During the time of Napoleon, a surgeon named Jacques Lisfranc de St. Martin performed an amputation of a soldier's foot. During Napoleon's winter invasion of Russia, this particular soldier had suffered a frostbitten foot. Gangrene had set it. Rather than sawing through bones, as would have been customary at the time, he cut through the tarsometatarsal joints above the arch of the foot (without anesthesia, but much less painfully than if he had cut through bones). Since that time, these joints in the middle of the foot have been called Lisfranc joints, named after the surgeon who cut through them rather than for the soldier who suffered the injury.
It's surprisingly easy to tear ligaments or break bones in this part of the foot. There have been cases in which a foot slipped out of a high heeled shoe and tore the ligaments. There have been cases in which a driver about to crash a car tried to stomp on the brakes and missed, pressing the foot hard against the floorboard, and breaking bones. High jumpers, basketball players, receivers in both American and European football, even wine grape stompers have been known to suffer Lisfranc injuries. A Lisfranc injury can be just a dislocation of one of more of the joints in this part of the foot, or a combination of a dislocation, the bones no longer meeting in the joint, with a fracture, a break in one of more bones. The injury can range from a sprain to a complete disruption of the joint.
Because this kind of injury can happen in so many different ways, with greatly Differing severity, treatments and the course of recovery vary a great deal from person to person. The techniques used in treatment vary from doctor to doctor. It's best to get your prognosis from the doctor who treats you, but there are certain reasonable expectations for just about anyone who has a Lisfranc fracture.
- Lisfranc injuries are commonly misdiagnosed. Doctors expect to see them in athletic males in their 30's, and in professional athletes and dancers, but they can occur to anyone at any age.
- Lisfranc injuries usually cause a lot of swelling, but the swelling sometimes suddenly goes down for no obvious reason, before the injury has healed.
- A relatively minor sprain can be more disabling than a break of the foot. Broken bones get the doctor's attention. Sprains that don't cause obvious problems with balance or load bearing do not. Sometimes an injury to this joint is only diagnosed when the doctor notices a wound on the side of the foot that just won't heal, or skin that seems to pull apart as if it had been cut, even though it hasn't been. A friction callus on the side of the foot, with hard skin building up as much as 25 mm (1 inch) thick, without any obvious injury, often is a sign of a tarsometatarsal joint problem. These calluses can get so thick they interfere with circulation and the skin on the distal side (the side farthest from the heart) ulcerates and turns black.
There are also variations in the course of recovery.
- A cast only helps when the injury is stable. If the joint is "moving around," surgery usually is the only option.
- Improper treatment can result in flat feet, which are not stable for standing, walking, and running, or jumping.
- Lisfranc fractures can cause bruising. The middle of the foot, or the middle of the foot and the toes, even the whole foot, can turn black or blue.
- The podiatrist or the orthopedist may stabilize the joint with metal screws. The tips of the screws may protrude from the foot. How long the screws will stay in depends on the condition of the joint as judged by your doctor after examining your foot. The Lisfranc fracture club on Facebook and Lisfranc fracture forums cannot give you accurate information on when you will get better, because individual cases are so different. When a pin is removed less than 3 months after it is put in, almost always the reason is the doctor is concerned the pin is about to break.
- Returning to normal activity too soon after a Lisfranc injury can lead to chronic pain and progressive deterioration of the joint. It's best to wait.
- Some doctors use bioabsorbable screws. The screw stabilizes the joint but dissolves over the next 12 to 14 months. This makes it possible to avoid a second operation to remove the screw. The technique is not widely available, but it does not hurt to ask.
The most common complaint about Lisfranc injuries is that the foot feels fine until you stand up, and then it hurts like hell. For six months to a year after this kind of injury, you will have to remember to put weight on your foot slowly to avoid having to start the process all over again.
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