Lisfranc joint injuries are rare, complex and often misdiagnosed. Typical signs and symptoms include pain, swelling and the inability to bear weight. Clinically, these injuries vary from mild sprains to fracture-dislocations. On physical examination, swelling is found primarily over the midfoot region. Pain is elicited with palpation along the tarsometatarsal articulations, and force applied to this area may elicit medial or lateral pain. Radiographs showing diastasis of the normal architecture confirm the presence of a severe sprain and possible dislocation. Negative standard and weight-bearing radiographs do not rule out a mild (grade I) or moderate (grade II) sprain. Re-evaluation may be necessary if pain and swelling continue for 10 days after the injury. Proper treatment of a mild to moderate Lisfranc injury improves the chance of successful healing and reduces the likelihood of complications. Patients with fractures and fracture-dislocations should be referred for surgical management.
The Lisfranc joint, or tarsometatarsal articulation of the foot, is named for Jacques Lisfranc (1790-1847), a field surgeon in Napoleon’s army. Lisfranc described an amputation performed through this joint because of gangrene that developed after an injury incurred when a soldier fell off a horse with his foot caught in the stirrup. The incidence of Lisfranc joint fracture dislocations is one case per 55,000 persons each year. Thus, these injuries account for fewer than 1 percent of all fractures. As many as 20 percent of Lisfranc joint injuries are missed on initial radiographs.
Lisfranc joint fracture dislocations and sprains can be caused by high-energy forces in motor vehicle crashes, industrial accidents and falls from high places. Occasionally, these injuries result from a less stressful mechanism, such as a twisting fall. Since Lisfranc joint fracture-dislocations and sprains carry a high risk of chronic secondary disability, physicians should maintain a high index of suspicion for these injuries in patients with foot injuries characterized by marked swelling, tarsometatarsal joint tenderness and the inability to bear weight.
Lisfranc joint complex injury can occur as a result of direct or indirect trauma. Direct trauma occurs when an external force strikes the foot. With indirect trauma, force is transmitted to the stationary foot so that the weight of the body becomes a deforming force by torque, rotation or compression.
Early diagnosis of a Lisfranc joint injury is imperative for proper management and the prevention of a poor functional outcome. If surgical repair is warranted, it should be done within the first 12 to 24 hours after the injury. Alternatively, surgery can be performed after seven to 10 days to allow the reduction of swelling.