What is a Lisfranc fracture?

A Lisfranc fracture occurs when there are either torn ligaments or broken bones in the midfoot area of one or both feet. The midfoot is the area of your foot that makes up the arch, where the forefoot (bones of the toes) and hindfoot (bones including the ankle and heel bone) connect.

Your midfoot contains the Lisfranc joint and the Lisfranc ligament, both of which can be injured in a Lisfranc injury. These fractures are among the most common foot injuries. They range from mild to severe, depending on how the injury occurred.

Symptoms of a Lisfranc fracture depend on the severity of the injury. Common symptoms include tenderness and swelling at the site of injury and the top of your foot. You may also have pain that gets worse when you walk or stand.

Bruising can occur on both the top and bottom of your foot as well. Bruising on the bottom of your foot is the strongest indication that you have a Lisfranc fracture, and not a sprain.

A variety of injuries can result in a Lisfranc fracture. This injury most commonly occurs when you twist your foot while falling. However, if your foot is crushed or damaged while flexed, you may also experience this fracture. This typically results in a mild injury.

However, direct trauma can cause an even more severe form of the fracture. For example, falling from a great height has been known to create Lisfranc fractures that require extensive treatment.

Lisfranc fractures are commonly mistaken for simple sprains due to their location and because they typically occur from a twisting fall.

To determine the type of injury you have in your foot, your doctor will perform a physical exam.

While assessing the injured foot for bruising, tenderness, and pain, your doctor will look for bruising at the bottom of your foot, a key indicator of a Lisfranc fracture.

Your doctor may also perform a series of tests to determine the injury. The “piano key” test is done by moving each of your toes one by one to see if this causes pain. Alternatively, your doctor might have you do a single limb heel rise (that is, you’ll stand on the tips of your toes). Pain resulting from either or both of these tests is an indication of a Lisfranc fracture.

A series of imaging tests may also be done, ranging from X-rays to MRI and CT scans. These give your doctor a more detailed picture of exactly which bones or ligaments are injured.

Treatment for a Lisfranc fracture will also depend on the severity of the injury.

A mild Lisfranc fracture can often be treated the same way as a simple sprain — with ice, rest, and by elevating the injured foot. Your doctor may recommend you use crutches to help with the pain that can occur upon walking or standing.

More severe injuries might require you to wear a cast for up to six weeks. Your doctor will continue to check up on you, taking X-rays to monitor the improvement of the injury and to see if surgery is required. Surgery is how the most severe Lisfranc injuries are treated.

You may undergo a surgical procedure called internal fixation, where the bones of your foot are repositioned and held in place with screws or plates in order to heal.

Alternatively, you may undergo a fusion treatment. This surgery is less common than internal fixation. In this procedure, the cartilage around your joints is removed before the screws are added. The goal of this procedure is to fuse the bones in your midfoot together to create a single bone. If you do need to have surgery, you will most likely not be able to bear weight on the injured foot for a period of six to eight weeks afterward while wearing a cast.

Your doctor may recommend that you have the pins and plates removed about four to six months after your surgery.

A Lisfranc fracture can often be treated with rest, a cast, or surgery. However, people who’ve experienced this injury are more likely to develop arthritis or chronic pain in their Lisfranc joint or ligament. This may result in decreased levels of ability or the need for a fusion surgery in the future.

Talk to your doctor if you’re still experiencing pain in the midfoot area after your treatment is over. They can help you determine if further treatment is needed.