The joint in the midfoot (Lisfranc joint) plays an important role in stabilizing the arch of the foot and in walking. This joint has a specialized structure that provides stability to the foot. As you walk, your midfoot transfers the forces created by the leg muscles to the front of your foot.
An injury to the Lisfranc joint occurs if the bones are fractured or when the ligaments supporting the midfoot are torn. A Lisfranc injury can vary from simple to complex, depending on the severity of damage to the midfoot. Symptoms may include pain, swelling and bruising on the top and the bottom of your foot. Pain may worsen when you stand or walk. Although a Lisfranc injury may be mistaken as a simple sprain after a twist and fall, it should not be just "walked off." This type of foot injury is considered a serious injury that may require surgical treatment and take several months to heal.
Immediate evaluation must be done for proper diagnosis and treatment of the foot injury. A delay in treatment may result in poor functional outcome. Furthermore, the choice between conservative treatment and operative treatment must be determined early.
Treatment Of Lisfranc Injury
Standard treatment for immediate relief of symptoms includes rest, ice application and elevation of the affected foot. If these do not relieve your symptoms, consult a foot doctor or orthopedic surgeon.
A stable Lisfranc injury may be given non-operative treatment, which includes six to eight weeks of foot immobilization using either a short leg cast (around the foot and leg below the knee) or a removable boot. Pain medications may also be taken.
Surgery is warranted for an unstable Lisfranc injury. It involves rigid stabilization of the injured joints using screws and wires to allow proper healing. Weight-bearing on the joint is restricted for 6-8 weeks, while physical therapy may be initiated. Many athletes who sustain severe midfoot injury are not able to return to the same level of athletic performance they had before the injury.
Even with excellent surgical results, damage to the cartilage may result in post-traumatic arthritis, a common complication of Lisfranc injury. This condition results from wearing out of the cartilages in the joint, which leads to chronic pain, swelling, and reduced tolerance for sports and other activities that put stress on the joint. Factors that influence the occurrence of complications associated with Lisfranc joint injuries include the extent of trauma to the foot, the degree of joint displacement, and delayed recognition and treatment of the injury.
Treatment for post-traumatic arthritis includes weight loss to reduce stress on the joint, non-steroidal anti-inflammatory medicines (NSAIDs) to reduce pain and inflammation, low impact exercise and muscle strengthening exercises to improve foot function. Injection with cortisone or substances that act like artificial joint fluids may also be done. These measures aim to make the joint more functional and comfortable, but they do not cure arthritis.
The best way to prevent post-traumatic arthritis is to prevent injuries. If these cannot be prevented, immediate treatment of the injured joint with surgery to restore them to proper condition may help reduce their occurrence.
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