Description
Some joints seem to get all the attention. The ankle joint, for instance, is forever being coddled by bandage strips and ice packs. Even the big toe joint has its fair share of groupies. But who ever stops to think about the Lisfranc joint? Of the more than 30 joints in the foot, the Lisfranc joint is hardly the most well-known. It would be hard-pressed to be considered a household name. And yet, problems with this joint can be just as disruptive as injuries to other joints. (So take that, smug ankle joint.)
The Lisfranc joint is located at the point where the metatarsals (the long, thin bones that connect to the bottoms of the toes) meet the tarsals (squat, squarish bones that make up the arch of the foot and the midfoot). Additionally, there are ligaments that connect these bones together and keep them properly aligned.
Injuries to the Lisfranc joint usually happen to people involved in car accidents, people in the military, athletes (runners, football players, horseback riders, etc.), those who have fallen from a height, and patients who have nerve damage in the foot (such as diabetics and those whose neuropathy is caused by alcohol consumption). Unfortunately, doing something as simple as missing a stair, or dropping something heavy on your foot (like an anvil) can also result in an injury to the Lisfranc joint.
This type of injury was first described by Jacques Lisfranc, a surgeon in Napoleon’s army. Men in the cavalry would sometimes wrench their feet violently in the stirrups, resulting in an injury to the Lisfranc joint. The most common treatment back then was partial amputation. Fortunately, medical treatment has come a long way since the early 19th century. (In short, your podiatrist is unlikely to suggest amputation as your best treatment option.)
Lisfranc injuries may come in three different forms: sprains, dislocations, and fractures. A sprain of the Lisfranc joint means that the ligaments connecting the bones have been strained and stretched. (In short, it’s an injury of your soft tissues.) The problem is that these ligaments help keep the joint and your foot properly aligned. When they’ve been stretched and are out of balance, the foot may lose stability. Or, the bones of the joint may break. They may be avulsion fractures (which is basically a piece of bone breaking off, usually due to a ligament pulling away from the bone), or there might be a break running all the way through the bone.
Dislocations of the Lisfranc joint mean that some or most of the metatarsals have been forced out of their proper positions. They may all move together, or some may shift and others remain in their proper place. Dislocated bones sometimes return to their proper positions after the dislocation, so diagnosing the injury might be rather difficult.
Symptoms
Because symptoms of Lisfranc injuries are so similar to sprains, these injuries can be difficult to diagnose. However, with this type of injury you’re likely to see swelling on the top of the foot, and there may be some bruising and blistering along the arch of the foot as well. The shape of your foot may also change, looking wider after the injury. The middle of the foot is likely to feel painful when you stand or press on it, and if the damage is severe, you may not be able to stand at all. Holding the heel and rotating the foot in a circle is also likely to be painful with a Lisfranc joint injury, but not with ankle sprains.
Diagnosis
When Lisfranc injuries, particularly fractures or dislocations, are left untreated, there may be serious consequences. Your foot may develop compartment syndrome, in which pressure builds up in the soft tissue and starts to shut down blood vessels and damage nerves. (Compartment syndrome often requires immediate surgery in order to prevent significant tissue damage to your foot.) It’s always a good idea to get your foot checked out by a podiatrist when you’ve experienced an injury, particularly when symptoms such as swelling and pain don’t go away after a day or two.
Your podiatrist will probably take a few minutes to ask you about your injury, such as how long ago it occurred, what symptoms you’ve experienced, and so on. He or she will also likely perform a physical examination of your foot. At times, a thorough examination may be done under anesthesia. Because Lisfranc injuries may be difficult to diagnose, your podiatrist may use other tools at his or her disposal, such as X-rays or other imaging devices.
Treatment
While Lisfranc injuries often requires surgery, depending on the type of injury you’ve sustained, your podiatrist may feel optimistic about treating it conservatively at first. Often, these non-surgical treatments involve resting the foot as much as possible, so stay off your feet if you can, and elevate your injured foot at or slightly above hip level. Icing your foot (20 minutes on over a thin towel, then at least 40 minutes off) can also help reduce swelling and pain, as can taking anti-inflammatory medications such as ibuprofen. Your podiatrist might cast your foot to keep it immobilized and allow the injured joint to heal, and you may have to learn how to get around on crutches for awhile.
In cases where the Lisfranc injury is severe, your podiatrist may recommend surgery as your best option. Surgeons will often use pins or screws to secure bones in their proper locations while they heal, but these implements are often removed at a later time (usually around four or five months later). Unfortunately, Lisfranc injuries frequently result in arthritis in the joint at some later point. The good news is that your podiatrist can treat this arthritis as well.
With all that treating a Lisfranc injury involves, you may be shocked to realize you never really thought about this joint much before. You may think that the injury even seems a little grim. But, even if you do have an attention-seeking Lisfranc joint, you can take comfort in knowing that at least modern medicine has progressed far beyond the Napoleonic era. So, well. That’s pretty good news, right?