While a Lisfranc injury may have different causes, it is especially common in athletes who participate in contact sports. This injury occurs in the Lisfranc joint or ligament in the midfoot area that makes up the arch. It connects the metatarsal bones (long bones that lead up to the toes) to the tarsal bones (bones in the arch of the foot).
The Lisfranc ligament, a tough band of tissue that joins these bones, helps to maintain joint alignment and strength. Athletes can sprain the ligament, fracture the bones, or dislocate the joint. Learn how to get back in the game after a Lisfranc injury with information about its types, causes, symptoms, and treatments.
Types of Lisfranc Injuries
- Sprains – Sprains are caused by trauma to or stretching of the Lisfranc ligament . The Lisfranc ligament and other ligaments on the bottom of the midfoot are stronger than those on the top. Therefore, when they are weakened through a sprain, athletes experience instability of the Lisfranc joint.
- Fractures – Fractures of the Lisfranc joint can be either avulsion fractures, in which a small piece of bone breaks off, or complete fractures, in which a bone or several bones of the midfoot are fully broken.
- Dislocations – Dislocations occur when the bones of the Lisfranc joint are forced from their normal positions.
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Causes and Risk Factors of Lisfranc Injuries
Lisfranc injuries occur as a result of direct or indirect forces or stress on the foot. Direct forces often involve a heavy object falling on the foot, while indirect forces involve twisting or stretching the foot. While the injury also can happen by simply missing a step on a staircase, you may be especially at risk if you are:
- An athlete who participates in contact sports
- A horseback rider
- Military personnel
- A runner
Symptoms and Diagnosis
The key sign of a Lisfranc injury is bruising on both the top and bottom of the arch area. Other symptoms may include:
- Swelling of the foot, especially on the top
- Pain in the midfoot that worsens when standing/walking or when pressure is applied
- Abnormal widening of the foot
- Inability to walk without an aid, such as crutches (in severe injuries)
Diagnosis of Lisfranc injuries
Lisfranc injuries are known for being easily misdiagnosed as they often present as ankle sprains or other foot/ankle injuries.
To arrive at a diagnosis, both physical examinations and imaging tests are necessary. The sports medicine doctor or surgeon will ask how the injury occurred and examine the foot to determine the severity of the injury. X-rays, other imaging studies, and further examinations may be needed to evaluate the extent of the injury.
The physical examination may include exercises like standing tiptoe on the injured foot or holding the toes and moving them up and down. Standing on your tiptoes puts significant stress on the midfoot and will cause pain from even a slight Lisfranc injury. Meanwhile, moving the toes up and down puts pressure on the midfoot, which will also produce pain if there is an injury.
Imaging for a Lisfranc injury may include x-rays to show broken bones and joint alignment. If the joint complex is not aligned, it may suggest that there is injury to the ligaments in that area of the foot. In some cases, CT scans or MRIs will also be used to provide detailed images of the foot. X-rays of the undamaged foot may be helpful for comparison
[Did you know? The Lisfranc joint and tendon are named after French surgeon Jacques Lisfranc de St. Martin, who served in Napoleon’s army and treated a number of soldiers for the injury. ]
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Treatment of Lisfranc Injuries
Nonsurgical treatments for Lisfranc injuries include:
- Immobilization – A cast to keep the injured foot immobile, and crutches to avoid putting weight on it.
- Ice and elevation – Ice and elevation work in combination to reduce swelling in the affected area.
- Oral medicines – Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen may help reduce pain and inflammation.
- Physical therapy – After swelling and pain have subsided, physical therapy may be recommended to rehabilitate the injured foot.
Lisfranc injuries that include a bone fracture, joint dislocation, or torn ligaments may require surgery. Surgical treatments for Lisfranc injuries include:
- Internal fixation surgery (most common) – This surgery involves positioning the injured bones correctly and holding them in place with wires, screws, or plates. The plates stay in place until the bones or joints heal and are then surgically removed.
- Fusion (severe injury) – This surgery involves fusing damaged bones together so that they heal as a single bone. Fusion may reduce motion in the foot, but it can be the best course of action in cases where internal fixation is impractical.
- Rehabilitation and physical therapy – This treatment will often follow surgical procedures. Physical therapy is done under the supervision of surgeons and physical therapists. This process may take several months, and athletes may not full recovery for a least a year. Depending on the severity of the injury, it may take longer than a year to regain full strength and mobility.
Make an appointment for a Lisfranc injury
A UPMC Sports Medicine expert can help diagnose and manage the symptoms of a Lisfranc injury. Our team routinely helps athletes recover from foot injuries and get back in the game.
To make an appointment or learn more about Lisfranc injury care, contact UPMC Sports Medicine at 1-855-93-SPORT (77678).
About Sports Medicine
Sports and physical activity bring with them a potential for injury. If you are looking to prevent, treat, or rehabilitate a sports injury – or improve athletic performance – UPMC Sports Medicine and the UPMC Sports Medicine Concussion Program can help. We serve athletes and active people of all ages and experience levels. Our experts partner with the Pittsburgh Steelers, Pittsburgh Penguins, Pitt Panthers, and about 100 other high school, college, and regional teams and events throughout Pennsylvania – working daily to build better athletes.