You don’t want to miss this! Understanding The Complex Midfoot Injury

The Lisfranc Injury

A Literature Review of Anatomy, Etiology, Evaluation, and Management

KEY TAKEAWAYS:

Imaging should be considerd as Bilateral X-ray > CT > MRI.

If X-rays are clear and Lis franc is suspected, CT should be ordered.

You should have a high index of suspicion for Lisfranc instability when patients present with acute midfoot pain.

MRI is a highly sensitive modality in the detection of subtle Lisfranc injuries due to its effectiveness at depicting soft tissue and ligamentous injuries

In cases of a missed Lisfranc injury or a chronic injury greater than 6 weeks old, there may be a greater tendency toward arthrodesis, particularly if displacement is present or early signs of arthritis. No consensus as to if ORIF or arthrodesis is better.

Anatomic variants of this configuration such as a shallow mortise and a short second metatarsal are correlated with greater rates of Lisfranc injury.

Lisfranc injury, a type of injury that impacts the tarsometatarsal (TMT) and intercuneiform joints of the foot, is a rare condition that occurs in approximately 1 out of every 55,000 people in the United States, accounting for only 0.2% of all fractures. This injury is named after French gynaecologist and field surgeon Jaques Lisfranc de Saint-Martin who described an amputation through the TMT joint in 1815. Newcastle Podiatrists explain that Lisfranc injuries are more common in men, who are up to 4 times more likely to suffer from them than women, and typically occur in individuals in their thirties.

The Lisfranc joint complex is made up of the medial, middle, and lateral cuneiforms, cuboid, and the bases of the 5 metatarsals. Anatomical variations such as a short second metatarsal and shallow mortise have been associated with higher incidences of Lisfranc injuries. The interosseous ligament, which originates from the plantar aspect of the medial cuneiform and attaches to the medial base of the second metatarsal, and other ligaments like the Lisfranc ligament, play a vital role in maintaining the bony relationship.

Lisfranc injuries can occur due to various circumstances, including high-energy traumas such as motor vehicle accidents (43%), falls from heights (24%), and crush injuries (13%), as well as low-energy injuries typically encountered in sports activities such as basketball, football, or rugby, which involve indirect mechanisms of injury. Newcastle Podiatrists warn that even though these lower-energy injuries may be subtle, they can still alter the mechanical loading of the TMT joint complex, potentially leading to posttraumatic arthritic changes.

When patients present with acute midfoot pain, a high level of suspicion for Lisfranc instability is crucial. A detailed assessment of the area of pain and tenderness, as well as the position of the foot at the time of injury and the direction of force applied, should be determined if possible. Patients may have an inability to bear weight and pain and swelling over the midfoot, with more subtle injuries presenting with mild symptoms that may only be apparent with strenuous activity. Newcastle Podiatrists recommend seeking medical attention from a Podiatrist near me in case of such symptoms.

To diagnose Lisfranc injuries, standard radiographs of the foot including Anteroposterior (AP), lateral, and oblique views are commonly used. Weightbearing radiographs are more sensitive in detecting subtle injuries. Computed tomography (CT) scans and magnetic resonance imaging (MRI) can be used in the evaluation and diagnosis of Lisfranc injuries, particularly in cases of high-energy or comminuted injuries where plain radiographs are inconclusive. Bilateral radiographs are recommended for comparison due to the variability in patient midfoot morphology.

In conclusion, Lisfranc injury is a rare condition that requires immediate medical attention from a Newcastle Podiatrist in case of any symptoms like midfoot pain, inability to bear weight, and swelling over the midfoot. Proper diagnosis using imaging techniques such as CT scans, MRI, and radiographs is crucial to treat the injury effectively.