Lisfranc Injuries

Original Editor - Your name will be added here if you created the original content for this page.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Clinically Relevant Anatomy

The Lisfranc joints are tarsometaral articulations. In the normal Lisfranc joint complex, first 3 metatarsal bases articulate with their respective cuneiforms, and the lateral 2 metatarsals articulate with the cuboid. The second metatarsal base is tightly recessed in a mortise formed by the 3 cuneiform bones. The intertarsal ligaments, dorsal and plantar tarsalmetatarsal (TMT) ligaments, and transverse ligaments provide soft tissue stability.

Mechanism of Injury / Pathological Process

Injuries to the Lisfranc joint are usually the result of combined external rotation and compression force. Injuries can be caused by either direct or indirect trauma. Injuries to the joint are often missed due to anatomical complexity and rarity.

Clinical Presentation

Clinically, with the calcaneus held stable, abduction or pronation of the forefoot will produce pain over the midfoot. Typically, there is difficulty weight bearing, minimal swelling over the midfoot, and palpable tenderness along the tarsometatarsal joints.

Diagnostic Procedures

Currently, there are no specific clinical tests to confirm the extent of an injury. Therefore, diagnosis of ligmentous injuries may be based on a high level of suspicion. In suspected Lisfranc injuries, use of imaging modalities is warrented. Recommended radiographs include anteroposterior, lateral, and 30 degree internal oblique projections in weightbearing.  

Outcome Measures

add links to outcome measures here (see <a href="Outcome Measures">Outcome Measures Database</a>)

Management / Interventions

Treatment to Lisfranc injuries may be operative or non-operative depending on severity. In mild to moderate sprains, the lower extremity may be immobilized for approximately six weeks. More severe injuries may be treated with open reduction and internal fixation. Following ORIF, the foot is usually immpbilized for 8-12 weeks.

Physical therapy intervention begins shortly following immobilization in both operatvie and conservative treatment. Interventions include: edema reduction, strengthing to address post immobilization atrophy, flexibility exercises, gait training, and manufacturing of foot orthoses to help support the tarsometatarsal articulations.

Differential Diagnosis

add text here relating to the differential diagnosis of this condition

Key Evidence

add text here relating to key evidence with regards to any of the above headings

Resources

add appropriate resources here

Case Studies

add links to case studies here (case studies should be added on new pages using the case study template)

References

References will automatically be added here, see adding references tutorial.