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Lisfranc Injury: What to Know

Reviewed by Michael W. Smith, MD on August 25, 2021

What Is a Lisfranc Joint Injury?

A Lisfranc joint injury happens when you damage bones, or connective tissue called ligaments, in the middle part of your foot. You may hear your doctor call it a tarsometatarsal joint injury.

Named after a surgeon in Napoleon’s army, the Lisfranc joint complex includes the bones and ligaments that connect the middle part of your foot to the front. Lisfranc injuries vary in seriousness. They can involve broken or dislocated bones, torn or strained ligaments, or both. Usually, they damage cartilage that covers bones in your foot.

This type of injury is considered uncommon, affecting about 1 in every 60,000 people each year.

The middle part of your foot plays a key role in walking. It transfers the force created by your calf muscle to the front of your foot. So even though a Lisfranc injury may sometimes feel like a simple sprain, it's more serious than that. You can’t just walk it off.

Here’s what you need to know, including symptoms to be aware of, causes, treatments, and more.

What Causes It?

You can get a Lisfranc injury due to a twisting fall, often by stumbling over the top of your foot when it’s pointing downward. It’s more likely to happen to you if you’re a soccer or football player. In Napoleon's time, you might have gotten one when you fell off a horse with your foot caught in the stirrup.

This type of injury can also result from a direct impact, like a car crash or falling from a height.

What Are the Symptoms?

It’s common to have:

  • Pain and swelling in the top of your foot
  • Bruising on the bottom or top of your foot
  • Pain that gets worse when you stand, walk, or push off on the injured foot

If you notice any of these symptoms, talk to your doctor. Also pick up the phone if you think you have a sprain but your foot doesn’t get better after you rest, ice, and elevate it.

How Is It Diagnosed?

Your doctor will ask you about your symptoms and any past foot problems. Then they’ll check your foot for signs like bruising, tenderness, and pain. They may touch or move your foot in ways that hurt, but this won’t make your injury worse.

They might also do imaging tests like an X-ray, MRI, or CT scan to check for damage inside your foot. These can help them see whether you have a Lisfranc injury or something else.

What Are the Treatments?

Your treatment and recovery time depend on how serious your Lisfranc injury is.

Nonsurgical treatment. If you haven’t broken or dislocated any bones or completely torn any ligaments, your doctor may have you wear a cast or boot for about 6 weeks. During this time, you can't put weight on your injured foot. Afterward, your doctor may have you wear a removable cast, boot, or orthotic.

While you’re recovering, you’ll see your doctor for follow-up care and get X-rays to check on how well your foot is healing. If your doctor spots signs that the bones in your injured foot have moved, you’ll need surgery to put them back in place.

Surgery. Your doctor will likely recommend this if you have broken bones or dislocated joints in the middle of your foot.

One type of surgery for Lisfranc injuries involves implanting plates or screws in your bones to hold them in place. Your surgeon may remove some or all of them later.

Another, less common type of operation called fusion surgery can treat a severe injury. You may need it if your surgeon can’t fix your broken bones with plates or screws, or if you have badly torn ligaments. In this procedure, your surgeon fuses the damaged bones together so they mend into a single piece.

You’ll need to wear a cast or boot for 6-8 weeks and stay off your foot after either type of surgery. Your doctor will then give you the OK to start putting weight on your booted foot if your X-rays look good. They’ll tell you how much weight you can bear and how far you can walk on that foot.

What Are the Possible Complications?

After a Lisfranc injury, you might get arthritis in your injured foot, which can lead to chronic pain. This is more likely if your injury was severe.

You can get arthritis even if you had successful surgery for a Lisfranc injury. If you develop severe arthritis, your doctor may recommend fusion surgery to treat it.

There’s also a chance that your bones won’t heal properly after surgery for a Lisfranc injury. You might need another operation to fix it. The odds of this happening may be higher if you smoke or have conditions like diabetes or thinning bones (osteoporosis).

While you’re recovering from foot surgery, call your doctor if you have:

  • High fever or chills
  • Pain that gets worse
  • Numbness in your foot

Show Sources

SOURCES:

OrthoInfo: “Lisfranc (Midfoot) Injury.”

University of Rochester Medical Center: “Lisfranc Joint Injury.”

BMJ Case Reports: “A rare Lisfranc-type injury involving dorsal dislocation of the intermediate cuneiform.”

Orthopaedic Trauma Association: “LisFranc Injury.”

American College of Foot and Ankle Surgeons: "Lisfranc Injury: Easy to Miss, Hard to Get Over."

Foot and Ankle Clinics: "Complications of missed or untreated Lisfranc injuries."

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