Lisfranc Joint Injury

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What is a Lisfranc joint injury?

A Lisfranc joint injury is a type of injury to the bones or ligaments, or both, in the middle part of your foot. There is often damage to the cartilage covering these bones in a Lisfranc joint injury.

A cluster of small bones form an arch in the middle part of your foot (midfoot). Five of these long bones (the metatarsals) extend to the toes. The group also includes smaller bones: the cuboid bone and the medial, middle, and lateral cuneiform bones. Tight connective tissue bands hold these bones in place and give the joint its stability. This part of the foot is important in stabilizing your arch. It also transfers the force from your calves to the front of your feet.

There are different categories of Lisfranc injuries. It depends on the direction of the displaced metatarsals and their degree of displacement. It also depends on how many bones are affected. The injury gets its name from a French surgeon, Jacques Lisfranc de St. Martin.

What causes a Lisfranc joint injury?

Lisfranc joint injuries occur from trauma to the foot. This may happen with a simple twist and fall on top of a foot that is pointing downward. It is common in football and soccer players. Lisfranc injuries can also happen from direct trauma, like a fall or a motor vehicle accident. Such an injury is more likely to cause a more severe injury. There may be multiple fractures and dislocated bones in the midfoot area.

What are the symptoms of a Lisfranc joint injury?

A Lisfranc joint injury might cause symptoms such as:

Pain in your midfoot, especially sore to the touch
Swelling or deformity in the middle region of your foot
Inability to put weight on your foot
Bruising in the middle of your foot

The intensity of these symptoms may vary. It will depend on the severity of your injury and how long ago it happened.

How is a Lisfranc joint injury diagnosed?

Your healthcare provider will start with a health history. They will ask questions about your recent symptoms and your past health problems. They will also do an exam of your foot. They will check for soreness, deformity, bruising, and swelling. They may grasp your toes and move them up and down, seeing if this causes pain.

To definitively diagnose your Lisfranc injury, you will have X-rays taken. Your provider might need to order special views of the foot. That's because these injuries sometimes don’t show up on standard X-rays.

In some cases, you may need more detailed imaging to get more information about your foot. MRI gives more information about damage to the soft tissues in your foot. CT scans give more detailed information about damage to your bones. These tests may pick up injuries that an X-ray alone might miss. It is important to have your injury diagnosed correctly. That's because this can often be misdiagnosed as a simple ankle sprain. But the treatment for each is quite different. An emergency room healthcare provider typically makes the diagnosis. But an orthopedic specialist might help treat you.

How is a Lisfranc joint injury treated?

Your treatment may vary based on the severity of your injury. You may need only nonsurgical treatment for your injury if:

You don’t have any bone breaks
Your bones are still in alignment
Your ligaments are not completely torn

For these types of injuries, your treatment might include:

Taking pain medicines
Wearing a non-weight-bearing cast or boot for 6 weeks
Wearing a weight-bearing cast or a special foot support after the first 6 weeks
Having serial X-rays to find out how your foot is healing

It is very important not to put weight on your foot during the early healing period.

If your injury was more severe than this, you likely will need surgery as well. Your healthcare provider may do a surgery called open reduction and internal fixation. During this surgery, they put your bones back in the correct alignment. Using special metal plates and screws, your surgeon physically reattaches the pieces of your bones back together. They might remove some or all of this hardware at a later date. They might also repair other ligament injuries.

Less often, the surgeon does a joint fusion as the initial procedure. Surgeons usually only do this if the damage is very bad and they cannot fix it. This surgery permanently fuses 1 or more of the bones in the region together. This is so they heal into a single, solid piece.

After either type of surgery, you would need to use a splint or cast for a few weeks. You should not put weight on your foot during this time.

What are possible complications of a Lisfranc joint injury?

Lisfranc joint injuries often cause arthritis in the injured bones of your foot. This might cause long-term (chronic) pain in the region. You are more likely to develop arthritis if you had a severe Lisfranc joint injury that damaged much of the cartilage in the region. This arthritis might develop even if your initial surgery was successful. Some people need to have joint fusion surgery to ease these symptoms if their arthritis is bad.

There is also a risk that your bones will fail to heal correctly. This might need follow-up surgery. These risks may be higher if you smoke and if you have certain health conditions, such as diabetes or osteoporosis.

When should I call my healthcare provider?

Call your surgeon if you have a high fever or chills, if the pain is increasing, or if your foot feels numb.

Key points about a Lisfranc joint injury

A Lisfranc joint injury is a type of injury to the bones or ligaments in the middle part of your foot. It can range from mild to severe.
Your Lisfranc joint injury might cause bruising, deformity, swelling, or pain in the middle of your foot. Your foot will likely also be unable to bear weight.
Your healthcare provider can diagnose your injury with a health history, a physical exam, and imaging tests.
If your injury is mild, you might only need treatment with casts or boots and pain medicines.
If your injury is more severe, you will likely need surgery.
Sometimes these injuries cause long-term arthritis of the bones of your foot.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.

Medical Reviewer: Rahul Banerjee MD

Medical Reviewer: Raymond Turley Jr PA-C

Medical Reviewer: Stacey Wojcik MBA BSN RN

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