The point where your bones in the arch (tarsal bones) and the long bones leading up to your toes (metatarsal bones) connect is known as the Lisfranc joint. The Lisfranc ligament is a strong band of tissue which connects a couple of these bones. It's an essential ligament for maintaining the strength and correct alignment of your joint.
Types of Lisfranc (Midfoot) Injuries
There are a few different types of these injuries that happen together in some cases. These are:
On the bottom of your midfoot, you have the Lisfranc and other ligaments that are stronger than the ones found on the top of your midfoot. When you get a sprain or your ligament stretches and they become weakened, it can result in your middle foot joint becoming unstable.
This is when a bone is broken in your Lisfranc joint and can be either a break through the bones of your midfoot or you pull off a small piece of bone (avulsion fracture).
A dislocation is when your Lisfranc joint bones are forced from their regular positions.
Symptoms of a Lisfranc Injury
The various symptoms you can experience from this injury include:
- Foot swelling
- Painful midfoot when you stand or apply pressure
- Injury is severe enough that you can't bear weight
- Arch blistering or bruising; sometimes on the top of your foot
- Your foot widens abnormally
Causes of a Lisfranc Injury
One of the most common causes of Lisfranc injury is a car accident. You can get this injury for other reasons such as:
- Horseback riding
- Playing football
- Playing contact sports
- Military injuries
The direct or indirect force to your foot is what leads to this injury. If you drop a heavy object on your foot this is known as a direct force. Twisting your foot is an example of indirect force.
Your Lisfranc Injury Diagnosis
A Lisfranc injury can occasionally be mistaken for an ankle sprain, therefore a proper diagnosis is important. Your Pensacola foot and ankle surgeon will ask you a series of questions about your injury and will give you an examination of your foot in order to determine how severe your injury is and come up with a diagnosis.
He may take x-rays or some other type of imaging study to get a full evaluation of the severity of your injury. Additional examinations might be needed while you are under anesthesia to evaluate a weakening of your joint and surrounding bones or fracture.
Treatment Options for Lisfranc Injury
There are both conservative, non-surgical treatments and surgical procedures for a Lisfranc Injury.
If you are experiencing symptoms of this injury, it's important you set up an appointment with your Pensacola orthopedic specialist immediately. If you can't, elevate and keep off your injured foot. You should also apply an ice pack to the injured area every 20 minutes, which will help keep your pain and swelling down.
Other types of nonsurgical treatments for a Lisfranc injury might include:
- Immobilization. A cast and crutches might be used to keep your foot immobile and avoid any added weight on it.
- Oral Medications. To reduce inflammation and pain, the doctor might recommend ibuprofen and other nonsteroidal anti-inflammatory medications.
- Elevation and Ice. You can reduce swelling by keeping your foot elevated and applying ice to the affected area.
- Physical Therapy. Once your pain and swelling have subsided, your doctor might prescribe physical therapy.
In some cases, particularly when there is significant displacement of the midfoot joints with instability, you might require surgery for your Lisfranc injury, which may include internal fixation or fusion, followed by rehabilitation. Your Pensacola orthopedic surgeon will work with you to decide which type of surgery will best suit your individual case. Emergency surgery might be needed for more extreme injuries.
What should patients expect following Lisfranc surgery?
Directly following surgery, you will receive a non-weight bearing splint. This splint is designed to protect your incisions and bones as they heal. Although patients will receive pain medication, elevating the foot to reduce inflammation also helps decrease pain; therefore, Dr. Erik Nilssen and his team recommend that you keep your foot elevated as much as possible.
Your two-week follow-up appointment
Approximately two weeks following surgery, you will return to Nilssen Orthopedic Center and Dr. Nilssen and/or members of his team will remove your non-weight bearing splint and sutures. Once these are removed, you will receive a boot or cast; however, you still need to keep weight off of your foot for another four to six weeks.
Your six-week appointment
At your six-week appointment, you may receive a walking boot or cast. It is important to note that some patients will not receive their walking boot or cast until their eight-week, post-surgical appointment. Once you do receive your walking boot or cast, you will continue using it for four to six weeks. If pins were placed during your surgery to stabilize the fourth and fifth metatarsals, these pins are removed approximately six- to eight-weeks following your surgery.
