Lisfranc joint injuries are rare 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 joints. Radiographs are necessary are often show a diastasis of the normal architecture and confirm the presence of dislocation or fracture. 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 less than 1 percent of all fractures.
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.
Lisfranc joint fracture-dislocations and sprains can be caused by a variety of high-energy forces including 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 disability consulting your Podiatric Physicians is important to avoid long term discomfort. Key characteristics that should not be ignored are foot injuries characterized by marked swelling, tarsometatarsal joint tenderness and the inability to bear weight.
Early diagnosis of a Lisfranc joint injury is imperative for proper management and the prevention of a poor functional outcome.