A FAQ on the Lisfranc injury

Sports fans have heard a lot about football players with Lisfranc injuries recently. Maurice Drew-Jones, running back for the Jacksonville Jaguars and Santonio Holmes, receiver for the New York Jets, have been in the news.  Matt Schuab, QB for the Houston Texans missed last  season from a Lisfranc injury.

Many of you may know that a Lisfranc injury is a type of foot injury and that it can sometimes be very serious requiring surgery and take a year or more to recover.  What you may not know is that most Lisfranc injuries have nothing to do with sports, being much more common from more violent accidental trauma.  Read on any you will learn what the Lisfranc joint is, how it gets injured, when to suspect a Lisfranc injury, a little bit about treatment, and enough history and anecdote to make it interesting.

The Lisfranc joint is named for a surgeon in Napoleon’s army, Jacques Lisfranc de St. Martin, who performed an amputation of a soldier’s gangrenous foot through the midfoot, where the arch of bones known as the tarsal bones connect the hindfoot to the metatarsals, or forefoot.  These 5 bones of the tarsus function as a unit, and are connected by ligaments and a contained within a capsule, and are sometimes referred to as the Lisfranc joint.  This joint is really pretty stable, and most injuries to the Lisfranc joint occur from high impact trauma like motor vehicle accidents and industrial accidents.  These cases are often these are referred to as direct Lisfranc injuries, for example when the foot is run over by a car and a crushing injury occurs, or a fall from a height with the victim landing with the foot pointed downward. Indirect Lisfranc injuries are very uncommonly seen in athletes. The mechanism of injury is usually when the foot is pointed down and fixed, and a violent twisting force is applied to the joint.  Examples are a horse back rider thrown with the foot caught in the stirrup, a snow boarder or wind-surfer  falling with the foot in a binding across the mid-foot, and less often in a football situation where the foot is planted on the ball of the foot and a tackle or sudden change of direction leads to a wrenching injury across the Lisfranc joint.

Darren McFadden and Cedric Benson are two other well known NFL players with Lisfranc injuries.   The University of Maryland quarterback Devin Burns has also been in the news this month with a Lisfranc injury.

Here are some questions and answers that may help you think about Lisfranc injuries:

Q: What are the signs and symptoms of a Lisfranc injury?

A: Swelling and pain over the mid-foot, the area just in front of the ankle, and bruising of this area, especially noted on the bottom of the midfoot.

Q: How is a Lisfranc injury diagnosed?

A: The first thing is that to diagnose a Lisfranc injury you have to have a high level of suspicion i.e. think of the diagnosis.  Sometimes an x-ray, especially if taken bearing weight will show a separation of the bones of the midfoot, most commonly a widening of the space between the first and second metatarsals.  Often an MRI or CT scan is needed to look for ligamentous or bone injuries.

Q: Does a Lisfranc injury require surgery?

A: Sometimes. If a major disruption of the ligaments or displaced fractures is found, often surgery is needed.  Sometimes for less severe injuries immobilization is adequate.  An orthopedic surgeon experienced in the treatment of Lisfranc injuries should be involved in helping decide on the best treatment for any individual injury.

Q: How long does it take to recover from a Lisfranc injury?

A: This is variable depending of course on the severity of the injury and the treatment chosen, but longer than many other injuries, sometimes a year or more.

Q: Are there more Lisfranc injuries now that in the past since it seems like we hear more about these now?

A:  I don’t know, but I suspect better imaging, popularity of using the eponymous Lisfranc injury, and the information age have all led to a much higher visibility.

Edward Pullen is a family physician who blogs at DrPullen.com.

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