10 to 12 weeks following surgery
At some point between 10 to 12 weeks, your boot will probably be replaced with an athletic shoe. The athletic shoe is designed to be more rigid and provide your foot with an adequate amount of arch support. The arch support insert reduces the amount of stress placed on the middle of your foot. The majority of Dr. Nilssen's patients will be prescribed physical therapy. The goal of physical therapy is to strengthen the foot and improve its function: A full recovery can take more than 12 months.
As with any surgical procedure, there are complications that can arise:
- There are risks associated with the use of anesthesia, the potential for excessive bleeding, blood clots and/or an infection.
- During Lisfranc surgery, an incision must be made very close to a nerve: Should this nerve become injured during the procedure, the patient will experience numbness in the foot. However, this numb sensation is usually painless and the foot typically recovers with time.
- After suffering a Lisfranc injury, some individuals will develop post-traumatic arthritis in the joints located in the middle of the foot. This occurs due to a degeneration of the cartilage in these joints. Post-traumatic arthritis can cause the middle part of the foot to become painful and stiff.
Frequently Asked Questions
1. What if I do not seek treatment for a Lisfranc injury?
An untreated Lisfranc injury can lead to serious complications. These complications may include joint degeneration as well as damage to the blood vessels and nerves in the foot. This damage is caused by the buildup of pressure within the muscles of the foot.
2. How can I determine if I have a Lisfranc injury or just a sprain?
Lisfranc injuries can be minor: It is possible to "sprain" the Lisfranc ligament, which does not require surgical intervention. Conditions or injuries in which the ligament is completely torn or ruptured cause the foot to become unstable. When instability occurs, surgical fixation is usually required.
If you think you have sprained your foot, you need to rest it, apply ice to it and keep your foot elevated for the initial 24-48 hours following the injury. If after this amount of time your foot is still inflamed and painful, you need to contact your physician to request a referral to Nilssen Orthopedics Ankle and Foot Center in Pensacola, Fla. In addition, if at any point you notice extensive bruising on the bottom of your foot, contact your doctor to request a referral right away.
3. What determines if I need Lisfranc surgery?
If you have just sprained the ligaments of the foot and it remains stable, you will not need surgery. Injuries such as this usually require the use of a cast or boot. Most patients need to wear the boot or cast for six to eight weeks.
4. Is there anything I need to tell Dr. Nilssen before my surgery?
Yes, inform Dr. Nilssen if you notice substantial inflammation within your soft tissues if you have a foot fracture that was caused by nerve dysfunction (referred to as Charcot foot) or severe peripheral vascular disease.
5. Does the hardware placed in my foot during surgery remain there indefinitely?
Sometimes the plates or screws that are placed during Lisfranc surgery are removed. This removal usually occurs within four to six months following surgery. However, if the hardware placed during surgery intends to help your bones fuse together, this hardware is not removed unless it becomes bothersome.
6. I recently injured my foot, should I have it realigned or do I need to have it fused?
Orthopedic foot and ankle specialists have debated this topic: Dr. Nilssen’s opinion is that a patient with a simple Lisfranc injury does not necessarily need surgery. Conversely, patients who have more substantial injuries resulting in a fracture that involves the joint surfaces or an obvious displacement of the joints can benefit greatly from surgical intervention. In cases such as these, Dr. Nilssen recommends a fusion.
Other factors that Dr. Nilssen takes into consideration when determining whether a patient needs surgery include the age of the patient and whether or not the patient already has arthritis in his or her foot. Dr. Nilssen recommends the treatments he feels will provide the patient with the best results possible.
7. How long will it be before I can return to my normal activities?
As each patient is unique, recovery times vary. However, it is essential that you follow Dr. Nilssen’s orders and refrain from returning to your normal activities until you receive direction to do so. Patients who disregard his orders and return to their normal activities too soon may cause other injuries: Injuries that could lead to damage to the blood vessels in the foot. Moreover, these individuals are more apt to develop arthritis and/or slow their recovery.