Lisfranc fractures are fractures of the midfoot. The midfoot area is where a cluster of small bones forms an arch at the top of the foot. The metatarsals extend from the midfoot to the toes. Most of the bones in this area are held in place by ligaments that extend across and down the foot. However, there are no ligaments holding the first metatarsal to the second metatarsal, leaving it more vulnerable to dislocation or fracture.
There are three classifications of Lisfranc fractures:
- homolateral: all five metatarsals are displaced in the same direction
- isolated: only one or two metatarsals are displaced
- divergent: metatarsals are displaced in different directions
If a Lisfranc fracture is suspected, x-rays will be taken. In some cases, a CT scan or MRI may be ordered to confirm the diagnosis. Undiagnosed Lisfranc fractures can lead to joint damage or pressure can build-up in the muscles, damaging nerve cells and blood vessels.
Lisfranc Fracture Treatment
Most Lisfranc fractures require surgery. Reduction is achieved by means of screws that are inserted into the bones across the joints. The screws can be inserted through punctures in the skin, rather than an incision.
With a Lisfranc fracture, the foot will be in a cast for 6-8 weeks and during that time the foot cannot support weight. After the cast, a rigid arch support or walking brace may be recommended. It is helpful to do foot exercises to build strength and help restore ROM.
In some Lisfranc fracture cases, post-traumatic arthritis develops in the joint. The bones may have to be fused together. Another complication is planovalgus deformity, a condition where the foot flattens and turns outward.
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