trauma | Podiatry Help

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)

A Jones fracture is a particular type fracture that occurs at the diaphysis of the fifth metatarsal of the foot that was fist described by the British orthopedic surgeon, Dr Robert Jones.

A Jones fracture is a specific type of break that occurs at the base of the fifth metatarsal, the long bone on the outside of the foot that connects to the little toe. It’s named after Sir Robert Jones, who first described the injury in 1902—after experiencing it himself while dancing. What sets this fracture apart from other fifth metatarsal injuries is its location: the fracture occurs in a spot that receives less blood flow, which makes healing more difficult and slower compared to other foot fractures.

This injury typically results from acute trauma or repetitive stress. It’s common in athletes, particularly those involved in sports like basketball, soccer, or football, where sudden twisting motions or jumping and landing awkwardly put pressure on the outside of the foot. A person might feel a sharp pain and sometimes even hear a “pop” at the time of injury. Swelling, bruising, and difficulty bearing weight are all classic symptoms. The limited blood supply in this part of the foot means it doesn’t always heal well on its own, which sets it apart from more straightforward avulsion fractures.

Treatment for a Jones fracture depends heavily on the severity of the break and the patient’s activity level. For minor or non-displaced fractures, doctors often recommend non-surgical treatments like rest, immobilization in a boot or cast, and non-weight-bearing protocols for several weeks. However, due to the high risk of delayed healing or nonunion, surgical intervention is sometimes the preferred route—especially for athletes or those with displaced fractures. Surgery typically involves inserting a screw along the shaft of the bone to stabilize the fracture and promote faster healing.

Recovery from a Jones fracture can be frustratingly slow. Even with surgery, it can take anywhere from 6 to 10 weeks—or longer—for the bone to heal properly. Return to full activity, especially for athletes, might take several months. Physical therapy is often part of the recovery process, focusing on restoring strength, mobility, and balance. Because of the recurrence risk, proper footwear, gradual return to activity, and regular monitoring are key to preventing future complications.

Most Useful Resources:
Jones Fracture (Foot Health Forum)
Jones Fracture Average healing times (Foot Health Forum)
The Jones Fracture (Foot Health Friday)
Jones Fracture (Podiapaedia)
Jones Fracture (Podiatry TV)
Jones fracture (Podiatry Update)

Tag: trauma

LisFranc Injury

Jones Fracture