A Lisfranc joint injury occurs in the middle region of the foot.
This type of injury can affect the bones or the ligaments in that area. The Lisfranc is not a single joint but more of a joint complex due to the number of bones and ligaments in this region of the foot.
Because Lisfranc joint injuries are rare, they are often misdiagnosed during a regular physical examination. Proper treatment is necessary to protect the stability and use of the affected foot.
What Is a Lisfranc Joint Injury?
The Lisfranc joint is located in the middle of the foot, creating the arch. There are many small bones and ligaments that make up this joint. An injury that damages even one bone or ligament in this region can affect several others. A Lisfranc joint injury may be caused by a sprain of the main supportive ligament in this region, known as the oblique interosseous ligament. Unlike a simple sprain, an injury to the oblique interosseous ligament can be more serious and lingering. An injury to the middle of the foot may also cause a dislocation of the Lisfranc joint. One or more bones may also break at the area where they connect at the Lisfranc area.
A Lisfranc joint injury may be caused by a direct impact to the region, such as during a car accident. An injury to the middle of the foot may also occur from indirect impact, such as during a fall when there is also a twisting of the foot.
Getting a Diagnosis
Because a Lisfranc joint injury can mimic other problems that can occur with the foot, including sprains, it is important to get a diagnosis from a medical professional. Along with a medical history, your physician will perform a physical examination. Your practitioner will check your symptoms. Symptoms of Lisfranc joint injury include:
- Pain on the top of the foot or in the midfoot that is tender to the touch
- Pain when putting pressure on the foot
- Swelling or bruising of the foot
Because the causes and symptoms that are associated with Lisfranc joint injury are the same as for a basic sprain, your medical care provider may request imaging tests to make a proper diagnosis. An x-ray is most commonly used because it can determine if there are any breaks in the bones. X-rays can also detect ligament issues based on widening between specific bones in the foot. While an MRI or CT scan are not necessary, your physician may use one of these imaging tools to determine the exact position and severity of an injury to the Lisfranc joint complex.
Treatment Options for Lisfranc Joint Injury
In many cases, the issue can be treated conservatively with rest and NSAID medications to reduce the pain. You might also keep your foot elevated as much as possible and use ice as directed by your medical provider. Your physician may order a cast be worn on the foot for 6 weeks. During this time, you will not be allowed to put any pressure on the affected foot, so you may have to use crutches or another type of walking aid. After 6 weeks, a walking cast or other orthotic device may be used. You might also be required to go to physical therapy to restore strength and range of motion following any immobilization.
If any bones are broken or there is severe damage to ligaments causing dislocation within the joint complex, surgery might be necessary. The affected bones might be realigned to their proper position and then fixed in place through the use of screws and plates. This hardware will typically be removed at a later date to allow for full movement of the foot. If the damage is severe, bones may be fused together. Either way, there will be a recovery period following the surgery that may include rehabilitation therapy. You will most likely wear a cast and avoid putting pressure on the foot for 6 to 8 weeks before moving forward with therapy.
If left untreated, the bones may heal improperly, resulting in some deformation of the foot. Arthritis is a common complication that can occur with Lisfranc joint injury, even if you have the condition treated and any surgery completed is successful. If there is chronic pain in the middle foot area, even after surgery, fusion surgery may be necessary. This will reduce the range of motion in the foot but will help to reduce the pain.