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Lisfranc Who?

Submitted By David A. Porter M.D. PhD.
11.03.2009

The History of a Common Midfoot Injury

Jacques Lisfranc de St. Martin was a surgeon in Napoleon’s army that developed a method of amputation across the midfoot as a treatment for gangrene.  Eventually the midfoot joint became known as the Lisfranc joint (a complicated arch made up of many bones and ligaments).  Today, when someone experiences a complete rupture of the midfoot ligaments, it’s known as a Lisfranc injury.

Classically, this injury took place when a rider fell off his horse with his foot caught in the stirrup, twisting and injuring the joints in the midfoot. Nowadays, the occurrence of this injury is most commonly seen in American football players.  However, a Lisfranc injury can occur in any sport or from virtually any physical activity associated with the foot or ankle. The most common everyday causes are twisting your foot from stepping in a hole or missing a stair.

Symptoms of this injury include pain in the midfoot, mild swelling in the midfoot and forefoot, and inability to run. Treatment and severity depend on whether the injury is stable or unstable. If the Lisfranc is stable (meaning the main ligament is intact), treatment will usually include the R.I.C.E. method (rest, ice, compression, and elevation), crutches, and/or a walking boot. If the ligament is torn, then the Lisfranc is unstable and surgery is needed to reverse the injury. The procedure usually includes repair of the ligament and placing screws across each of the disrupted joints.

For athletes, recovery from a Lisfranc injury can take five to eight months. Ultimately, the athlete’s ability to return to play depends on pain level, stability of the foot, endurance and agility. Athletes may need to limit activity early on, and use a custom shoe insert when they initially return to the field.  With proper treatment, patients can usually have a complete recovery from the Lisfranc injury.

If you believe you’ve experienced a Lisfranc injury, you should seek medical attention immediately from an experienced orthopedic foot specialist.  Doing so will make sure you’ll be on your road to recovery in no time.



Replies

Rachel Strothman

On December 23rd ’09 I was running down the stairs in my home and felt an indescribable pain shoot through my right foot. Initially I thought it was just a muscle strain. Boy was I wrong. On Christmas day I was in enough pain that I knew something had to be fractured. In the emergency room I was told that I had broken my 4th and 5th metatarsal bones in my right foot. The doctor suited me with a temporary cast, some pain meds, and a number to call to arrange an appointment to see a specialist but not much else. Unfortunately, all the info that I have about these breaks I have learned on my own via the web. The info varies greatly. So I am unsure of what is truely reliable. The doctor in the emergency room told me that I have a spiral fracture on the 4th and what appeared to be a straight across break near the joint on the 5th. He used a technical term for this break but I cannot remember it. The doctor also told me that at my appt. on the 19th I will learn the severity of my injury and find out if it may require surgery. I’ve learned that the 5th metatarsal break is called a Jones fracture. I have also learned of a LisFranc injury of wich I don’t know much about. I do know that because of the location of my injury it is a possibility. From the info that i’ve given what is the likely hood of my needing surgery and do you think that I should request it? You mentioned before that cast treatment can take 3-4 months with 50-75% healing and an operative approach has a 6-10 week recovery with 98-99% healing. The latter sounds better to me. Why do healing times differ so greatly? Do you have any recommendations on how to get my healing off on the right foot(no pun intended…ok maybe a little) Also, I have very intense calf and heel pain. The heel pain is the worst when I am in bed. The calf pain is more muscular. Is there anything I can do to control this pain? Additionally, I have a persistant numb sensation in virtually my entire foot. Is this normal? And finally, I know this sounds odd but how do you recommend I bathe? I tried using a plastic trash bag but water still seeped in and dampened my cast.

David A. Porter M.D. PhD.

I am sorry you hurt your foot. I can’t tell you how to treat your foot since I have not seen you or your foot. Lis franc is most a problem when it involves the ligaments of the first and second metatarsal. If the fracture on the fifth is near the toe, it would not be a Jones, if it is more toward the midfoot, then could be Jones. The fourth is typically treated non-operatively.

If you are in a cast and the cast seems tight you should call your doctor, That can be a cause of numbness and you can get cast syndrome.


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