Lisfranc (midfoot) fracture : symptoms, diagnosis, treatment

Lisfranc (midfoot) fracture

Lisfranc fracture is the type of broken foot by which the middle bone of the foot where metatarsals connected become damaged. In this condition affected person is unable to walk. More than one metatarsal bone of the foot can be dislocated in this condition. 

Due to the similarity in causes and symptoms, it is often confused with a sprain. Examination and imaging tests are important for the diagnosis of Lisfranc fracture. Sometimes we can remove it by a surgical process. Its healing process is long. [1]Lisfranc fracture-dislocations: current management (nih.gov)

Reasons

There are many reasons behind the midfoot fracture

  • Twisting the foot when a person falls can cause a Lisfranc injury. It also happens through simple low-energy injuries. When football players stumbled above their stretched feet midfoot injury can occur.
  • More serious trauma can also cause a Lisfranc fracture. 
  • When the foot is flexed then dropping can also cause the dislocation or fracture of joints.
  • Accidents by automobile or motorcycle or any other reason can be of Lisfranc fracture.
  • When bones are cracked in the midfoot or ligaments are broken then a Lisfranc fracture occurs.
  • When we fall from the high area then a simple twist or sprain may happen in the midfoot. [2]dickyricky.com/Medicine/Papers/2017_01 EMJ Lisfranc fracture dislocation.pdf

Symptoms

Following are common symptoms of Lisfranc fracture

  • Swelling of the foot especially on the upper portion
  • Pain in affected parts while walking or standing

Diagnosis

The common method of diagnosing Lisfranc fracture is the imaging technique. In diagnoses of Lisfranc fracture, doctors take their time as they can easily diagnose. In a hurry, it can be misdiagnosed. Physical examination and imaging tests both are involved in this diagnosis of Lisfranc fracture. 

The middle portion of the foot is gently squeezed by a doctor. In a Lisfranc fracture, the surrounding area or damaged portion can cause tenderness and pain. [3]www.rimed.org/rimedicaljournal/2013/05/2013-05-33-ortho-lisfranc.pdf

Physical examination for lisfranc fracture

Each tarsometatarsal articulation of the foot should be palpated first distally and continue proximally when Lisfranc joint complex injury is mistrust. Soreness along the tarsometatarsal joints provides the diagnosis of the midfoot sprain and supports the potential for incapability.

When direct palpation is applied at the tarsometatarsal region, then pain can restrain to the inside or side-wise view of the foot. Through abduction and pronation of the forefoot, it can be manufactured. The hindfoot is held fastened. During footing on tiptoe, the incapability of the patient to carry weight also causes diagnosis.

The dorsal pedals best and vessel mixture must also be estimated. The dorsal pedals vein flow above the proximal head of the 2ndmetatarsal. For disruption, this one is susceptive in a plain fracture.

Radiographs

Bone examining or computed tomographic scanning is also supportive for the diagnosis of Lisfranc joint injury. It is also helpful in making the surgical therapy plan.

Imaging test

To confirm a diagnosis of Lisfranc injury, imaging tests are most important. One or more imaging tests are done to look at the bones and tissues in the foot before deciding on the treatment. Broken bones are shown by X-rays and also the alignment of the Lisfranc joint complex is shown. If not properly aligned it may suggest there is a fracture to the ligament in the area.  The X-ray also provides an image of the fracture 

Treatment 

Non-Surgical treatment

We should avoid walking with fractured feet. Doctors must observe the injured foot as soon as possible.  Management Started fatly to reduce fractures and sometimes open surgical processes can be avoided. The treatment of this fracture or injury builds upon the seriousness of the injury. It means how much this injury has severity. [4]www.rimed.org/rimedicaljournal/2013/05/2013-05-33-ortho-lisfranc.pdf

A Lisfranc injury can be treated frequently with rest, ice etc.  Your surgeon or doctor may suggest you use braces that support you with this suffering injury. This may help you to step out or stay stable.

If this injury or fracture is most critical then your surgeon will examine it continuously. He treated you through X-rays and saw on the monitor for better recovery and examined if surgery was needed. 

Non-surgical treatment has only one situation in which this treatment is specified. As a result, this is the best treatment and patients can come back for their games or sports and in daily life. 

Surgical treatment

Surgery is very important for Midfoot injury that includes a bone fracture, joint dislocation or abnormal positioning, and torn ligaments. Surgery depends on the type of injury. The most common treatment is internal fixation; this surgical process involves the accurate positioning of injured bones. In this process, bones are held with wires, screws, and plates. Plates are surgically removed when bones and joints heal. [5]https://upload.orthobullets.com/journalclub/free_pdf/21119138.pdf

Written by: Dr. Muhammad Mohsin Ahsan

Reviewed by:
Dr. Shafaat Yar Khan  (Ph.D.) 
Medical University of Vienna, Austria 
Present: University of Sargodha, Pakistan

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