LisFranc (Midfoot) Fracture-Dislocation

What is LisFranc (Midfoot) Fracture/Dislocation?

LisFranc (Midfoot) Fracture/Dislocation Definition

The LisFranc fracture or injury occurs in the portion of the foot known as the "midfoot," approximately halfway between the ankle and the toes. These injuries involve tarsometatarsal joints, bones, and ligaments. The injury is named after Jaques Lisc Franc de St. Martin, a French surgeon, who described the injury during the Napoleonic wars as soldiers were thrown from horseback and the midfoot was injured as the soldier's foot was caught in the stirrup.

A LisFranc fracture can occur in athletic activities like windsurfing, wake boarding, snowboarding, or other activity where the foot in secured into a boot. Contact sport athletes can suffer this injury when the foot is in a downward position with the ball of the foot low to the ground and another player lands on the heel. Indirect injury occurs with the rotation of the body around a fixed forefoot like being thrown backwards from a horse while the foot is fixed in the stirrup. Direct injury can occur by a heavy object falling onto or rolling over the top of the midfoot.

LisFranc (Midfoot) Fracture/Dislocation Symptoms and Anatomy

Symptoms include pain and significant swelling and focal tenderness and often bruising localized to the tarsometatarsal/midfoot region of arch of the foot. Patients are typically unable to put weight on that foot. Many patients describe feeling a pop or a snap in the area of the midfoot.

Physical examination will reveal localized tenderness in the tarsometatarsal region or LisFranc ligament, localized swelling in the tarsometatarsal region, and discoloration and/or bruising in the tarsometatarsal region and arch of the foot.

When a LisFranc injury has occurred weight-bearing x-rays, CT scan, or MRI imaging will typically show widening of space between the first metatarsal and second metatarsal with a lateral shift of the base of the second metatarsal. X-rays may also show a bone fragment at the base of the second metatarsal where the LisFranc ligament attaches.

LisFranc (Midfoot) Fracture/Dislocation Treatment Options

For recent and stable, non-displaced (less than 2 mm) injuries, casting with non-weight bearing treatment for six weeks followed by physical therapy and foot orthotics.

For recent unstable and significantly displaced injuries or for older injuries with chronic pain or arch collapse deformity, surgery may be required.

LisFranc (Midfoot) Fracture/Dislocation Surgery

For recent unstable and significantly displaced (greater than 2 mm) open reduction and internal fixation with temporary screws or more permanent sutures or anchor systems may be implemented.

For older injuries with chronic pain or arch collapse deformity midfoot arthrodesis/fusion of the bones may be required.

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