What are the other Names for this Condition? (Also known as/Synonyms)

• Lisfranc Injury of the Foot
• Midfoot Fracture
• Tarsometatarsal Injury 

What is Lisfranc Fracture? (Definition/Background Information)

• A Lisfranc Fracture is a break or crack in one or more bones of the midfoot (middle region of the foot). The foot bones involved in fracture could either be the metatarsal bones and/or the tarsal bones
• These fractures may occur from high-energy impacts, due to athletic sports or motor vehicle accidents. Other reasons for Lisfranc Fractures also include falling/dropping of heavy objects onto the foot
• Treatments for a Lisfranc Fracture include both nonsurgical and surgical methods. The prognosis of the condition is usually excellent, though the recovery period may extent to 6-8 weeks

Who gets Lisfranc Fracture? (Age and Sex Distribution)

• Lisfranc Fractures may occur in individuals of all ages, gender, race and ethnic groups
• Young athletes, who participate in sports, such as soccer or football, and older individuals with weak bones, seem to have a very high rate of occurrence of such fracture types

What are the Risk Factors for Lisfranc Fracture? (Predisposing Factors)

Common risk factors for Lisfranc Fractures include:

• Participation in high-risk contact sports, such as soccer and football
• Reduced bone mass (osteoporosis) in postmenopausal women
• Inactive older individuals (those having a lack of physical activities or exercise)
• Poor nutrition
• Not wearing shoes, while taking part in any physical activity, sports, etc.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Lisfranc Fracture? (Etiology)

Lisfranc Fractures causal factors include:

• This injury is seen to predominantly occur when a heavy object falls/drops onto one’s foot
• Falling from a significant height; especially landing on one’s foot (or the fracture occurring since the individual is overweight)
• Direct trauma to the foot, such as caused by an automobile accident
• Participation in any rough or high-impact sport, such as soccer or ice hockey
• Violently twisting one’s foot

What are the Signs and Symptoms of Lisfranc Fracture?

Sign and symptoms of Lisfranc Fractures include:

• Severe and immediate pain at the site of injury
• Swelling and tenderness, noticeable deformity in the middle region of the foot (hence the condition is also called Midfoot Fracture)
• Stiffness surrounding the injury site
• Noticeable bruising on top of the foot
• Inability to apply any weight, put pressure on the ankle/foot
• Pain that gets worse while standing or walking

How is Lisfranc Fracture Diagnosed?

Diagnostic methods that a physician may use to help diagnose Lisfranc Injury of the Foot include:

• Physical examination: A thorough physical examination is important in identifying any noticeable deformities, swelling, contusions, in the foot. Individuals are also expected to provide an explanation of the circumstances that caused the injury. In addition to this, a complete medical history can aid in arriving at a definitive diagnosis
• X-ray of the foot: X-rays are commonly used in evaluating a fracture; to see, if the bone has been displaced. This diagnostic imaging test helps provide a clear image of the bone, identify the exact location of the injury, and determine the extent of the fracture
• Computerized tomography (CT) scan of the affected region: A CT scan takes a series of x-ray images from several different angles. These images are then merged to create cross-sectional images of bones and soft tissues of the foot. This then allows the physician to examine the foot and surrounding structures to confirm a diagnosis
• Magnetic resonance imaging (MRI) of affected region: An MRI is a more detailed scan that uses a magnetic field to generate thorough images of the interior bones and soft tissues, which helps confirm a diagnosis
• Bone scan: A bone scan is a diagnostic method used to identify any bone abnormalities, by injecting tiny amounts of radioactive material into the bloodstream. This test may occasionally be used to identify stress fractures

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Lisfranc Fracture?

A few complications associated with Lisfranc/Midfoot Fractures could include:

• Degenerative joint disease (osteoarthritis)
• Osteonecrosis: A serious disorder characterized by the temporary or permanent disruption of blood flow, to the bones
• Abnormal deformity, or permanent disability of the foot
• Prolonged and chronic pain
• If any part of the bones protrudes through the skin, bacteria may cause an infection to the exposed bone. This condition is called osteomyelitis
• Permanent damage to the nerves and blood vessels, around the midfoot region
• There may be an abnormal pressure build-up within the muscles, around the toe and forefoot. This may reduce the blood flow and prevent nourishment and oxygen, from reaching the nerve and muscle cells (termed as compartment syndrome)

How is Lisfranc Fracture Treated?

The treatments associated with Lisfranc Fractures depend on the severity of the fracture. These measures may include both nonsurgical and surgical methods.

The nonsurgical treatment measures may include:

• Any activity that further aggravates the foot condition should be avoided. The physician would normally advise the individual to refrain from all such activities, until the symptoms stop and the bone heals
• Applying ice to the foot, can help with pain and reduce any swelling
• Complete immobilization of the foot with a cast is required to restrict movement. This may require individuals to refrain from putting weight on the foot, for around 6 weeks. One the cast is removed, the individuals may then be required to wear a rigid arch support
• Non-steroidal anti-inflammatory oral medications, such as indomethacin and acetaminophen, may be used to treat Lisfranc Fractures. These medications can help decrease the pain and swelling
• Individuals are also likely to need physical therapy exercises after the cast is removed. The goals of these exercises are to strengthen the foot muscles, improve flexibility, and decrease stiffness. It may take several months for an individual to complete a physical therapy program and regain full strength and functionality in the affected foot

The surgical treatment methods may include:

• Open reduction and internal fixation (ORIF): An open reduction is a surgical procedure to realign the fractured bone, to its original position. Surgical hardware (such as a plate, screw, or rod) is then used to stabilize the fractured bones under the skin, until it is fully healed

How can Lisfranc Fracture be Prevented?

To prevent Lisfranc Fractures, individuals should be careful and consciously aware while performing any physical activities, such as sports, or even some normal daily activities that could lead to situations involving accidents. Children must be provided a safe environment to work, study, or play. Any possible dangers should also be anticipated and appropriate safety measures adopted.

A few ways to further help prevent unwanted injuries or Lisfranc Fractures include:

• Individuals, who participate in any high-risk sports, such as soccer or football, should wear proper padding and appropriate shoes to help prevent the possibility of a Lisfranc Fracture
• Wearing properly fitting and appropriate footwear (such as the proper shoe size) may help prevent accidents
• Consuming foods rich in calcium, such as milk, yogurt, and cheese, help build bone strength. Having a regular diet with appropriate calcium-intake is recommended, even after such fractures. For women, the recommended amount of calcium, increases with age and menopause
• Perform weight-bearing exercises to strengthen bones

What is the Prognosis of Lisfranc Fracture? (Outcome/Resolution)

• A high percentage of foot injuries, such as Lisfranc Fractures (or Midfoot Fractures), heal without any serious complications
• A full recovery and return to sports or normal daily activities may usually require 6-8 weeks. This depends on the severity of the fracture
• The presence of any complication may prolong the recovery period and may result in a less successful outcome
• When properly treated, under the guidance of a healthcare specialist, a high percentage of individuals regain full strength and range of motion in their injured foot

Additional and Relevant Useful Information for Lisfranc Fracture:

Lisfranc Fracture is named after a 18^th/19^th century French surgeon, Jacques Lisfranc de St. Martin.