FOOT HEALTH: Get on the Good Foot

   A Lisfranc injury is the result of bone or ligament injury or combination of both in the middle of the foot, usually due to a twisting injury, fall, or high-energy trauma. The severity of the injury can vary from a pure ligament injury to disastrous fracture dislocations. Many times, a Lisfranc injury is mistaken for a simple midfoot sprain.  However, injury to the Lisfranc joint is in fact a serious injury that requires close clinical scrutiny and possibly surgery. If not properly identified, the injury can result in long term disability.

   The midfoot is defined as a region of the foot where the long bones of the toes meet the cluster of small bones in the middle of the foot. A ligament called the Lisfranc ligament stabilizes a portion of this area along with other soft tissue structures. As stated above, injury usually occurs from a twisting injury of the foot, many times while playing football, or a fall from height onto the foot.    

   Most common symptoms are pain and swelling on top of the foot, bruising on the bottom of the foot, pain that worsens with walking or standing, and continued pain despite rest and elevation. Any athlete reporting these symptoms in the middle of the foot should be carefully evaluated by an orthopedic surgeon.    

   After discussing your injury and symptoms with your orthopedic surgeon, he or she will carefully examine your foot. Radiographs will be obtained of your foot to evaluate for bony injury. If injury occurred with a simple twisting of the foot, then the orthopedic surgeon may ask the patient to take a weight-bearing standing radiograph and possibly image the uninjured foot for comparison. Further advanced imaging such as a CT or MRI might be needed. 

   Treatment will depend on the level of injury to the Lisfranc complex. Simple partial injuries can be treated with weight-bearing restrictions in a boot or cast. Regular follow-up is essential to evaluate for any changes. More severe injuries, such as a complete tear, joint dislocations, or fractures, will require surgery. If proper treatment is not initiated, long term disability and even permanent damage can result that can prevent the athlete from returning to his or her sport.  

   A Lisfranc injury is a serious condition that requires a careful evaluation. Any athlete with pain, swelling, and bruising in the midfoot should be evaluated by an orthopedic surgeon to rule out this condition. Early recognition and treatment can minimize damage to the joint and reduce the risk for future disability.

David E. Oji, MD is an orthopedic surgeon, foot and ankle fellowship trained. He works in Tracy, Pleasanton, and San Ramon