Lisfrancs Injury

About

  • Lisfrancs injurys are uncommon, but involve any trauma (inclusive of fracture, dislocation/subluxation) to the Tarsometatarsal joints (TMTJ) of the foot. They usually involve the lisfrancs ligament of the TMTJ.

Mechanism of Injury

  • Forced twisting of the Lisfrancs Joint

  • High Ground reaction forces from falling from something falling on their foot

  • MVA/MBA Football falling down stairs construction sites

 

Common Clinical Presentation

  • Unable to bear weight on foot

  • Cannot single leg balance

  • Profuse swelling over dorsum and plantar foot 

  • Ecchymosis

  • Tarsometatarsal joint ++ tender with palpation

  • Inversion/eversion of mid foot joints on manual assessment is ++ painful 

 

Scans and Investigations 

  • Weightbearing AP Xray is scan of choice be looking for separation of any of the TMT joints 

  • If not clear -> MRI/CT

Appropriate General Medical Management

  • If separation reported on AP WB Xray - refer to Orthopaedic foot / ankle surgeon with experience in O.R.I.F. of Lisfrancs injuries that also have a good sense of the importance of rehabilitation of this injury. 

  • If stable on weightbearing X-ray refer to Lower Extremity Group for assessment and treatment below

Rehabilitation of Injury

Nonsurgical Treatment

  • If no fractures / dislocations in the joint and the ligaments are not completely torn, nonsurgical treatment may be all that is necessary for healing. 

  • A non-surgical treatment plan involves using a non-weightbearing boot for 6-8 weeks. 

  • Be very strict about not putting weight on your injured foot during this period. 

  • Progress to weightbearing in a removable cast boot or an orthotic in rocker sole lightweight shoe.

  • Rehabilitation flows as similar to week 6 and beyond for surgical fixation rehab but can usually progress quicker

 

Surgical Treatment

  • Surgery is recommended for injuries with a fracture in the joints of the midfoot or with abnormal positioning or unstable joints. The goal of surgical treatment is to realign joints / return the fractured fragments as close as possible to a neutral position.

    • Internal fixation - In this procedure, the bones are positioned correctly (reduced) and held in place with plates or screws. Because the plates or screws will be placed across joints that normally have some motion, some or all of this hardware may be removed at a later date. 

    • Fusion - If the injury is severe and has damage that cannot be repaired, fusion may be recommended as the initial surgical procedure. A fusion is essentially a "welding" process. The basic idea is to fuse together the damaged bones so that they heal into a single, solid piece. The hardware will not need to be removed because the joints are fused and will not move after they heal.

  • Surgical recovery on this injury should and does progress  ​slowly. Treatment for surgery will take at least 6 months. It is normal for this injury to take up to a year or more to completely recover. 

  • It is not essential to remove hardware of fixation, but if necessary this should be done approximately 6 months after the original surgery.

Global Rehabilitation Network

  • We provide a complete program of 26 consecutive weeks of instructions on how to conservatively manage this injury

  • We provide a global network of therapists that can chat remotely via our Telehealth services to guide you through the process week by week for minimal cost.

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