Foot & Ankle

Linsfranc (Midfoot) Injury

The Lisfranc joint complex is a vital structure in the midfoot that connects the forefoot to the rest of the foot. It consists of a group of ligaments and bones that stabilise the foot, enabling proper movement and effective weight distribution.

Understanding Lisfranc Injuries

A Lisfranc injury occurs when these ligaments or bones are damaged due to high-impact trauma, falls, or sports injuries.

Lisfranc injuries can vary in severity, from sprains and ligament tears to fractures and dislocations of the bones in the midfoot. This type of injury is particularly concerning as it can significantly impair the ability to walk and lead to long-term complications like chronic pain, arthritis, and instability if left untreated. Early intervention and accurate diagnosis are essential for optimal recovery.



Causes and Risk Factors

Lisfranc injuries are typically caused by trauma or abnormal twisting of the foot. Common causes include:


Symptoms of Lisfranc Injuries

Recognising the symptoms of a Lisfranc injury early is essential for timely intervention. Common symptoms include:

  • Pain: A sharp pain in the midfoot or arch, often worsening with activity or pressure.
  • Swelling and Bruising: Swelling in the foot or ankle, with bruising visible on the top and bottom of the foot.
  • Visible Deformity: In severe injuries, there may be visible displacement or misalignment of the bones in the foot.
  • Difficulty Bearing Weight: Difficulty walking or bearing weight on the affected foot.
  • Tenderness on Palpation: The midfoot may be tender to touch, with pain concentrated in the injured area .


Diagnosis of Lisfranc Injuries

Accurate diagnosis of Lisfranc injuries is essential to determine the appropriate treatment. Dr. Ryan du Sart will conduct a comprehensive clinical examination, focusing on assessing swelling, tenderness, and possible deformity. Imaging studies, such as X-rays, are crucial for identifying fractures, dislocations, and joint alignment issues.

In some cases, CT scans or MRIs may be required to assess the severity of the injury, detect ligament damage, or evaluate joint instability . Detailed imaging is vital for planning the most suitable treatment approach for the patient.


Treatment Options for Lisfranc Injuries

Dr. Ryan du Sart offers both non-surgical and surgical treatment options for Lisfranc injuries, depending on the severity of the injury and the patient’s overall health and activity level.


Non-Surgical Treatment

For mild Lisfranc injuries, non-surgical management is often effective. Conservative treatment may include:

  • Rest and Immobilisation: The foot will be immobilised with a cast, brace, or walking boot to provide stability and prevent further injury during the healing process.
  • Ice and Elevation: Applying ice to the injured area and elevating the foot above heart level helps reduce swelling and manage pain.
  • Medications: Pain relief, such as paracetamol or NSAIDs (non-steroidal anti-inflammatory drugs) can be prescribed to alleviate pain and reduce inflammation.
  • Physical Therapy: After the initial healing phase, physical therapy will help restore strength, flexibility, and range of motion in the foot and ankle.

Dr. du Sart typically monitors progress regularly and will adjust the treatment plan based on how the injury heals.


Surgical Treatment

For more severe injuries or if conservative treatments fail, surgery may be necessary. Surgical treatment options include:

  • Open Reduction and Internal Fixation (ORIF): This procedure involves realigning the bones and securing them with screws, plates, or wires to ensure proper healing and stability. A key goal of ORIF is to restore the foot's normal function and prevent long-term joint instability.
  • External Fixation: For complex fractures or severe soft tissue damage, external fixation may be required. This involves the use of an external frame to hold the bones in the correct position during the healing process.
  • Fusion Surgery: In cases of joint instability, where conservative treatments or ORIF have not been successful, fusion surgery may be performed. This procedure involves fusing the bones in the joint to provide long-term stability and reduce pain.

Surgical intervention is often necessary for fractures that involve displacement or joint instability.


Recovery and Rehabilitation

The recovery process after a Lisfranc injury varies depending on the severity of the injury and the type of treatment received. However, the typical recovery process includes:

  • Initial Immobilisation: The foot will likely need to be immobilised for 4-6 weeks, depending on the severity of the injury. During this period, crutches or a knee scooter may be necessary to avoid putting weight on the injured foot.
  • Physical Therapy: Once healing has progressed, physical therapy will help restore strength, flexibility, and function to the foot. It is crucial to follow the prescribed rehabilitation exercises to prevent future complications.
  • Gradual Weight-Bearing: Once healing is sufficiently advanced, weight-bearing activities can be gradually reintroduced under medical supervision.
  • Return to Activity: Most patients can expect to return to normal activities within 3-6 months, though athletes and those involved in high-impact sports may require a longer recovery period.


Preventing Future Lisfranc Injuries

While some Lisfranc injuries are unavoidable, the following preventive measures can help reduce the risk:

  • Proper Footwear: Wearing supportive, well-fitted shoes is essential for preventing injuries to the midfoot and ensuring optimal foot alignment.
  • Foot Strengthening Exercises: Strengthening the muscles surrounding the foot can help provide stability and reduce the risk of future injuries.
  • Gradual Increase in Activity: Avoid sudden increases in physical activity. Gradually building stamina and strength can prevent overuse injuries and reduce stress on the midfoot.
  • Sports Taping or Bracing: In high-risk sports, ankle taping or wearing a brace can help protect the Lisfranc joint from excessive strain.


Why Choose Dr. Ryan du Sart?

Dr. Ryan du Sart is a highly trained orthopaedic surgeon with extensive experience in diagnosing and treating Lisfranc injuries. His patient-centred approach ensures that every treatment plan is tailored to meet the unique needs of each patient. Dr. du Sart’s use of advanced techniques and minimally invasive procedures helps patients achieve the best outcomes with faster recovery times.

Book a Consultation

If you suspect a Lisfranc injury or are experiencing foot pain after trauma, don’t delay seeking medical care. Early intervention can prevent long-term complications and promote a faster recovery.

Phone: (08) 9779 9767

Email: admin@ryandusart.com.au

Locations:

6 Higgins Street, South Bunbury, WA 6230

20 Prince Street, Busselton, WA 6280



References:

  1. American Academy of Orthopaedic Surgeons (AAOS). (2020). Lisfranc Injuries.https://www.aaos.org
  2. Cleveland Clinic. (2021). Lisfranc Injuries: Symptoms and Treatment.https://my.clevelandclinic.org
  3. Foot and Ankle International Journal. (2019). Lisfranc injuries: Diagnosis and treatment options.https://journals.sagepub.com
  4. Royal Australian College of Surgeons (RACS). (2020). Foot and Ankle Trauma.https://www.surgeons.org