Physical Therapy Videos - Foot & Ankle
Basic Anatomy
A "LisFranc" injury is an injury to the joint between the long bones in the foot (metatarsals) and the bones they connect to (tarsal bones). This injury can affect the ligaments (soft tissue that connects bone to bone) of these bones and/or include fractures of the bones themselves. The injury can hurt the whole foot or be limited to part of the foot.
Since there is very little skin over the bones of the foot, nerves and arteries that lie directly on top of the bones can be injured as well. This injury can cause the foot to swell a great deal. The bones can push on the skin causing damage or blistering of the skin.
The bones and ligaments are important for keeping the shape of your foot. When you step down, your bones and ligaments resist that force and keep the bones in their proper places, maintaining the arch of your foot. When your ligaments or bones are injured, your foot can collapse, which causes pain while walking.
Mechanism and Epidemiology
LisFranc injuries are rare and account for less than 1 percent of all fractures. They happen after trauma to a foot from a fall, motor vehicle accident, a crush injury, or even an athletic injury. This can happen when you have placed your weight on your foot, with your toes pointed down and you twist your foot. Since this injury can happen with injuries to the ligaments only or the bones and ligaments, it can happen in many different ways. A crush injury that causes a LisFranc injury can look very different from an athletic injury.
Initial Treatment
These injuries will make the middle of your foot hurt when you try to walk or stand. Your foot can swell up. The pain may be so bad you can’t walk. A doctor will examine your foot to make sure your skin is okay and that the bones are not pushing on it. X-rays of your foot will be taken, and x-rays of your other, uninjured foot may also be taken for comparison. A CT scan may also be done, because it can be hard to see the details of your injury using just x-rays. This is especially true if just the ligaments are injured.
If your bones are pushing against the skin or are far away from where they should be, your doctor may attempt a reduction (pushing the bones back into place). This can be done in the emergency room or the operating room. If the bones came through the skin or they can’t be put back into place, you will usually have to go to the operating room.
A splint or a boot may be used to protect your foot and to help with your pain by stabilizing your injury. Generally, your doctor won’t want you putting any weight onto your foot, and you should elevate your foot to help reduce swelling. As long as your skin is okay and your bones are in a good position, you can usually go home from the emergency room and be seen by an orthopaedic surgeon in a clinic on another day.
General Treatment
LisFranc injuries often require surgery. There are times when the bones are lined up in a way that allows them to heal without surgery. In that setting, they generally require a cast or splint and no weight bearing for several weeks to months.
Surgery can be done several ways. Screws, plates and screws or even pins can be used to hold your bones together. Your surgeon will make the decision how best to fix your specific injury. The bones can be fixed in a way that allows the ligament or bones to heal. This may keep the joints between the bones as they were. Your surgeon may also decide to fuse the bones together by removing the cartilage between the bones. A discussion about the risks and benefits of both of these options should be had with your surgeon. In surgery, pins may be placed through the skin to hold the bones in place. These may be taken out in clinic a few weeks later. This can be slightly painful, but in general is very quick and many patients tolerate the pain well.
If the bones are fixed and not fused together, the plates, screws or pins may need to be taken out later. This usually means another surgery that requires anesthesia.
Postoperative Care
After surgery, it is important to elevate your foot to reduce swelling. The skin on the top of your foot is thin, and swelling causes tension on the wound. Usually, you will be in a splint, cast or a boot for several weeks to months. This protects the bones and ligaments while they are healing. You will also probably not be able to put weight on your foot for 2-3 months while it is healing. This will require using crutches, a walker, a knee scooter, or even a wheelchair to get around safely. The most important thing is to follow the instructions of your surgeon. Falls, putting weight on your foot too early, or too much swelling can cause problems that may affect how you heal.
After a period of not putting weight on your foot, you may start physical therapy. The therapist may work on motion of your ankle, and once approved by your surgeon they may work with you on putting some weight on your foot. It is generally several months before you can put your full weight on your foot. While this may be frustratingly slow, it is important for proper healing of your bones and ligaments. It is important to follow the instructions of your surgeon.
Long Term
LisFranc injuries can have long term effects on your foot. Some people are able to get back to the activity level they had before the injury. However, it is common to have some persistent pain, stiffness, and weakness. This can happen even after a surgery and healing period that goes perfectly. Your foot takes all the weight of your body with each step. There is a lot of stress across these small bones and ligaments, and after a LisFranc injury they may not be as good as they were before your injury. This may mean that you have to modify your activities. It may also mean using special shoes or braces. Sometimes people require more surgery in the future.
Physical Therapy Videos - Foot & Ankle
More Information
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Christopher Domes, MD
Edited by the OTA Patient Education Committee and David Sanders, MD (section lead)
All x-rays and pictures taken from the personal collection of Dr. Domes
