A Lisfranc fracture is when there are broken bones in the midfoot area of the feet. The midfoot is the arch of your foot and where the toes and ankle/heel bone connect. This kind of fracture is rare in sport. However, because of its severe consequences if untreated, we must consider the diagnosis in all cases of midfoot injuries in athletes.
There are two main mechanisms of injury:
The first mechanism is direct. This injury is relatively uncommon and occurs as a simple crush injury. The second mechanism is indirect. This mechanism is more common and occurs when the foot takes excessive force while extended and rotated.
A patient with Lisfranc joint injury may complain to us of midfoot pain and difficulty weight-bearing. Pain is classically aggravated by fore-foot weight-bearing. This means the patient is unable to run on the toes and feels pain on the push-off phase of running and on calf raises. Often the presentation may be delayed, and the patient presents to us with ongoing midfoot pain and swelling.
Plain weight-bearing radiographs are recommended. Plain X-rays however, do not always pick up a Lisfranc fracture. If injury is suspected, and X-ray is normal, both CT and MRI can help the clinician make the diagnosis. MRI is more sensitive and specific than CT to demonstrate all the components of the Lisfranc complex.
How can we help?
The treatment of a Lisfranc injury depends on the degree of instability present. In grade 1 injuries, where there is no instability, we recommend conservative management with non-weight bearing. We will prescribe a CAM boot for 6 weeks. Our goal of this treatment is to restore the integrity of the ligaments of the foot and hence stability.
Following removal of the cast, we will perform mobilisation techniques for the ankle. Our mobilisation techniques aim to reduce joint stiffness and pain that has occurred due to the injury and also from immobilisation.
Once full range of motion has been restored in the ankle joint and pain levels have decreased, the next step is to progress to calf strengthening. This will be graded and gradually progressed to avoid any increases in pain.
Following strength work we will prescribe balance exercises. Balance exercises will help develop the stability of the ankle and also help to further build ankle strength. We will also prescribe functional exercises such as squats and lunges. These exercises help train the ankle under high loads.
In some cases we may also prescribe orthoses to correct the alignment of the foot and provide support. Following strength and balance work we will make a plan for graded return to activity. Recovery time from diagnosis to activity return often requires 3-4 months of treatment.
This is just a general guide of what can be done for Lisfranc fractures. Every foot and person is different so for more personalised information and advice, please call (02) 9870 0250 and one of our physiotherapists will be happy to provide a complementary phone consultation.
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