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Lisfranc Injury – We have PoCUS but do we still need the cavalry?

Lisfranc injuries are those that involve the tarsal-metatarsal joints. A spectrum of injury exists from ligamentous to fracture-dislocation. Up to 20% – 40% of injuries to the Lisfranc complex are missed in the Emergency Department. Unrecognized and untreated injuries can lead to long-term instability through the midfoot. As this region of the foot is responsible for a significant load during weight bearing, instability can accelerate degenerative changes in the foot resulting in chronic pain and disability

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Articles of Interest

Is the diagnostic validity of conventional radiography for Lisfranc injury acceptable?

Lisfranc injuries mainly involve the tarsometatarsal joint complex and are commonly misdiagnosed or missed in clinical settings. Most medical institutions prefer to use conventional radiography. However, existing studies on conventional radiographs in Lisfranc injury lack a large population-based sample, influencing the validity of the results.

Keys To Diagnosing And Treating Lisfranc Injuries

As the tarsometatarsal joint complex spans the width of the foot, several muscular and ligamentous injuries may occur, causing tenderness to palpation, limited range of motion and decreased strength.

Ligamentous Lisfranc Injuries in the Athlete

Ligamentous injuries to the midfoot during athletic endeavors are becoming more common and more troublesome as they can take significant time before the athlete is able to return to play.

Lisfranc fracture-dislocations: current management

It is essential to know and understand the anatomy of the tarsometatarsal (TMT) joint (Lisfranc joint) to achieve a correct diagnosis and proper treatment of the injuries that occur at that level. Up to 20% of Lisfranc fracture-dislocations go unnoticed or are diagnosed late, especially low-energy injuries or purely ligamentous injuries. Severe sequelae such as post-traumatic osteoarthritis and foot deformities can create serious disability.

Lisfranc Injury

The Lisfranc joint is located in the middle of the foot, and injury to this area, including both the bones and the surrounding ligaments, is classified as a Lisfranc injury; this may come in the form of a Lisfranc Fracture or a Lisfranc dislocation. This is a vital part of the foot, providing stability to the surrounding structures, so injury to this area with correct management can lead to long-term issues.

Lisfranc Injury - A Matter of a Few Millimeters

A Lisfranc injury occurs secondary to disruption of a major stabilizing ligament of the arch of the foot. In basic terms, it is a sprain of the Lisfranc ligament, also known as the oblique interosseous ligament. The Lisfranc ligament connects directly between the medial cuneiform and the second metatarsal....

Midfoot Fracture (Lisfrancs Fracture/Dislocation)

A fracture or break to the midfoot, also known as a Lisfranc fracture, is a significant injury often resulting in an extended recovery time. It is important that midfoot fractures are immediately diagnosed and properly treated to receive the best outcome possible. Early treatment can greatly increase your chances of avoiding surgery or permanent damage to your foot.

Trainer's Table | Lisfranc Injuries

A Lisfranc injury occurs that the midportion of the foot where the metatarsal (long) bones meet the tarsal bones. A Lisfranc injury can involve sprains, fractures, dislocations, or fracture/dislocations of the ligaments/bones involved at the midfoot. During the Jaguars’ third preseason game, Travis Etienne suffered a sprain injury.

Trauma X-ray - Lower limb gallery 2 - Foot - Lisfranc injury

This image shows a gap between the bases of the first and second metatarsals (MT); the second metatarsal is no longer correctly aligned with the intermediate cuneiform bone

Updates on Lisfranc Complex Injuries

Lisfranc injuries are a disruption of one or more of the tarsometatarsal joints and have an estimated incidence of 1/55 000 people. However, the total number of Lisfranc injuries could be underreported, because almost 20% of these injuries are initially missed. Because of the relative infrequency of these injuries, the current literature is inconsistent in regard to proper treatment.

What is a Lisfranc injury and how come it sidelines athletes for so long?

Lisfranc injuries are rare, affecting about 1 in 55,000 people in the U.S. every year, but too often they are misdiagnosed or dismissed as a simple sprain. Left untreated or treated improperly, they can lead to chronic foot pain, altered gait, osteoarthritis, and long-term disability. For elite athletes, Lisfranc injuries can be career-threatening.

Resources

Physiopedia

The injury was first noticed in the early 1800s by the French surgeon Jacques Lisfranc. The injury was caused when soldiers were thrown off their horses and their foot was stuck in the stirrup. Now automobile accidents, falls and sport injuries can also lead to an injury on the Lisfranc joint. This kind of injury is more and more seen by football players, gymnasts and ballet dancers. The injury can be potentially career ending.

Radiopaedia

Lisfranc injuries, also called Lisfranc fracture-dislocations, are the most common type of dislocation involving the foot and correspond to the dislocation of the articulation of the tarsus with the metatarsal bases.

StatPearls

A Lisfranc dislocation or injury describes a spectrum of injuries involving the tarsometatarsal joints of the foot. The Lisfranc joint is comprised of the articulation between the first, second, and third metatarsals bones and the cuneiform bones. Injuries of the joint can range from complete tarsometatarsal displacement with associated fractures and ligamentous tears to partial sprains with no displacement.