Why does it occur?
The Lisfranc joint is a unique and important stabilizing joint (Tarsometatarsal joint) in your midfoot, midway between the toes and the heel. A tremendous amount of force is transmitted through this joint with each step that you take. An injury to this joint ranges from a mild sprain to severe dislocations and fractures. Injury most commonly occurs when a force is transmitted to a foot that is hyper-plantar flexed, commonly seen in soccer and football players. Injury can also occur as a result of direct trauma to the area.
Patients typically present with pain, swelling and bruising around the midfoot area, painful weight-bearing or inability to bear weight. The tarsometatarsal joint will typically be tender, and stress testing of the joint often worsens the symptoms.
An x-ray is usually ordered to assess the Lisfranc joint to look for any evidence of fracture or dislocation. An MRI may be ordered to assess the ligaments of the Lisfranc joint. CT may be needed to further evaluate any fractures that may be present.
Nonoperative management is normally reserved for Lisfranc injuries where there is no evidence of joint instability or displaced fracture. These types of injuries are commonly considered to be Lisfranc sprains. Lisfranc sprains are serious injuries, so the treatment and recovery should be taken seriously. Nonoperative treatment usually consists of cast immobilization or CAM boot for approximately 8-12 weeks followed by 6-12 weeks of PT and a gradual return to normal activity. Depending on the severity, patients can expect to return to normal activities/sports in 3-6 months.
Surgery is usually indicated for failed nonoperative management, any evidence of joint instability, fracture-dislocations, and chronic injuries with delayed treatments. Surgery is designed to realign the Lisfranc joint, repair damaged ligaments, and stabilize/realign any fractures. This usually involves some combination of plates and screws. Recently, a new innovation called Internal Bracing has been proven to strengthen the repairs of ligaments. Its use for reinforcing and strengthening Lisfranc’s ligaments is showing great promise, and is another tool in our armamentarium to treat this complex injury.
Dr. Steven Lee is currently the Associate Director of the NISMAT, the first institute in the country dedicated to sports medicine research, and is part of the teaching faculty of the Lenox Hill Sports Medicine Fellowship program, the oldest fellowship in the country. As such, he is not only current with the most advanced techniques available today to treat this complex problem, but is also involved in research to advance the treatment for the future. Dr. Lee is also one of the world’s leaders in the pioneering and use of Internal Bracing. He has years of experience treating Lisfranc injuries.
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After surgery, patients are typically immobilized and non-weight-bearing in a Cam boot for at least 6-8 weeks after surgery. This is followed by physical therapy for at least two to three months. Proper treatment is imperative to increase your chances of a positive outcome. Even with proper care (surgical or non-surgical), patients Lisfranc injuries are at increased risk for developing chronic pain and arthritis of the affected foot. If this were to happen and it was debilitating enough, joint fusions would be considered the salvage surgery that could be done to help alleviate pain at the expense of losing some motion of the foot.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.