Lisfranc Injury Causes, Symptoms & Treatment Options

Overview

Lisfranc sprains and fractures involve injury to the Lisfranc joint complex in the midfoot region. This area comprises multiple bones, ligaments, and muscles, making injuries to the Lisfranc joint particularly complex. The joint is stabilized by three distinct layers of ligaments that may be compromised during trauma:

• Dorsal is located on the superior aspect of the foot
• Plantar positioned on the inferior aspect of the foot
• Interosseous is situated between the dorsal and plantar ligaments

These structures collectively maintain midfoot stability and integrity.

What causes Lisfranc Injury?

Lisfranc injuries most commonly occur due to twisting or falling motions that place excessive stress on the midfoot. They may also result from direct compression or crushing forces, such as when another player lands on the foot during athletic activity.

• How the Injury Occurs: The injury typically arises when the forefoot is fixed while the body rotates or shifts abruptly, causing separation or fracture within the Lisfranc joint complex. High-energy trauma, such as falls from height or motor vehicle accidents, can also produce similar damage.
• Common Everyday Causes: Lisfranc injuries are not limited to athletes. They may occur from slipping on stairs, missing a step while descending, or during vehicle collisions where the foot is braced on impact. Heavy objects falling onto the foot can produce a comparable midfoot sprain in workplace accidents.

Sports Commonly Associated with Lisfranc Sprains and Fractures:

• Ballet: Repetitive pointe work and plantarflexion can strain the midfoot ligaments.
• Basketball: Sudden pivots and awkward landings can cause ligament disruption or fractures.
• Football: High-impact tackles and foot twisting under body weight often lead to midfoot injuries.
• Gymnastics: Forceful takeoffs or uneven landings exert pressure on the Lisfranc joint complex.
• Soccer: Quick directional changes or collisions can overstretch or tear the supporting ligaments.
• Volleyball: Jumping and landing on uneven surfaces can transmit excessive load to the midfoot.

Symptoms

The clinical presentation of a Lisfranc injury varies depending on its severity. Mild sprains typically cause localized tenderness and swelling, whereas fractures are often associated with significant bruising on the plantar surface of the foot. Common symptoms indicative of a Lisfranc injury include:

• Bruising along the arch: Often appearing on both the top and bottom of the foot.
• Pain in the midfoot during activity: Especially noticeable during weight-bearing movements.
• Discomfort that intensifies with standing or walking: Pain typically increases with pressure or motion.

Non-operative treatment

Initial management of Lisfranc injuries typically focuses on immobilizing the foot and limiting physical activity. A protective boot is commonly prescribed and may need to be worn for up to six weeks to facilitate proper healing. During this period, the standard “RICE” protocol, rest, ice, compression, and elevation, should be followed to minimize pain and swelling.

Once the immobilization phase is complete, a structured physical therapy program under the guidance of a licensed professional is recommended for mild sprains. This helps restore strength, flexibility, and stability in the affected foot.

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Lisfranc Injury

Surgical Treatment

Severe Lisfranc injuries, including complete tears of the Lisfranc ligament, often require surgical intervention to restore the normal alignment and stability of the midfoot. The specific surgical procedure depends on the injury’s extent and complexity, and may involve surgical fixation or reconstruction techniques to realign the affected bones and ligaments.