The LisFranc injury or fracture occurs when there is a displacement of the metatarsals on the tarsal bone. Many different joint and bones are involved.
Lisfranc fractures are injuries that occur in the midfoot region, specifically involving the tarsometatarsal (TMT) joints, where the metatarsal bones meet the bones of the midfoot (cuneiforms and cuboid). The term “Lisfranc” originates from Jacques Lisfranc de St. Martin, a French surgeon who first described this injury in the 19th century. These fractures can range from subtle ligament sprains to severe dislocations with multiple fractures, and they are often misdiagnosed due to their sometimes vague presentation.
The mechanism of injury typically involves either a direct or indirect force. Indirect injuries are more common and usually result from a twisting motion of the foot, often when it’s plantarflexed (pointed downward) and an axial load is applied — like falling while wearing stirrups or stepping awkwardly off a curb. Direct trauma, such as a heavy object falling on the foot, can also cause a Lisfranc fracture-dislocation. Athletes, especially in sports like football and soccer, are at increased risk due to the high-impact and pivoting motions involved.
Diagnosis can be tricky and often missed if not carefully considered. Clinically, patients may present with midfoot pain, swelling, inability to bear weight, and bruising on the sole of the foot (plantar ecchymosis), which is a key indicator. Radiological evaluation typically starts with weight-bearing X-rays, but CT scans and MRIs are often required to fully assess the extent of the injury, especially in cases with subtle dislocations or purely ligamentous injuries. Missing the diagnosis can lead to chronic instability, deformity, and post-traumatic arthritis.
Treatment depends on the severity of the injury. Mild, nondisplaced injuries may be managed conservatively with immobilization and non-weight-bearing for 6–8 weeks. However, most Lisfranc fractures, particularly those involving displacement or instability, require surgical intervention. This may involve internal fixation with screws or plates, or in some cases, primary arthrodesis (fusion) of the affected joints. Postoperative rehabilitation is critical and often includes a lengthy period of non-weight-bearing followed by progressive physiotherapy to restore function and strength. Early and accurate management is key to achieving good long-term outcomes.
Most Useful Resources:
Outcome of surgically treated Lisfranc injury (Podiatry Arena)
LisFranc Fracture (PodiaPaedia)
LisFranc Fracture (Podiatry TV)
A fracture of the LisFranc Joint (Foot Health Friday)
LisFranc (Foot Health Forum)