Lisfranc Injury

The Lisfranc joint complex is a group of bones and ligaments in the middle of the foot that helps with stability and movement. A Lisfranc injury happens when these bones are fractured, or the ligaments are stretched or torn. Severity can vary from a simple injury involving one midfoot joint to a complex injury involving many midfoot bones. These injuries are classified into three main types:

1. Sprains: The ligaments in the midfoot are stretched but not torn.
2. Fractures: One or more bones in the Lisfranc joint complex break.
3. Dislocations: The bones in the midfoot move out of place due to ligament damage.

Lisfranc injuries can feel similar to an ankle or foot sprain, which is why they’re often overlooked. However, some key signs can indicate this type of injury:

• Pain and swelling in the top middle of the foot.
• Bruising on the top and bottom of the foot. Bruising on the bottom of the foot is a strong indicator of a Lisfranc injury.
• Difficulty walking or standing. There may be pain in the midfoot that worsens with standing, walking or attempting to push off on the injured foot. The pain may be so severe that weightbearing is not possible.

Lisfranc injuries happen when there is too much force or pressure on the middle of the foot. Common causes include:

• Sports injuries: Football, soccer, and basketball players often suffer Lisfranc injuries when they twist their foot or get tackled.
• Falls and missteps: A Lisfranc injury like missing a step or falling from a height can cause the midfoot to bend in an unnatural way, leading to an injury.
• Car accidents or heavy objects falling on the foot: These high-impact events can cause serious fractures and dislocations.
• Weak bones from medical conditions: People with arthritis or osteoporosis may be at a higher risk for Lisfranc injuries, even from minor trauma.

Since these injuries can be mistaken for simple sprains, it’s important to see a specialist like Dr. Allison Boden for a proper diagnosis. She uses a combination of a physical exam and imaging tests to determine the severity of the injury.

Physical Exam

Dr. Boden will check for swelling, bruising, and tenderness in the midfoot. She may perform simple tests, such as:

• Piano Key Test: Pressing down on the toes to see if it causes pain in the midfoot.
• Midfoot Stress Test: Gently twisting the foot to check for instability and discomfort.

Imaging Tests

• X-rays: The first step in diagnosing Lisfranc injuries. Weight-bearing X-rays (taken while standing) can show misalignment in the bones.
• MRI: Used if ligament damage is suspected but not visible on X-rays.
• CT scan: Provides a more detailed 3D image of the foot to detect small fractures.

Lisfranc injuries are serious and can lead to long-term problems, such as arthritis and chronic pain, if not treated properly. If you have midfoot pain after an injury and it isn’t improving, it’s important to see a specialist.