Lisfranc’s (mid-foot) joint injury

What is it?

The human foot can be separated into three main sections: the rear-foot consisting of the heel and ankle, the mid-foot containing smaller tarsal bones, and the fore-foot consisting of the metatarsals and toes. In simple terms, the Lisfranc’s joint is the connection between the metatarsal and tarsal bones. This major load bearing joint consists of multiple ligaments that intertwine between the bones and is primarily concerned with maintaining the arch of the foot. A Lisfranc’s joint injury occurs when there is damage to one or more of these small ligaments, resulting in loss of the structure/strength of the mid-foot.

Why did I get it?

Always due to trauma.
The following is a list of the 3 most common mechanisms in which a Lisfranc’s injury occurs:

• Falling from a height and landing on point of toes (e.g. Ballet dancer’s)

• Longitudinal compression while on toes (e.g. Rugby scrum)

• Falling backwards with foot strapped in (e.g. Horse riders/Snowboarding)

Symptoms:

A Lisfranc joint injury might cause symptoms like the following:

• Pain in your midfoot, especially tenderness to the touch

• Swelling or deformity in the middle region of your foot

• Inability to put weight on your foot

• Bruising in the middle of your foot

The intensity of these symptoms may vary according to the severity of your injury and how long ago it happened.

How is it diagnosed?

As a Lisfranc’s joint injury can be graded into 3 categories, your Podiatrist/ GP will almost always refer you for a weight-bearing x-ray, MRI or CT scan. These images will highlight the severity of the injury and grade you into 1 of the 3 categories.

Treatment Protocol:

• Grade 1: -

  • Non weight bearing for 6 weeks

  • Orthotics

  • Rehabilitation program

  • Gradual return to activity/sport

• Grade 2 & 3: -

  • Surgery

Prognosis:

• Largely dependent on the grade.

• For stage1 injuries, the prognosis is good providing absolute compliance by the individual.

• Referral to a surgeon for stage 2 and 3 injuries

• Post surgery/recovery return to activity with correct orthotics and footwear