Lisfranc Fracture: Diagnosing a Foot Injury

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Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editors: Melissa Conrad Stöppler, MD

In the middle of the pile, one lineman steps on another's foot; a common occurrence, no big deal. But add a little torque or twist and one of the joints in the mid foot can tear. Add a little more and disaster occurs. Indianapolis Colt defensive end, Dwight Freeney hurt his foot (on Monday, November 11, 2007) and the team signed his replacement within 24 hours. It seemed like more than just a sprain; the outcome was a Lisfranc fracture of his left foot. As a result of his injury, Mr. Freeney has been placed on the injured reserve list and is out for the season.

When Napoleon led his army to disaster in the Russian winter, many of his soldiers suffered from frostbite and developed gangrene of the toes and feet. Dr. Lisfranc figured out the anatomy of the foot and found that cutting through joint spaces made amputation easier. His legacy is that fractures, dislocations, and sprains that affect the junction between the upper and lower foot bones bear his name.

The foot is made up of rigid bones and joints near the ankle that don't move and provide stability to the foot. They are connected to the more flexible bones that allow the foot to turn and flex for walking and running. There are numerous joints that connect the two portions and ligaments hold them in place. On the athletic field, too much torque causes the ligaments to tear, the joint to be unstable, and the alignment lost. In car wrecks or other major trauma injuries, not only can the ligaments be damaged, but the bones can break and the midfoot dislocates; not a pretty sight. The fractures are not hard to miss, but the trainer or the doctor needs to look hard for subtle sprains.

Because all weight bearing gets directed through this part of the foot, the Lisfranc joint doesn't tolerate any injury or damage. Even minor sprains can cause significant pain and difficulty with walking. If the diagnosis is missed or treatment delayed, the long term consequences can include arthritis and loss of function of the foot.

If no surgery is needed initially, then a non-weight bearing cast is recommended for six weeks, then weeks  rehabilitation. Even with a cast, there is a possibility that the bones will shift and an operation will be needed using pins to keep the bones in place while the ligament heals. Post-op rehabilitation may last six months or more.

Football players get pulled, pushed, pounded, and stretched on every play. Mr. Freeney is unlucky to have been hurt on that particular play. Fortunately orthopedics has come a long way since the days of Dr. Lisfranc and his amputation saw.

Reference: ESPN.com