A Lisfranc (midfoot) injury is a significant injury that often has a prolonged recovery time. Fracture of the midfoot bones and/or disruption of the midfoot ligaments (Figure 1) leads to pain, swelling, and often an inability to weight-bear. During normal standing and walking the ligaments of the midfoot are subject to forces that are 2-3 times body weight.
What is lisfranc injury
The Lisfranc fracture is a fracture of the foot in which one or all of the metatarsals are displaced from the tarsus. It is named after 18th- and 19th-century surgeon and gynecologist Jacques Lisfranc de St. Martin. This type of injury classically occurred when a horseman fell while riding, having trapped his foot in the stirrup or fallen into a drain. At present, such an injury happens typically in activities such as windsurfing (where participants' feet are in foot straps that pass over the metatarsals), or when one steps into a hole and the foot twists heavily. Falling from a height of two or three stories can also cause this fracture. American football players occasionally get this injury, often when they have their foot pointing down and someone lands on their heel.
A Lisfranc injury is initially diagnosed based on the history and description of the athlete’s acute injury. Often an athletic trainer at the practice or competition may see the injury occur in real time and have an immediate suspicion for the injury. The athlete will describe the immediate onset of pain in the midfoot region. There may be difficulty or even an inability to put weight on the injured foot. Over the course of the ensuing day, swelling and bruising often occurs that when serious may even become evident on the bottom of the foot. On a physical exam, the injured athlete will be tender over Lisfranc’s joint and any others involved in the injury. In the most severe of injuries, those that involve a large direct crushing force to the foot, the swelling may be so severe that an emergent evaluation in an emergency room is necessary and possibly even immediate surgery. This is however extremely rare in the setting of athletic injuries.
Lisfranc injury recovery time
Most often the treatment of a Lisfranc injury is surgical, although some minor injuries can be treated conservatively. If there is minimal displacement of the bones, a stiff walking cast applied for approximately eight weeks is an appropriate alternative. However, the more common treatment is to secure the fractured and dislocated bones with either internal (screws) or external (pins) fixation.
Stable Lisfranc injuries that do not require surgery may cause an athlete to miss 2 months or more of their season. However, most athletes are able to successfully return at some point. Those injuries that are unstable, and require surgical repair, are serious injuries that almost always cause the injured athlete to miss the remainder of their season. It is also not uncommon for a high level athlete to not be able to return to the same level of athletic performance even in following seasons. Two well-known examples are Eric Rhett and Duce Staley both of whom had surgery for a serious Lisfranc injury and never successfully returned to their pre-injury form.
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