Lisfranc Fracture – Commonly Missed Diagnosis

When the bones in the middle of the foot are broken or if the ligaments that support those bones are torn, the result is what’s known as a Lisfranc fracture. There are varying degrees of Lisfranc injuries, which can range from simple muscle tears to more complex bone fractures that involve several of the numerous bones and joints that are located in the middle of the foot.

This is a common misdiagnosis in individuals who suffer from a common twist of the ankle which results in a fall. When a true Lisfranc injury occurs, it is more complex than a simple foot sprain. Telling the individual to go walk it off, as is commonly done for a foot sprain, will do no good whatsoever in the case of a Lisfranc injury, and can in fact make the injury worse. A true Lisfranc injury requires a proper diagnosis and proper treatment, and can take several months to heal properly. In some cases, one or more surgical procedures may be required to treat the Lisfranc injury.

Much like a sprained foot, a Lisfranc fracture can occur when the ankle or foot experiences a simple twist and fall. Lisfranc injuries generally occur as a result of a low-energy injury. This means that high impact activities such as running are not usually the cause.

Lisfranc injuries can also occur as a result of sustaining a direct trauma injury, such as those that occur from falling from an elevated height. These types of Lisfranc injuries are usually much more severe. Although they occur less often than low-energy injuries, these high-energy injuries can lead to the development of multiple Lisfranc fractures and/or the dislocation of the bones or joints in the middle of the foot. Ouch!

It is often difficult to diagnose a Lisfranc injury correctly, and that is because of where it these injuries are located. The Lisfranc bones and tendons are located deep in the middle of the foot, underneath the area where a stirrup would be placed. There are many other muscles and bones located in that area in addition to the Lisfranc, and the foot is in fact the body part that features the largest number of bones anywhere in the human body. This can make it difficult for doctors to diagnose the actual injury, even when x-rays and other diagnostic tests are used.

About Lisfranc Injuries

Jacques Lisfranc

The bone and ligament located deep inside the middle of the foot is known as the Lisfranc — which you know, but you may also wonder where it got its name. This area is named after Jacques Lisfranc, a former field surgeon who served in the army led by Napoleon. In his medical records, Jacques Lisfranc described an amputation that he performed on a soldier who had fallen off of his horse during battle. The soldier’s foot was stuck in the stirrup, and it did not come dislodged when he fell, resulting in the need for an amputation.

Lisfranc Injury Types

The two most common types of injuries that lead to a Lisfranc fracture are indirect injury and direct trauma. An indirect injury occurs as a result of the transfer of force from another area to the stationary foot, such as in the case of the soldier who fell off his horse. This can occur from a simple act such as twisting the ankle or foot, losing balance or falling and landing the wrong way on the foot. An indirect injury can affect both the Lisfranc bones and ligaments. A direct trauma injury occurs when the foot is hit by an outisde force. When this happens, a fracture of the Lisfranc bone can occur.

Symptoms of a Lisfranc Injury

Depending on the cause of the injury and it’s severity, symptoms can vary greatly. In some instances, the only indication that a Lisfranc injury has occurred is the presence of redness and inflammation in the middle foot area. Many times the top middle area of the foot will be painful and swollen. Sometimes bruising can occur in the middle foot area, on both the bottom and top of the mid-foot. Bruising on the top of the foot may or may not occur, and if it does occur, it may or may not be indicative of a Lisfranc injury. When the injury results in bruising on the bottom of the foot, it is much more indicative of a Lisfranc injury. Another indication of a possible Lisfranc injury is pain in the foot  following an injury that intensifies upon walking or standing still. In some cases, the foot may be so painful that walking requires the use of crutches to alleviate pain.

Diagnosis

Because of the nature of the injury, it is often very difficult to diagnose, and misdiagnosis is common. The injury is often diagnosed only after prior diagnosis and treatment show no improvement in the condition. When standard foot sprain treatments such as resting, elevating the foot and applying ice packs do not offer relief, a visit to an orthopedic surgeon may be in order. When speaking with the surgeon, you will be asked to describe the injury that occurred, as well as the symptoms you are experiencing. A thorough examination of your foot and ankle will be performed. Some of the tests may cause additional pain during the testing, however, they will not cause a worsening of the actual injury.

Treatment

There are a variety of treatment options for Lisfrance injuries, depending on the severity. Lisfranc injuries of the muscles or tendons are often treated with rest, supportive equipment, physical therapy and other homecare measures. For a Lisfranc fracture, one or more surgical procedures are often necessary followed by complete and total resting of the foot.