Nov 29 2007
Lisfranc’s Injury
A Lisfranc’s injury is becoming a common term among football fans with Indianapolis Colts defensive end, Dwight Freeney, sidelined by this injury.
The Lisfranc joint is actually a group of joints where the long bones in the foot (metatarsals) meet the midfoot (tarsal bones). These joints are held together by a series of ligaments on the top and bottom of the foot. The lisfranc’s ligament connects the base of the 2nd metatarsal to the 1st cuneiform and is the strongest ligament of the group.
A Lisfranc’s injury is the rupture of the lisfranc’s ligament and the associated dislocation of the lisfranc’s joint. The rupture of the ligament may be accompanied by metatarsal base fractures (breaks in the long bones in the foot). This injury is called a Lisfancs fracture-dislocation. The injury is often misdiagnosed as a simple foot sprain because the changes on X-ray can be very subtle.
Lisfranc’s injuries are not common, with an incidence of 1 in every 55,000 people. Only 0.02% of all fractures are lisfranc’s fractures. Yet, many speculate that this incidence is so low because these injuries are commonly misdiagnosed. The changes on X-ray can be very subtle and many times it’s necessary to X-ray both feet for comparison or do stress views. Since the bases of the metatarsal bones overlap on X-ray, it can be difficult to see fractures in this area. In many cases a CT scan is ordered to better visualize the metatarsal bones.
This injury was originally known to occur when an individual fell off a horse and the forefoot was caught in the stirrup, causing a separation between the front of the foot and the midfoot. The injury can also occur in car accidents when the ball of the foot is on the pedal and the impact of the crash forces the front of the foot up, rupturing the lisfranc’s ligament. Other mechanisms include a crush injury - a direct force to the foot - and in football, being tackled from behind while the foot is planted. The force from the tackle puts a tremendous force through the midfoot, causing rupture of the ligament, dislocation of the forefoot on the midfoot and possible breaks in the metatarsal bones.
Diagnosis is important because injuries which go without treatment can result in chronic midfoot instability and future arthritis. Even with treatment, there are chances for post-traumatic arthritis in the midfoot. The treatment depends on the severity of the injury, either with casting and crutches for minor Lisfranc’s injuries or surgical treatment involving screw placement and a long rehabilitation period, for more severe Lisfranc’s injuries.
The foot is a lot more complex than I would have thought…. and Seinfeld made fun of podiatrists.
The way it’s described, it’s amazing that anyone could actually ever recover from this. The human body is pretty amazing… as well as the accompanying surgery and treatment.
I think I may have one of these fractures. It started with a “freak” accident of dropping a board on top of my foot over a year ago. I wore a surgical boot several months to help the injury, a hairline fracture, heal. About 3 months ago, I noticed a bony bump on the bottom/right side of my right foot. I went back to the podiatrist/surgeon who had done plantar fasciotomy on that foot and the other foot, as well, and had x-rays & MRI done. He said it looked like a dislocated bone and referred me to another orthopedic doctor. I go to him tomorrow. Since it is so unusual and atypical of the places in the foot to have this kind of injury, I am wondering if this might be a Lisfranc injury. Fortunately, I have not had any major pain, which the podiatrist thought unusual, also. After reading up on this, and if it turns out to be the diagnosis, I wonder what the treatment will be. The podiatrist thought the bone could be shaved, but he thought it would be a shame to have to do that to a perfectly good bone. I will try to update on my new doctor’s findings.