It is possible to dislocate the bones within the Midfoot joint complex (aka Lisfranc joint) of the foot: This joint complex consists of the ligaments and bones that connect the forefoot to the midfoot. Lisfranc injuries include strains and tears to the ligament itself in addition to bone dislocations and fractures.

The Role of the Midfoot

As an individual walks, the midfoot is responsible for transferring the forces that the calf muscles generate to the front of the foot. Furthermore, the midfoot stabilizes the arch of the foot. If the ligaments within the midfoot tear or the bones fracture, the stability of the midfoot is affected. Some injuries affect a single joint; whereas, others disrupt multiple joints.

How Midfoot Injuries Occur

Individuals who play soccer and football commonly sustain Lisfranc injuries. A midfoot injury frequently occurs when an individual stumbles while the top of his or her foot is flexing downwards. Lisfranc injuries sustained in this manner are considered low-energy injuries and are usually mild. A more severe midfoot injury is typically the result of a direct trauma; therefore, Lisfranc injuries sustained due to a direct trauma (e.g., falling from a ladder, foot run over by a vehicle, etc.) are considered high-energy injuries. A high-energy Lisfranc Injury may include joint dislocation and multiple fractures.  

Symptoms commonly associated with a Lisfranc injury include:

• Bruising may be apparent on the top and the bottom of the foot. Bruising visible on the bottom of the foot is indicative of a Lisfranc injury.
• The top of the foot may be painful and appear swollen.
• Increased pain while walking or standing: This pain may be severe enough to require crutches.

The Importance of a Proper Diagnosis

Frequently, a Lisfranc injury is mistaken for a sprain, especially when the injury results from a twist and fall. However, unlike a simple sprain a Lisfranc joint injury can take months to heal: Furthermore, depending on the severity of the injury, it may require surgical intervention. For this reason, seeking care from an experienced orthopedic surgeon specializing in injuries related to the ankle and foot is crucial.

An Initial Evaluation at Nilssen Orthopedics Ankle and Foot Center in Pensacola, Florida

At the initial evaluation, Dr. Nilssen and his medical staff will request information related to the patient’s medical history, current medications and details as to how his or her injury was sustained. Dr. Nilssen will examine the patient’s ankle and foot. He may also perform several physical tests.

Symptoms and in-office tests that Dr. Nilssen can use to diagnose a Lisfranc injury include:

• Bruising on the bottom of the foot: This bruising is common when the midfoot ligaments are completely torn or when the patient has a midfoot fracture.
• Pain in the midfoot upon rotation (especially when turned downwards and to the outside).
• Tenderness along the midfoot when pressure is applied.
• The single limb heel rise test, which involves the patient standing solely on the injured foot and then rising up onto his or her “tip toes.”
• The “piano key” test. During this test, Dr. Nilssen will grasp the patient’s toes and gently move them up and down.

Common imaging tests:

• Dr. Nilssen may order a series of X-rays to view the bones of the ankle and foot. He may also order a magnetic resonance imaging (MRI) scan. An MRI scan can provide Dr. Nilssen with images of the soft tissues in the ankle and foot.
• An ultrasound may be used to assess a tear in the Lisfranc ligament.
• Dr. Nilssen recommends Lisfranc surgery when the joints of the midfoot are fractured and/or abnormally positioned. Patients requiring surgery may need to have a computerized tomography (CT) scan. A CT scan allows Dr. Nilssen to see the extent of a Lisfranc injury. A CT scan provides him with clear, cross-sectioned images of the bones in the foot: These images allow Dr. Nilssen to create individualized surgery plans.

If an individual sustains a Lisfranc injury, seeking treatment is essential. A severe Lisfranc injury left untreated will lead to arthritis and fallen arches (flat feet). 

Sources Include:

http://orthoinfo.aaos.org/topic.cfmtopic=A00162

http://www.iskinstitute.com/kc/feet/midfoot_sprain/midfoot_sprain.html

https://en.wikipedia.org/wiki/Lisfranc_injury

http://radiopaedia.org/articles/lisfranc-injury

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