By Dr. Roman Burk
Participation in sporting activities is important to living a healthy life. However, they are not without their risks. Pretty much every type of sporting activity has the potential to cause injury to the foot or ankle. Even swimming! It may surprise you just how many different kinds of foot and ankle injuries an athlete can encounter. Definitely too many to break down into one simple blog post, believe me, I tried! For this reason, it has been decided to do a short series on the Foot and Ankle Injuries Commonly Encountered by Athletes. For the first segment of this series, we will discuss the Lisfranc injury.
What is the Lisfranc Joint?
The Lisfranc joint is found at the point where the long bones that lead up to the toes (metatarsal bones) and the bones in the arch (tarsal bones) connect. This point is found in the middle of the foot. The Lisfranc ligament is a tough band of tissue that joins two of these bones. It is important for maintaining the strength and proper alignment of the joint. The Lisfranc joint is clinically known as the tarsometatarsal articulation of the foot. If an athlete complains of a sudden onset of pain in the middle of the foot while playing, they should be evaluated for a Lisfranc’s injury.
What is a Lisfranc Injury?
Lisfranc injuries are complex and often misdiagnosed. If left undiagnosed for a prolonged period of time, this injury has the potential for long-term disability. Of all the injuries we will be discussing in this series, the Lisfranc injury is probably the rarest, but definitely worth mentioning.
Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot. In either case, the injury occurs when there is a displacement of the Lisfranc joint. Strenuous, competitive athletic activities like running, basketball, football, soccer, and even horseback riding often result in Lisfranc’s injuries. However, it doesn’t always require a sporting activity to become injured, it can even happen with something as simple as missing a step on the staircase.
Lisfranc injuries vary from mild to severe. Typical signs of a Lisfranc injury include:
- Pain/tenderness throughout the midfoot when standing or when pressure is applied.
- Swelling is found primarily over the top of the midfoot.
- Inability to bear weight. In a more severe injury, the foot may be distorted and putting weight on it may be very painful. With a mild injury, the foot may appear normal and you may be able to put weight on it with minimal pain.
- Commonly found on the bottom of the foot with this kind of injury, bruising is a clue that this injury has occurred.
At first, Lisfranc injuries are often mistaken for an ankle sprain. If the standard treatment for a sprain (rest, ice, and elevation) doesn’t reduce the pain and swelling within a day or two, or there is extensive bruising on the bottom of the foot, you should request further evaluation to determine if you have a Lisfranc injury.
How is a Lisfranc Injury Diagnosed?
Early diagnosis and treatment are extremely important in preventing long-term chronic pain. As previously stated, Lisfranc injuries are often mistaken for ankle sprains, so the diagnostic process is very important. One of the most important steps we take in diagnosing a Lisfranc injury is asking questions. To arrive at the proper diagnosis, we will ask questions about how the injury occurred, where the pain is located, and so on. As we ask questions we examine the foot both visually and with touch to determine the severity of the injury. X-rays and/or other imaging studies may be used to fully evaluate the extent of the injury. X-ray images may show broken or shifted bones. A standing x-ray may be taken to help better identify shifting bones in the foot. MRI’s may be used to see if the ligaments have been damaged. CT scans are sometimes ordered to determine the extent of a bone injury and are often ordered if it appears that surgery will be necessary.
Treatment and Recovery Time for a Lisfranc Injury
Returning to the same level of performance after this kind of injury can take several months or longer. If the bones and ligaments are not severely injured, and the bones have not shifted from their normal positions, casting is often a successful treatment. The cast is usually worn for around six weeks. We may follow up with x-rays regularly to make sure the bones remain in a good position during recovery. Lisfranc surgery may be required if the bones or ligaments have been injured in a way that causes them to shift from their normal positions. This surgery will restore the anatomy of the foot. When surgery is performed, it may involve the placement of plates and screws that will be removed later, once the bones and ligaments heal. Recovery after a surgery varies greatly on the severity of the injury, and the patient’s commitment to their care and physical therapy. For most surgical cases, the patient will be in a cast and unable to place weight on the foot for at least six weeks. Following this, they will spend six additional weeks in a walking boot. Physical therapy is often required to strengthen the foot and ankle to help regain full function. Returning to maximum function and the ability to take part in sports and running again can take up to a year. Unfortunately, in some very severe cases, some patients will not be able to return to their pre-injury level of functioning, even with well-performed treatment and care.
As with any injury, it is important for you to follow doctor’s orders and refrain from activity until you are given the go-ahead. Ignoring instructions given to you could result in further injury and/or a longer healing time.
Lisfranc injuries have a few complications that may arise. As it states on the American College of Foot and Ankle Surgeons website, a possible early complication following the injury is compartment syndrome, in which pressure builds up within the tissues of the foot. A buildup of pressure could damage the nerves, blood vessels, and muscles in the foot, so this requires immediate surgery to prevent tissue damage. It is possible that arthritis and problems with foot alignment will develop. Arthritis usually develops several months after a Lisfranc injury and will require additional treatment.
A Lisfranc injury is only one of the many different types of sports-related injuries that can affect the feet and ankles. We have only just begun our exploration on sports injuries in this article, I hope you found it interesting and will join us for our future articles on Foot and Ankle Injuries Commonly Encountered by Athletes.
Remember, following through with the proper treatment of your injuries could mean the difference between resuming your sport or activity without pain and possibly never being able to participate in it again. Normal healing takes time, so even if it means missing a season of regular play, it is best to remain patient and follow the guidelines given to you by one of our friendly foot doctors. It is better to be able to play again the next season in top form rather than never play again.
Our foot and ankle care doctors and surgeons are board-certified by the American Board of Foot and Ankle Surgery and are members of the American College of Foot and Ankle Surgeons and the American Podiatric Medical Association. Call (208) 855-5955 or request an appointment online.