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Lisfranc injuries

Bunionette

What is it?

The Lisfranc joint is in fact a number of joints along the line separating the metatarsals and the middle part of the foot. The shape of bones within the joint provides high stability but it also acts as a major ligament network in the plantar section of the foot. The largest joint links the first cuneiform to the second metatarsal (Lisfranc ligament).

Lésions du Lisfranc
  • Fig. 1

    Lisfranc joint line (in green).

Note the Lisfranc Ligament, stabilising the first cuneiform (C1) with the 2nd metatarsal (M2).

Traumatic Lisfranc injuries are potentially serious as most of the joints within it are usually damaged. It is common to misdiagnose such injuries and they may be confused with a simple sprain. Radiological signs are very specific and can be missed if the healthcare staff are not perfectly aware of the condition. It is important to differentiate between a simple Lisfranc sprain – an elongation of the ligaments in the midfoot that recovers spontaneously – and a Lisfranc fracture/dislocation, which involves the displacement of several joints and represents a separation between the forefoot and the midfoot.  

pied normal vs Luxation traumatique du Lisfranc
  • Fig. 2

    Normal foot, alignment of metatarsals with the midfoot

  • Fig. 3

    Traumatic Lisfranc dislocation, with incongruence between the metatarsals and the bones in the midfoot, representing a major ligament injury.

Finally, chronic conditions usually result from a previous injury to the Lisfranc joint. The injury could have occurred many years ago and it then progresses into arthritis of the midfoot, i.e. wear and tear to the joint’s cartilage. These articulation determine the position of the bones from the front of the foot part of their orientation and angulation. Their lesion may therefore lead to a change in the alignment of the foot and it’s therefore sometimes accompanied by additional pathologies such as hallux valgus (onion), metatarsalgia or flat foot.

Clinical presentation

During acute trauma, the foot becomes very swollen and painful, and these symptoms are often attributed to an ankle sprain. It is extremely important to examine the x-rays or scans as they will reveal the severity of the injury, any dislocation or the existence of concomitant fractures. The failure to diagnose a severe Lisfranc injury often results in a progressive separation of the mid- and forefoot, which in turn causes a painful lateral deviation of the toes and ball of the foot. In general, when this stage is reached, the foot is very painful and surgery required.

When should you consult a specialist?

Traumatic injuries to the Lisfranc joint are generally diagnosed in the accident and emergency department. When a sprained foot or ankle with persistence of midfoot pain is diagnosed, it is important to mention the possibility of an undiagnosed injury to the Lisfranc line and perform the necessary radiography assessment.

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