What is a Lisfranc Fracture Dislocation?

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  • What is a Lisfranc Fracture Dislocation?

A Lisfranc Fracture Dislocation, or simply a Lisfranc Fracture, is when the Lisfranc joints are fractured or dislocated, or when the strong ligaments holding the lisfranc joint together are torn.

Lisfranc Fracture Dislocations are usually caused by high energy injuries such as Motor Vehicle Accidents, falling from a height. These injuries can also occur while playing sports. The most common cause is a forced plantarflexion of the foot (foot pointing away from the body) with the foot in a tiptoe position while bearing weight.

Lisfranc Fracture Dislocations can sometimes be mistaken for a slight sprain. However, it is actually a severe injury that will need many months to heal and usually requires surgery to treat. 

How is Lisfranc Fracture Dislocation diagnosed?

Symptoms of a Lisfranc Fracture:

  • Severe swelling and immense pain at the top of the foot
  • Bruising at the top and especially at the bottom of the foot.
  • Pain gets worse when you stand, walk or try to apply weight on the affected foot

If the usual treatment for a sprain (resting, applying ice, elevating your foot) does not relieve the pain and swelling, you should go see an orthopaedic doctor.

Your doctor will conduct a medical interview and a focused examination of the foot. Based on the findings, you will be asked to undergo plain radiographs (X-rays) of the affected foot. CT scans are often also required, and MRI scans may also be necessary for pure ligament injuries.

What are some complications of a Lisfranc Fracture Dislocation?

Planovalgus foot deformity

This is a complication of lisfranc injuries which are left untreated. The loss of the integrity of the foot joints results in the collapse of the foot arch with a resultant flatfoot deformity. This can cause chronic foot pain and ulcers to develop in the foot.

Post-traumatic osteoarthritis

This refers to the loss of joint cartilage over the joints damaged by the lisfranc injury. Patients who develop this condition will have chronic foot pain and swelling, and may have difficulty walking. This is the most common complication from a Lisfranc fracture dislocation. Patients who are at a higher risk of getting this are the ones who received delayed treatment. Even patients who underwent surgery to fix the lisfranc injury may sometimes develop this complication. Patients who develop this condition may require additional surgery to treat this.

How is Lisfranc Fracture Dislocation treated?

Surgical Treatments

The main treatment for Lisfranc Fractures is operative, through surgical fixation.

Generally, the skin over the displaced bones is incised and the displaced bones are placed back into their original positions (open reduction). After this, metal implants are usually inserted to keep the bones in a good position. In some patients, some of the joints involved may be fused (arthrodesis). After surgery, patients will be asked to avoid placing weight on the affected foot for up to 8 weeks. Typically, the implants placed during Lisfranc surgery are removed after about 4 months.

Occasionally, patients with non-displaced Lisfranc injuries may be treated with non-surgical techniques. This usually means the application of a plaster cast for up to 8 weeks. Patients treated non-surgically may still have non-unions of their injuries, meaning that the fracture does not heal properly. This will usually necessitate subsequent surgery.

Rehabilitation and Recover

Patients treated for lisfranc injuries will usually be asked to undergo a course of foot and ankle physiotherapy. This may include ankle range of motion and calf stretching exercises. A course of up to 6 months may be necessary.

Most patients who underwent surgery will require a second surgery to remove their foot implants after about 4 months. The second course of foot and ankle rehabilitation may be necessary after this second operation.

For assessment of your condition, please book an appointment with Dr. Yong Ren.

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Sarah Taylor

Obstetrics & Gynaecology