What is it?
Lisfranc (midfoot) injuries occur when there is a breakage of bone in the midfoot, or when supporting ligaments in this area are torn. This type of injury can range in severity from mild to debilitating, simple or complex, depending on how many bones and joints have been affected.
A lisfranc injury is frequently diagnosed as a simple sprain, particularly if it is attributed to a twisting of the lower limb during a misstep or fall. These injuries are different from sprains, however; they are more complex and attempts should never be made to simply ‘walk it off’. This type of injury can be severe enough to warrant several months of healing and might, in some cases, require surgery.
The midfoot is a crucial stability point in the arch, and plays a primary role in walking. While walking, it is responsible for transferring the force generated by the calf muscle to the front of the foot. This particular network of joints is stabilised by a complex structure of bones and ligaments.
These injuries can happen with a simple twist and fall. This is a low-energy injury. It is commonly seen in football and soccer players. It is often seen when someone stumbles over the top of a foot flexed downwards.
More severe injuries occur from direct trauma, such as a fall from a height. These high-energy injuries can result in multiple fractures and dislocations of the joints.
The most common symptoms of Lisfranc injury include:
• Swelling and pain on the top of foot.
• Bruising on both the top and the bottom of the foot.
• Pain that worsens with standing or walking. The pain can be so severe that crutches may be required.
If standard treatment for a sprain (rest, ice, elevation) does not relieve pain and swelling, you should seek care from an orthopaedic surgeon.
These specific checks will be done by your doctor:
• A review of the bottom of the foot first, if bruising exists, as it is highly indicative of a Lisfranc injury. This type of bruising typically indicates either a midfoot fracture or a complete tearing of the ligaments in this area.
• Application of pressure along the midfoot, to ascertain levels of sensitivity and soreness.
• Conduct of a stress examination of the midfoot. The front of your foot may be twisted while grasping the heel to determine the pain level (when pain is present). The same test would not cause pain in the uninjured foot.
• Movement of your toes up and down to see if there is pain. This is known as the ‘piano test’ and the stress it places across the midfoot will cause discomfort when injury is present.
• Possible request to do a single leg heel rise, which requires you to stand on one foot, and leverage upward until you are on your “tip toes”. This move places your midfoot under considerable stress and can reveal even mild injuries. This test will not cause pain in an uninjured foot.
Apart from the physical examination, your doctor may wish to take further steps to confirm your diagnosis, such as:
• CT Scan
The treatment varies, depending on if you had a sprain, dislocation, fracture, or all of the above. It also depends on when you were diagnosed with the injury.
Sprain – You may wear a dorsal pad for pain on top of the foot – this reduces the pressure and friction. Generally though, you will need to be non-weight bearing (no weight on the foot), in a cast or removable cast boot for four to six weeks. This will usually be followed by physical therapy and a gradual return to activity.
Dislocation and fracture injuries – These are usually treated with surgery. It is important to try and line up the bones and joints as much as possible. This is done with wires, screws or plates. After surgery you are usually non-weight bearing for six weeks and then you begin walking with a cast-walking boot for another four weeks. If the bones and joints are not lined up properly, there is an increased risk of degenerative changes, which can lead to arthritis, flat foot, and instability.
If pain in the midfoot continues for a long time, sometimes a second surgery is needed to fuse the bones together. Unfortunately, arthritis may still occur later in life, despite successful surgical outcomes.
Your feet mirror your general health . . . cherish them!
Leana Huntley is an English trained foot health practitioner attached to ALMAWI Limited The Holistic Clinic. Contact the Clinic at firstname.lastname@example.org or visit the Website at www.almawiclinic.com.