Lisfranc fracture refers to a break in the bones that connect the mid foot to the forefoot. This part comprises of a group of bones and connective tissues called ligaments that form the arch on top of the foot. Five long bones called metatarsals extend out from the mid foot to the toes. The arch not only supports the foot while walking, but also helps to transfer the pressure exerted by the leg muscles to the forefoot. The lisfranc complex is important to maintain a proper gait and ensure even distribution of body weight through the lower extremities.
Lisfranc fracture may affect one or more joints in the foot and can be accompanied by a ruptured ligament. It is a serious injury that should be treated immediately as it may take months before the patient can regain complete functionality of the limb. Severe injuries may result in a permanent loss of arch (Flat Foot) or cartilage and Arthritis.
Causes
- Sudden twisting of the foot
- Sports injuries which may occur due to falling while the foot is flexed downwards
- A fall from a height can severely fracture or dislocate the bones
- Vehicular accident
- If a heavy or large object falls directly on the foot
- Diabetes and neurological defects may increase the chances of such injuries
Symptoms
- Swelling may occur on the top of the foot
- Pain may increase with movement
- Bruising, accompanied with discoloration above and below the foot
- Difficulty in bearing weight
- The foot may appear abnormally wide
Diagnosis
- Thorough clinical examination of the injured foot and ankle
- Analysis of the patient’s symptoms, injuries and medical history
- Palpation may be done by the orthopedic doctor to check for tenderness and dislocations
- Piano Key Test- the toes are moved up and down to see if it causes pain
- Single limb heel rise test to check if the patient can stand on tip toes without pain
- X-ray imaging to evaluate changes in alignment of the Lisfranc joint
- MRI and CT scan may be done to obtain cross-section images of the foot and identify damage to soft tissues
Treatment
- The foot may be immobilized for a few weeks using a cast. The patient may not be allowed to put weight on the foot. After the immobilization period, the cast may be replaced with a removable one and slight weigh bearing may be permitted
- Ice packs may be applied during the initial period to reduce pain and swelling
- The injured foot should be kept elevated to compress swelling
- Internal fixation of the broken or dislocated bones may be done. In this, the bones are put back in place and held together using metal screws and plates
- Surgical fusion of the damaged bones so that they are allowed to grow back into one single bone mass. This is done in case of severe injuries when internal fixation is not possible
- Surgical repair of torn or stretched ligaments may also be recommended in some cases
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