Lisfranc Injuries

Lisfranc injuries refer to a spectrum of rare injuries involving the tarsometatarsal joint complex of the midfoot. This includes the tarsometatarsal joints, the intermetatarsal ligaments and the intercuneiform joints.

Such injuries could broadly range from ligamentous sprains to fracture dislocations of some or all the tarsometatarsal joints, which often result in debilitating consequences for the individual.

One of the most well-respected classification of Lisfranc injuries was given by Quenu and Kuss in 1909. It is based on a three-column conceptualisation of the midfoot with the injuries divided into types A, B and C.

Type A injuries include homolateral ruptures which entail movement of all the metatarsals in the same direction. Type B injuries comprise an isolated rupture of the first metatarsal or the smaller rays. Type C injuries refer to a divergent displacement of the first ray and lesser rays in contrasting directions.

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Wynter and Grigg describe the mechanism of Lisfranc injuries as arising from a variety of situations, with both direct and indirect injuries acting as triggers for the onset of the damage.

Direct injuries involve force applied directly to the dorsum of the foot, for instance in motor vehicle accidents or falls, which causes soft tissue injury, vascular dysfunction and fractures.

Indirect trauma implies axial force through the foot, twisting on a plantar flexed foot or forced external rotation of the foot; this could easily occur during sports activities such as football or even during household accidents.

With a significant proportion of Lisfranc injuries missed during initial diagnosis, it is necessary for the clinician to maintain a high level of clinical awareness and suspicion while examining a swollen midfoot after a traumatic incident.

Orthotic support in the form of MASS4D® foot orthotics is recommended for consideration in cases presenting no evidence of instability or diastasis on weightbearing radiographs.

This should follow a conservative treatment programme involving physiotherapy and a period of immobilisation.

MASS4D® foot orthotics can be customised according to individual specifications to provide the patient with an optimal balance of flexibility and rigidity necessary to facilitate a functional change. This would also serve as a good long-term measure to prevent the development of post-traumatic arthritis in the foot.

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Related Links
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Optimal Rigidity and Flexibility of MASS4D®

References:

1. Wynter, S., Grigg, C. (2017) Lisfranc Injuries. Australian Family Physician: March 2017, Vol. 46, No. 3, pp. 116-119
2. Sobrado, M. F., Saito, G. H., Sakaki, M. H., Pontin, P. A., Dos Santos, A. L. G., Fernandes, T. D. (2017) Epidemiological Study on Lisfranc Injuries. Acta Ortopédica Brasileira: January-February 2017, Vol. 25, No. 1, pp. 44-47. DOI:  10.1590/1413-785220172501168995
3. Eleftheriou, K. I., Rosenfeld, P. F., Calder, J. D. F. (2013) Lisfranc Injuries: An Update. Knee Surgery Sports Traumatology Arthroscopy: April 2013, Vol. 21, pp. 1434-1446. DOI 10.1007/s00167-013-2491-2

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