What is a Lisfranc Fracture Dislocation?
The term ‘Lisfranc joint’ is used to refer to a special area that runs across the middle of the foot.
The foot is made up of many bones, and the connection between two bones is called a joint. There are five joints in the foot called the “tarsometatarsal joints” and together these joints make up the “Lisfranc joint”.
These five joints are kept in place partly by the close-fitting shape of the bones, and partly by strong surrounding soft tissues, especially the ligaments. One of these, the Lisfranc ligament, is a small but very strong ligament that holds the bone near the base of the big toe to the base of the second toe.
Despite its small size, the Lisfranc ligament is needed to keep the foot stable, and along with other ligaments, helps to maintain the arch of your foot. Overall, the five joints act together, so that when one is injured the others are highly likely to be injured as well. Also, the soft tissues around the joints are likely to be damaged.
A dislocation is when the bones that make up a joint are no longer in the correct position. A fracture-dislocation is when the bones are broken and also the joint is dislocated.
Lisfranc dislocations and dislocation-fractures usually occur following sports injuries or car accidents. They are usually very serious injuries that need surgery.
Symptoms
- Pain. Having a Lisfranc fracture dislocation is usually very painful.
- Swelling and bruising. Your foot will be swollen and bruised.
- Deformity. In serious injuries, your foot will be deformed.
Causes
Large forces are needed to cause Lisfranc dislocation such as:
- Falling onto the feet from a height
- Sports injuries
- Car Accidents
Risk Factors
The Lisfranc joint is a very strong joint so there needs to be large force to injure it and cause a fracture or dislocation. Such as:
- Car and motorcycle accidents
- Falling onto the feet from a height
- Sports injuries
Investigations
- X-rays. One of the first tests that you may have is an X-ray of the foot. Often a number of X-rays are taken from different directions. X-rays are usually enough to diagnose a Lisfranc fracture dislocation.
- Weight-bearing X-rays. Sometimes it is difficult to tell whether or not you have injured your Lisfranc Joint. One of the best ways to tell is to take an X-ray of your foot whilst you are standing. If your Lisfranc joint is injured, the normal arch in your foot will collapse.
- CT Scan. A CT Scan is an excellent test to show more detail about your foot and any fractures that you may have. It can show in great detail which bones are broken so that your surgeon can plan the surgery to fix your foot.
Complications
Lisfranc Fracture Dislocations are serious injuries and can lead to a number of problems.
- Compartment Syndrome – when swelling is severe the blood vessels can become compressed by the swollen muscles and other soft tissues. This reduces the blood flow, and can lead to further serious injury to your foot.
- Deformity – such as widening of your foot or permanent flat foot. if bad enough, this may affect your ability to wear shoes
- Chronic foot swelling
- Osteoarthritis
Treatment
Plasters and Braces
If your Lisfranc ligament has been strained and not completely torn, your doctor may decide that your injury does not need surgery and can be treated in either a plaster cast or a brace.
Avoid strenuous exercise for a length of time to avoid re-injuring the ligaments.
Surgery
Most Lisfranc Injuries need to be treated with surgery. During the operation, your bones and joints will be realigned, and then fixed with a combination of screws, plates and wires.
Long-term pain
Lisfranc injuries are usually very serious and often cause long-term problems such as arthritis, pain and stiffness.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
Lisfranc Fractures and Dislocations usually occur from serious accidents such as motor vehicle accidents or falls from a height.
Preventing these accidents is the best way to prevent these injuries.
F.A.Q. | Frequently Asked Questions
What is a Lisfranc injury?
It is an injury to the joints and ligaments in the middle of the foot, where the long bones of the foot meet the small bones in front of the ankle. It can be a sprain, a dislocation or a fracture, and it is often missed at first because X-rays can look normal.
Why does it need surgery?
The middle of the foot is the arch, and it carries the body weight with every step. If the joints are left out of place the arch collapses and arthritis follows. Surgery lines the joints up and holds them with screws or plates while the ligaments heal.
How long is recovery?
Longer than most foot injuries. Expect 6 to 12 weeks without weight on the foot, then a gradual return to walking in a boot. Full recovery and return to sport often takes 6 to 12 months.
Will I need the screws removed?
Often yes. Screws that cross the joints are usually taken out at about 4 to 6 months, once the ligaments have healed, so the joints can move again.
How do I know if I have a Lisfranc injury?
You often cannot tell from the pain alone, which is exactly why these injuries get missed. Bruising on the sole of the foot, inability to bear weight, and pain across the middle of the foot rather than the ankle all point towards a Lisfranc injury. If there is any doubt it needs proper X-rays, sometimes taken while standing, because a subtle injury can look normal on a relaxed foot.
Will I have long term problems?
It is common, even when the injury is treated well and promptly. That is a reflection of how much force it takes to cause the injury in the first place. Good treatment reduces the risk and severity, but cannot remove it.
When will I be back to normal?
Later than most people expect, often close to a year, and some people do not return to the same level. Driving, work and everyday walking come back well before sport does.
References
- Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle. 1986;6(5):225-242.