What is a Lisfranc injury?
A lisfranc injury is a disruption between the tarsometarsal joint complex specifically damage to the lisfranc ligament that connects the medial cuneiform to the 2nd metatarsal.
How to diagnose a Lisfranc injury?
X-rays are typically used to diagnose lisfranc injuries and specifically attention is paid to a widening of the gap between the medical cuneiform and 2nd metatarsal base. Often the “Fleck” sign is seen which is a bony fragment in the 1st intermetatarsal space. X-rays are also used to look at the continuity of the entire tarsometarsal complex to make sure the metatarsals line with their perspective tarsal bone such as the medial border of the 4th metatarsal lines up with the cuboid. Stress X-rays are often due to ensure the stability of these joints and typically a CT/MRI is done in a suspected lisfranc injury.
How to treat a Lisfranc injury?
Non-operative treatment is done in patients with a negative stress X-ray and no obvious bony fractures.
If there is ligamentous damage or bony damage then surgery is warranted. If surgery is not done, the patient will most likely develop arthritis in the tarsometatarsal joints. Literature has advocated for primary fusion in pure ligamentous and comminuted fractures. ORIF is for bony fractures that aren’t severely comminuted and the principle of bridge plating has emerged in literature. Typically a screw has been used to stabilize the medial cuneiform to the 2nd metatarsal, but in recent literature surgeons have been using a suture button as an alternative to stabilize the lisfranc ligament.
Video of lisfranc surgery: https://www.youtube.com/watch?v=WWK4-K2Gv0A
If you have foot or ankle pain and would like a consultation. Make an appointment at Orange County Podiatry with Dr. Andrew Yang https://ocfootandankleclinic.com/appointments/ or call (949) 651-1202