Lisfranc's injury? What in the world is that?

Lisfranc’s injury is one that we don’t hear about regularly. It certainly has an unusual name. Most people wonder what it is and why it can be one of the most devastating foot injuries for athletes. One of my favorite NFL players, Taysum Hill, sustained this type of injury on the final game of the regular season. For him and his team this was fortunate because this type of injury usually is a season ender for athletes. I just read that he will be having surgery for his injury soon. Recovery is long, but he should be ready to go for training camp in the summer. Lisfranc’s joint is the joint where the 5 metatarsal bones connect to the rest of the foot. It is roughly in the middle of the foot. This joint is named after a French surgeon from the 1800’s that described injury to this area in cavalry soldiers that fell from horses with their foot caught in the stirrup. Unfortunately, the only treatment at the time was amputation of the front part of the foot. Fortunately we have better options now! Lisfranc’s joint is a very stable joint, contributing to the structure of the arch. There are many ligaments around this joint that along with bone interlocking, contribute to the stability of this joint. Injury to this complex requires a significant force. Automobile or motorcycle accidents and falls from heights are the most common causes. The injury can be caused in sports when a force is applied above the foot, such as a tackler, while the front part of the foot is stuck to the playing surface. This causes tearing of one or more of the ligaments stabilizing the joint. Occasionally, fractures of the bones in the area can occur as well. A high index of suspicion is needed in diagnosing these injuries as x-ray findings can be subtle or absent. Stress x-rays under anesthesia may be necessary in some cases to arrive at the diagnosis. Mild cases without fracture or displacement can usually be managed with a period of non weight bearing immobilization for 4-6 weeks followed by rehabilitation. Cases with displacement, fractures or gross instability would need surgical intervention. Surgical options include closed reduction with percutaneous pinning and open reduction with internal fixation. The choice of procedure is based on the severity of the injury, the injury pattern and the reducibility of the injury. A period of non weight bearing for 6-8 weeks is needed. Non weight bearing rehab exercises can start earlier after surgical intervention as soon as swelling and pain has reduced. Surgical hardware is commonly removed after healing. Full recovery can take 6 months or more. Should you have any questions about this or any other foot and ankle injury, give me a call.