Lisfranc Injuries – Symptoms, Causes & Treatment
The midfoot joint complex is located at the point in which your metatarsal bones intersect with your tarsal bones. The metatarsals then proceed to the point where your toes are located, while the tarsals reside at the arch that is atop your foot.
This midfoot joint complex is also referred to as the Lisfranc joint. It received that name due to the accomplishments of French surgeon Jacques Lisfranc de St. Martin, who became the first physician to describe injuries in this area during the 1800s.
The bones of this joint are joined by the Lisfranc ligament, which supplies the sturdy connective tissue that supports the connection of the metatarsal and tarsal bones. This gives the Lisfranc joint complex the critical responsibility of preserving the balance of your midfoot, in order to sustain its necessary alignment.
Lisfranc Injury Causes
A Lisfranc injury will occur if the bones in this area are broken. It will also emerge if the ligaments that provide support become torn. In some cases, these issues are not severe. But for other patients, the situation is more complex.
Lisfranc issues can develop as a result of twisting or falling. This is a common occurrence during a large number of competitive sports. But some Lisfranc issues reach the more serious end of the spectrum. These can occur due to severe trauma, such as falling from a long distance.
Lisfranc Injury Symptoms
The indications that a Lisfranc injury has occurred include pain and swelling at the top of your foot.
Bruising at the top or bottom of your foot can also develop. Any form of bruising that emerges at the bottom of your foot is often a sign that a Lisfranc fracture has occurred.
If you encounter an increase in pain when you attempt to stand, walk or place any pressure on your foot this can also be a sign that a Lisfranc problem has emerged.
Types of Lisfranc Injuries
Sprains are one of the most common types of Lisfranc injuries. This results from a stretching of the Lisfranc ligament, which weakens the middle of your foot if it occurs.
Fractures present a more serious issue since they involve an actual break in the Lisfranc joint. This can develop with a small portion of the bone or a complete break of the bone.
Dislocations are also a more complicated form of Lisfranc injury, which entails the bones being shifted from the usual positions.
What A Doctor Will Do
It is essential that you or your family member visit an orthopedic surgeon if you are experiencing any of the symptoms that were mentioned. This is also the case if you believe that you are dealing with a Lisfranc issue for any other reason.
Your doctor will ask a series of questions concerning your symptoms and the circumstances that caused the issue that you are experiencing. He or she will also examine your foot, which could compel your physician to order imaging tests. These might include X-rays, MRIs or CT scans.
Non-Surgical Treatments
Once your doctor has completed a diagnosis, there are a number of potential treatment plans that could be constructed.
Ice is one of the potential non-surgical treatments, and your doctor might also advise you to elevate your foot. This will be designed to prohibit you from placing any weight on your foot.
Anti-inflammatory medications might be prescribed, and physical therapy could also be recommended. Your exact form of treatment will be determined by the specifics of your situation.
Surgical Treatments
Surgery will likely be recommended for any Lisfranc injury that involves a fracture in either the joints of the midfoot. It will also be advised if the normal positioning of the joints has been altered. There are several types of surgery that might ensue although that is dependent upon the specific injury and other factors surrounding the treatment plan.
One form of surgery for a Lisfranc injury is referred to as internal fixation. This procedure involves positioning the bones correctly through the use of screws or plates. Another form of surgical treatment is referred to as fusion. This entails connecting the bones in a manner that causes them to fuse into one piece.
If either of these types of surgery transpires, a rehabilitation period of six to eight weeks is likely.
Midfoot Fusion
The midfoot refers to the bones and joints that make up the arch of the foot. These bones and joints connect the forefoot to the hindfoot and allow motion of the foot. During midfoot fusion, a foot and ankle surgeon fuses the bones of the midfoot together. Fusing the midfoot can preserve the joint function due to the joint having very little movement naturally. A successful midfoot fusion decreases pain and improves function, allowing patients to get back to everyday activities without pain or limited mobility.
Determining Candidates for Midfoot Fusion
Several factors can play into a patient needing a midfoot fusion. Typically the need for a midfoot fusion arises from another limiting condition. These conditions include:
- Arthritis
- Bunions
- Flatfoot Deformity requiring Flat Foot Reconstruction
- Acute Fractures
- Joint Displacement
A surgeon should not perform a midfoot fusion on a patient if they have uncontrolled diabetes, poor blood circulation, osteoporosis or poor skin quality. Your surgeon may also utilize additional procedures to correct the shape of the foot such as bone reshaping procedures like a Cotton osteotomy.
Performing a Midfoot Fusion
An anesthesiologist places the patient under general anesthesia. The skilled foot and ankle surgeon creates one or two incisions into the top of the foot, carefully protecting the tendons and nerves of the foot. The surgeon uses screws and plates to immobilize the joints and allow for bone to form across the joint space. The surgeon may use bone graft, either autograft or allograft, to fill in any spaces between the bones following the excision of cartilage. Autograft means that the bone comes from somewhere else in the patient while allograft means that the bone comes from a cadaver or synthetic material.
Recovering From a Midfoot Fusion
Following a midfoot fusion, the patient typically leaves the hospital on the same day and must wear a cast for six to 10 weeks and may not bear weight on the foot for six to 12 weeks. The treating physician may prescribe physical therapy to aid in the patient’s recovery. Once the physician permits the patient to begin walking again, the patient wears a boot and gradually increases the weight placed on the foot. Physical therapy can help the person relearn how to walk and improve balance following a midfoot fusion.
Potential Risks and Complications Associated With Midfoot Fusion
Every time the skin is penetrated in a procedure, potential risks may arise. During a midfoot fusion potential risks include those associated with anesthesia, infection, excessive bleeding, blood clots and nerve damage.
Surgery-specific potential risks include the failure of the bones to fuse, over or under correction of deformity or issues with the plates and screws used.
If a patient suspects they may have any of these previously listed risks, they must let their provider know immediately.
At OrthoTexas We Can Help
If you have any questions or concerns about Lisfranc injuries or any other issues with your feet, the professionals at OrthoTexas are ready to assist you.
Your path to recovery starts here. Schedule an appointment with OrthoTexas or find a location near you.