Introduction

A Lisfranc injury refers to damage to the midfoot, specifically involving the tarsometatarsal (TMT) joints, where the metatarsal bones connect with the tarsal bones. These injuries can range from mild sprains to severe fractures and dislocations, often resulting from trauma. Prompt diagnosis and appropriate treatment are crucial to prevent long-term complications such as chronic pain and deformities.

What is a Lisfranc Injury?

A Lisfranc injury encompasses a spectrum of injuries to the midfoot, including sprains, fractures, subluxations, or fracture-dislocations. The injury typically involves the displacement of the metatarsal bones from the tarsal bones, particularly affecting the articulation between the medial cuneiform and the base of the second metatarsal. This disruption compromises the stability of the foot's arch and its ability to bear weight effectively.

Why Do People Get Lisfranc Injuries?

Lisfranc injuries are often the result of trauma, with common causes including:

• High-Energy Trauma: Motor vehicle accidents and falls from significant heights can exert excessive force on the midfoot, leading to fractures or dislocations.

• Sports Injuries: Activities that involve sudden twisting motions or direct impact to the foot, such as football or basketball, can cause Lisfranc injuries.

• Low-Energy Trauma: In some cases, even minor trauma, like a simple fall or misstep, can result in a Lisfranc injury, especially if ligaments are weakened or stretched.

Additionally, conditions that affect bone density or ligament strength, such as osteoporosis or rheumatoid arthritis, may predispose individuals to these injuries.

Medical Classification of Lisfranc Injuries

Lisfranc injuries are classified based on the severity and pattern of displacement:

• Myerson Classification:

  • Type A: Total incongruity with complete dislocation of all metatarsals.

  • Type B: Partial incongruity; B1 involves medial dislocation of the first metatarsal, while B2 involves lateral dislocation of metatarsals two through four.

  • Type C: Divergent dislocations; C1 involves partial displacement of the first metatarsal and some of the others, while C2 involves total displacement of the first metatarsal and all others.

• Orthopaedic Trauma Association (OTA) Classification:

  • Type A: Homolateral injuries with all metatarsals displaced in the same direction.

  • Type B: Injuries with partial displacement of some metatarsals.

  • Type C: Divergent injuries with metatarsals displaced in different directions.

These classifications assist in determining the appropriate treatment approach, ranging from conservative management to surgical intervention.

Common Signs and Symptoms of a Lisfranc Injury

Individuals with a Lisfranc injury may experience:

• Pain and Swelling: Localized pain and swelling in the midfoot, especially when bearing weight.

• Bruising: Visible bruising on the top or bottom of the foot.

• Inability to Bear Weight: Difficulty or inability to stand or walk due to pain.

• Deformity: Visible misalignment or abnormal positioning of the toes or midfoot.

• Tenderness: Tenderness upon palpation of the midfoot area.

Early diagnosis and appropriate management are essential to prevent long-term complications, including chronic pain and foot deformities.

Conclusion

Lisfranc injuries, though relatively rare, are significant due to their potential to impair foot function and mobility. Understanding the nature of these injuries, their causes, classifications, and clinical presentations is crucial for timely diagnosis and effective treatment. Early intervention can lead to better outcomes and a quicker return to normal activities.