BARRET JONES and :
The Lisfranc joint is the point at which the metatarsal bones (the long bones that lead up to the toes) and the tarsal bones (the bones in the arch, which include the cuneiform bones) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. It is important for maintaining proper alignment and strength of this joint.
Lisfranc injuries occur as a result of trauma to the midfoot. In the case of a football player, a Lisfranc injury most commonly occurs when the forefoot is planted on the ground with the heel in the air. A downward or twisting force on the heel causes stress on and potential damage to the foot.
There are three types of Lisfranc injuries, which sometimes occur together:
- Sprains: The Lisfranc ligament, as well as other ligaments on the bottom of the midfoot, are stronger than the ligaments on the top of the midfoot. Therefore, when they are weakened through a sprain (a stretching of the ligament), patients experience instability of the joint in the middle of the foot.
- Fractures: A break in a bone in the Lisfranc joint can be either an avulsion fracture (a small piece of bone is pulled off) or a break through the bone or bones of the midfoot.
- Dislocations: The bones of the Lisfranc joint may be forced from their normal positions.
A Lisfranc injury is initially diagnosed based on the history and description of the injury. A patient may describe the immediate onset of pain in the midfoot region. There may be difficulty or even an inability to put weight on the injured foot.
Over the course of the ensuing days, swelling and bruising often occurs, and on a physical exam, the injured patient will be tender over Lisfranc's joint.
Any suspected injury should be evaluated studied initially with x-rays of the foot. When an injury occurs that involves a fracture in this region, a CT scan or MRI are best for evaluating the complex bony detail of the region. MRI in particular is helpful in detailed evaluation of the ligaments, and it can see bruising in the small bones of the foot, which indicates an acute injury.
If testing determines that the injury is stable, with the bones still in their proper orientation, a Lisfranc injury may be treated with a period of non-weightbearing followed by gradual return to normal activites. For a stable Lisfranc injury, treatment begins with a period of immobilization either in a removable boot or frequently a cast that includes the foot and the leg below the knee (a short leg cast).
This typically lasts 6 to 8 weeks with the patient using crutches and not allowed to put weight on the injured extremity.
If the injury is unstable, or even if the suspicion is there for it to be unstable, then surgical treatment is warranted. The timing of surgery depends on the amount of swelling and the status of the skin overlying the injured foot. If there is too much swelling or the skin is in poor condition from the injury, a short period of elevation and swelling control is warranted prior to surgery.
Surgery typically involves rigidly stabilizing the injured joints. The specific midfoot joints that are stabilized depend on the specific ligaments that are injured and may vary somewhat on a case-by-case basis.
The majority of the time, stabilizing the injured region requires one or a few relatively small incisions, the placement of screws and in some cases wires. By holding the involved joints rigid, the torn ligaments are allowed to heal.