Fluoroscopic stress views are also helpful but they are painful and require anaesthesia. Weight-bearing X-rays and comparisons with the unaffected foot may help in diagnosing subtle injuries. Clinicians should be guided by the clinical picture even if X-rays are normal, as Lisfranc injuries are easily missed. Regarding imaging, an X-ray is used as a first-line with weight-bearing anteroposterior, oblique and lateral views. The midfoot will be tender on palpation and passive forefoot movement will elicit pain. Patients typically present in significant pain, unable to weight-bear, with midfoot swelling. A detailed history of the mode of injury is important including foot position, degree of energy involved, and force direction. Missed and delayed diagnoses are associated with devastating long-term disabilities. The incidence of missing a Lisfranc injury is 20% and typically occurs in low-energy injuries and polytrauma patients. Ī thorough history and examination are key in assessing Lisfranc injuries. The Lisfranc ligament is the most robust ligament, and the second metatarsal is important in stabilising the midfoot arch. The Lisfranc ligament complex encompasses the Lisfranc ligament and the first and second metatarsals’ TMT ligaments. Dorsal displacement in Lisfranc injuries occurs as the dorsal ligaments are weaker (ii) Inter-metatarsal ligaments, which connect the second to fifth metatarsals (iii) Lisfranc ligament, the plantar interosseous ligament connecting the medial aspect of the second metatarsal to the lateral aspect of the first cuneiform bone. Ligamentous structures are critical in stabilising the Lisfranc joint and comprise: (i) TMT plantar and dorsal ligaments, which cross every TMT joint. Studies show that a shallow second tarsometatarsal (TMT) joint mortise increases the risk of Lisfranc injury. Between the medial and lateral cuneiform lies the base of the second metatarsal. The bases of the metatarsals form an arch-like structure with the second metatarsal acting like a keystone. The osseous structure of the midfoot makes it inherently stable. The Lisfranc joint complex comprises the first to fifth metatarsals, three cuneiforms, the cuboid, communicating ligaments, capsules, and stabilising tendons. This review will focus on the current literature on Lisfranc injury management. Delayed or missed diagnoses are associated with arch collapse, midfoot instability, post-traumatic osteoarthritis, and forefoot abduction, which cause stiffness, chronic pain, and foot and ankle complex dysfunction. Studies report that 20% of Lisfranc injury diagnoses are missed initially, likely due to the intricate anatomy of the midfoot rendering diagnosis and detection of subtle cases difficult using X-ray alone. Lisfranc injuries can result from high-impact injuries sustained from motorcycle accidents or high velocity falls, or low-impact injuries sustained from sports. This term originates from Jaque Lisfrant de Saint-Martin, a French military surgeon and gynaecologist who described both the injury and amputation through the midfoot. Often times, certain Lisfranc injuries will result in surgery due to fractures and torn ligaments.Lisfranc injuries encompass bony or ligamentous injuries where one or more metatarsal is displaced relative to the tarsus. Treatment involves immobilization, rest, NSAIDs, icing, physical therapy and orthotics to support healing and stabilization of the foot. Lisfranc injuries are serious injuries and if a person believes they have them they should see a clinician immediately and avoid using or place weight on the injured foot. To confirm a diagnosis, a clinician will observe the patient’s past medical history, perform a physical examination of the foot and is likely to order imaging studies to observe the severity of the injury. Misalignment of the structures of the foot. ![]() Sprains: damage of a ligament due to excessive stretching of the ligament and imbalanced biomechanics.Fractures: a break in a bone, possibly multiple bones. ![]()
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