The year is 1815 and French surgeon, Jacques Lisfranc de St. Martin is looking for the best place to make an amputation on his patient’s foot. This joint is at the junction between the midfoot and forefoot. The tarsometatarsal joint he chose now bears his name, and refers to an injury involving a break and possible dislocation of your metatarsal and tarsal bones in your foot.
Lisfranc injuries can be difficult to diagnose and treat, but if not detected and appropriately managed by a musculoskeletal physio they can cause long-term problems.
What causes a Lisfranc injury?
Lisfranc injuries can be caused by either direct or indirect trauma.
Extreme force applied to the midfoot, usually following a car accident or a fall from height and crush injuries such as dropping heavy objects onto your foot or your foot being run over are the most common ways of sustaining a Lisfranc injury.[1]
In terms of indirect trauma, injury can occur from plantarward bending associated with rotational stress along with mechanisms where the forefoot is suddenly adducted relative to a fixed hindfoot. This type of injury occurs in equestrians during a fall from a horse when their foot remains in the stirrup.[2]
Sports where your foot is held in position, for example; horse riders, cyclists, snowboarders, kitesurfers and windsurfers are more at risk of a Lisfranc injury. If a fall happens, the foot often is not removed from its placings, resulting in extreme force being applied to the midfoot region causing a dislocation or fracture.
What does a Lisfranc injury feel and look like?
A Lisfranc injury will usually present with:
- Swelling of the foot and/or ankle
- Bruising of the foot and/or ankle
- Pain usually in the middle part of the foot
- Widening of the midfoot area
- Large bump on the top midfoot area
- Not being able to put any weight on the injured foot
What Lisfranc injury symptoms can physiotherapy help with?
Physiotherapy improves the healing process allowing you to return to normal life as quickly as possible following a Lisfranc injury. After a Lisfranc fracture, your foot and ankle will likely be immobilised in a cast or walking boot.
Fixio Physiotherapy treatment provides many benefits following a Lisfranc fracture. These include:
- Decreased pain
- Decreased swelling
- Gait (walking) education without the use of aids
- Increase in muscle strength
- Increase in range of movement
- Increase in function
What does physiotherapy treatment for Lisfranc involve?
There are various treatment techniques that our physiotherapists will utilise depending on your presenting symptoms. Physiotherapy treatment should begin shortly after immobilisation and may include:
- Soft tissue massages to decrease swelling
- Calf stretches to regain the flexibility in the calves
- Range of motion exercises: Plantarflexion, dorsiflexion, inversion and eversion
- Toe and midfoot arch flexibility stretches:
- Ankle and foot strengthening exercises
- Balance exercises
- Plyometrics and jumping exercises: Jumping and landing, single leg hops
- Strengthening to address post immobilisation weakness
- Gait training
A bespoke rehab program will be designed when weight bearing has been commenced. This is to further develop strength, range of movement and flexibility.
You may benefit from the services of a musculoskeletal physio if you have suffered a Lisfranc injury. Your Fixio physio can assess your condition and offer treatments to help decrease your pain and improve your range of motion (ROM), strength, and overall functional mobility.
[1] Haapamaki V, Kiuru M, Koskinen S. Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography. Foot Ankle Int. 2004 Sep;25(9):614–9.
[2] Wiley JJ. The mechanism of tarso-metatarsal joint injuries. J Bone Joint Surg Br. 1971 Aug;53(3):474–82.
