Lisfranc Mid Foot Fracture Dislocation
There are many different types of fractures that can occur in the foot. Most foot fractures are cause by an external force acting on the foot that will fracture or break the bone. There are a group of joints in the middle of the foot that are situated behind the long bones (metatarsals) of the foot. Collectively these joints are called the tarsometatarsal joint or Lifranc’s Joint.
When there is a forced twisting of the foot, like in a fall, and the middle of the foot is asked to move in a direction it can not, this Lisfranc’s joint can become disrupted and or fractured. First, the ligaments that hold the 2nd metatarsal to the midfoot bone that lies behind the 1st metatarsal next to it (medial cunieform). This ligament will often tear and allow a gapping between these bones. Once this happens, the 2nd metatarsal is now misaligned from the bone behind it (middle cunieform). This misalignment will eventually lead to erosion of the joint and arthritis and pain. This type of foot fracture or dislocation is often misdiagnosed as a simple sprain of the foot. A more severe injury as the middle of the foot continues to twist will then push the the rest of the metatarsals and they can then all slide off the bones behind them causing a more severe dislocation. If there is severe misalignment of several major joints, that if not corrected, will lead to arthritis and severe pain.
Lisfranc Foot Fracture Injury Diagnosis
Lisfranc injuries are diagnosed in several ways. When there is a high suspicion for a midfoot sprain, a detailed history and clinical examination can help to confirm the evidence of the injury. The patient usually presents with pain along the 1st and 2nd rays, with pinpoint palpation pain within the space between the bases of the 1st and 2nd metatarsals and the medial cuneiform. There is often pain in this same area with simultaneous medial and lateral compression or squeezing of the midfoot from side to side. The experienced clinician should be able appreciate the instability of the 1st metatarsal complex through the examination and range of motion. Weight bearing x-rays should be used to determine the degree of injury, including stress views. In those cases where there is a suspicion on plain x-rays, an MRI or CT will be indicated and helpful in the final diagnosis of the severity of the sprain or foot injury.
Subtle Lisfranc Foot Fracture Injury
With most of the slight or minimal sprains of this joint, the foot can be stabilized with a non weight-bearing cast for a period of 4 to 6 weeks followed by a walking boot and several weeks of physical therapy. In many cases, however, surgery is indicated. It is imperative to realign the bones with one another in an anatomical fashiion.
This can only be achieved by surgical reduction and correction of the injury. In the case of the more subtle ligament tear and slight dislocation, the 2nd metatarsal must be brought back to position by buttressing it to the medial cunieform, the bone behind the 1st metatarsal. This can be achieved by using a screw or special strong stitches that will bind the bones together to the give the ligaments time to heal without undo stress. The stitches are preferred, as the screw would need to be removed later.
Severe Lisfranc Foot Fracture Sprain
In the more severe injury most or all the joints that dislocated would need to be stabilized. This is achieved by placing screws or pins across the joints from one bone to the other through the joint while placing them in alignment. The patients is placed in a cast for 4 to 6 weeks and then placed in a boot for 2 weeks. The screws and pins are then removed. Several weeks of physical therapy will be needed for the foot injury.
Many of the slight sprains of the foot are really more than a simple sprain and are actually dislocations of the middle of the foot and are serious injuries that need special attention. It is imperative that the surgeon recognize this injury and treat it correctly and accordingly.
The University Foot and Ankle Institute Advantage:
The surgeons at the University Foot and Ankle Institute are specifically trained in these types of foot injuries and employ the newest technologies and techniques for realignment and repair of Lisfranc’s foot fracture dislocations. For an appointment in one of our 11 Southern California locations please call 877-677-0011.
Dr. Baravarian been involved in athletics his entire life and played competitive tennis in high school and college. He has an interest in sports medicine, arthritis therapy and trauma/reconstructive surgery of the foot and ankle. He servers as a consultant to the ATP (Association of Tennis Professionals) tour, multiple running organizations and several shoe manufacturers. He is also fluent in five languages (English, French, Spanish, Farsi and Hebrew),
Podiatrist Dr. Bob Baravarian is available for consultation at the Santa Monica, Sherman Oaks and UCLA Westwood offices.
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