Lisfranc Midfoot Injury

What is a Lisfranc Midfoot Injury?

The Lisfranc or tarsometatarsal joints refer to the middle of the foot. This area is critical to supporting the foot's arch. Please see Foot - Anatomy and Imaging to understand more.


Interesting fact : in 1815, Jacques Lisfranc de St Martin, a French surgeon, described injury requiring amputation through the midfoot in horse riders who fell with their foot trapped in the stirrup. Fortunately, this drastic treatment is not required in 2024!


Lisfranc injuries involve soft-tissue (ligament tears) and/or bone (fractures) damage that disrupt this important area (see 3D CT image).

Types of Lisfranc Midfoot Injuries

Lisfranc midfoot injuries range from mild cases with partial sprains of the Lisfranc ligament through to severe fractures and dislocation of the midfoot joints (see images below).

Causes of Lisfranc Midfoot Injury

The most common causes of Lisfranc midfoot injuries are:

 

  • motor vehicle accidents
  • slips and falls
  • twisting sports (tennis, soccer, football, etc).

 

Interesting fact : Dr Beamond has fixed Lisfranc injuries in two Australian Matildas players with full recovery to play.


Symptoms of Lisfranc Midfoot Injury

A midfoot injury causes:
  • pain
  • swelling and bruising on top and under the foot (see image)
  • inability to bear weight or push-off.
Often a "minor" foot injury just doesn't get better with ongoing foot "weakness" and "instability" during attempted push-off and direction change.

Severe injuries can result in deformity of the foot and significant pain.

Diagnosis of Lisfranc Midfoot Injury

The diagnosis of a Lisfranc injury is made after:
  • taking a complete history
  • examination of the foot 
  • imaging investigations.
Initially, non-weight-bearing X-rays are performed to rule out severe injury. Sometime, a Lisfranc midfoot injury is obvious on these views.

If these X-rays appear normal but concern remains, weight-bearing X-rays, CT and MRI are performed. These diagnose the extent of the injury and how "stable" it is.

Treatment of Lisfranc Midfoot Injury

  • If the midfoot bones and joints remain normally aligned ("stable"), these injuries can be treated without surgery. 
  • If there is any "instability", surgery is usually recommended to restore alignment and stability. This is proven to reduce the chance of long-term midfoot pain and osteo-arthritis.

Non-surgical Treatment of Lisfranc Injury

 

  • RICE
  • immobilisation in a "moon-boot"
  • crutches for four to six weeks
  • orthotic supports (insoles).

 

Interesting fact : Dr Beamond has non-surgically treated Adelaide Crows and Adelaide 36ers players with Lisfranc midfoot injuries.

Surgical Treatment of Lisfranc Injury

This involves the placement of plates and screws or strong sutures across the midfoot joints to restore alignment and stability.

Plates are removed after four to six months. Midfoot fusion is rarely needed.

Please see Lisfranc Stabilisation under the TREATMENTS menu for more information.