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Lisfranc Injury: Easy to Miss, Hard to Get Over

Elite athletes like NFL quarterback Matt Schaub and wide receiver Santonio Holmes had productive seasons ended by the little-known and often overlooked Lisfranc injury, a serious foot injury that few have heard of and no one wants. But foot and ankle surgeons are evaluating how to effectively diagnose and treat this injury, which can result in severe long-term complications like chronic pain, osteoarthritis and even foot deformities.

Relatively uncommon, found in only 1 of every 55,000-60,000 people annually, Lisfranc injuries occur in the midfoot where the long bones leading up to the toes (metatarsals) connect to the bones in the arch (tarsals). "The Lisfranc complex is a critical joint in propulsion during walking and running. Unfortunately, injuries there are easily overlooked. As many as thirty percent of Lisfranc injuries are missed at initial diagnosis by providers who are not foot and ankle specialists. The long-term effects can be debilitating," observes Cleveland, Ohio foot and ankle surgeon Mark Hardy, DPM, FACFAS, and a conference presenter.

Diagnosis can be difficult because the signs, even during examination and imaging, can be extremely subtle. Injuries most often occur to car accident victims where the foot is jammed into the floorboard or to athletes when the foot is planted and twisted. Direct trauma injuries can result when a heavy object is dropped on the foot. Most people don't have an appreciation of the amount of force required to disrupt the Lisfranc complex. Whether you're an athlete or a laborer, early and appropriate treatment is mandated.

Lisfranc injuries can also result simply from missing the last step on the stairs; even a minor slip and fall can cause serious injury. Symptoms of a Lisfranc injury may include swelling of the foot, pain throughout the midfoot upon standing or during examination, inability to bear weight, bruising on the bottom of the foot in the arch area and an abnormal widening of the foot, possibly signaling dislocation.

Lisfranc injuries fall into three categories: sprains, fractures and dislocations. Sprains typically do not require more than rest and recuperation time, as they are comparable to ankle sprains. In a fracture, a break in a bone in the Lisfranc joint occurs. In a dislocation, the bones are forced from their normal positions. In severe cases, both fractures and dislocations occur. In fractures and dislocations, surgery is often the best option. Patients hope for a nonsurgical response, but foot and ankle surgeons are well aware of the dangers associated with putting off necessary surgery.

A number of factors impact the surgeon's decision on treatment options; the patient's age, overall health and activity level. Because of the possible long-term impact of this injury, the chief objective is ensuring a positive outlook for the future.

Wires, pins and even surgical buttons can be used to stabilize the joint, both permanently and in some cases, temporarily. Some promising studies have focused on the effectiveness of a minimally invasive technique that can help reduce the recuperation period.

Lisfranc injuries can be successfully treated when properly diagnosed and treated in a timely manner. If you have experienced any sort of foot trauma and symptoms appear, it's time to see a foot and ankle surgeon. Especially in the case of Lisfranc injuries, the earlier someone visits a foot and ankle surgeon, the greater the likelihood of a positive outcome.