnosing a Lisfranc injury typically involves several steps, including a thorough medical history, physical examination, and imaging studies. Here’s how it’s generally done:
  • Medical History: The doctor will ask about how the injury occurred, the specific symptoms you're experiencing, and any previous foot injuries.
  • Physical Examination
The healthcare provider will assess the foot for:
  • Swelling, bruising, or tenderness in the midfoot.
  • Range of motion and ability to bear weight.
  • Any deformities or misalignment.
  • Imaging Studies
  • X-rays: The first line of imaging to look for fractures and dislocations. Special views may be taken to assess alignment.
  • Weight-Bearing X-rays: These may be performed to see how the bones align when weight is applied.
  • MRI or CT Scans: If the diagnosis is unclear or if there are concerns about soft tissue damage, these imaging techniques provide a more detailed view of the ligaments and joints.
  • Physical Tests: The healthcare provider may perform specific maneuvers to test the stability of the Lisfranc joint complex.
  • Differential Diagnosis: It’s important to rule out other potential injuries, such as fractures in the foot or ankle or ligament injuries.
Prompt and accurate diagnosis is crucial for effective treatment, so if a Lisfranc injury is suspected, it’s essential to seek medical attention right away.

How is it Treated?

The treatment for a Lisfranc injury depends on the severity of the injury and whether there are associated fractures or
dislocations. Here are the common treatment options:

Conservative Treatment

For mild injuries, treatment may include:

  • Rest: Avoiding weight-bearing activities to allow the injury to heal.
  • Ice: Applying ice to reduce swelling and pain.
  • Compression: Using an elastic bandage or brace to provide support.
  • Elevation: Keeping the foot elevated to minimise swelling.
  • Immobilisation: A walking boot or splint may be used to stabilise the foot during the healing process.
  • Physical Therapy: Once healing begins, physical therapy may help restore strength and range of motion.
  • Orthotic therapy: To support the mid foot and offload the damaged/healing ligament to aid healing.

Surgical Options

For more severe injuries, particularly those involving significant dislocation or multiple fractures, surgical intervention may be necessary:

  • Realignment: The surgeon will realign the bones and stabilise the Lisfranc joint complex.
  • Fixation: This may involve the use of screws, plates, or pins to hold the bones in place during healing.
  • Ligament Repair: Damaged ligaments may need to be repaired or reconstructed.

Post-Surgical Rehabilitation

  • After surgery, a period of immobilisation is typically required, followed by gradual weight-bearing as advised by the healthcare provider.
  • Rehabilitation exercises will help regain strength, flexibility, and function.

Follow-Up Care

Regular follow-up appointments will be necessary to monitor healing through physical exams and imaging studies.

The recovery time can vary widely depending on the severity of the injury and the chosen treatment method, but it often
takes several weeks to months for a full recovery. Early diagnosis and appropriate treatment are crucial for the best
outcomes.

Frequently Asked Questions

Here are some frequently asked questions about Lisfranc injuries:

What is a Lisfranc injury?
A Lisfranc injury involves damage to the Lisfranc joint complex in the midfoot, which can include fractures, dislocations, or ligament sprains.
Common causes include trauma from falls, sports-related injuries, and twisting motions while the foot is planted, as well as high-impact activities like car accidents.
Symptoms typically include pain and swelling in the midfoot, difficulty bearing weight, bruising, and possibly a visible deformity.
Diagnosis involves a medical history review, physical examination, and imaging studies like X-rays or MRIs to assess the extent of the injury.
Treatment may range from conservative measures like rest, ice, and immobilisation to surgical intervention for more severe injuries, which may involve realignment and fixation of the bones.
Recovery time varies based on the severity of the injury and the treatment method, but it typically takes several weeks to months for a full recovery.
Yes, physical therapy is often recommended to help regain strength, flexibility, and function after the injury has healed.
While not all injuries can be prevented, wearing proper footwear, avoiding high-impact activities without adequate preparation, and being cautious during physical activities can reduce risk.
Some people may experience lingering pain, stiffness, or arthritis in the midfoot, especially if the injury was severe or not treated properly.
You should seek medical attention if you experience significant pain, swelling, or difficulty bearing weight on your foot after an injury. Early evaluation is crucial for effective treatment.

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