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What are the secrets of Lisfranc injuries revealed when a heavy object falls on the foot? Learn about this thrilling situation!
A Lisfranc injury, also known as a Lisfranc fracture, is a foot injury that involves one or more of the metatarsal bones being displaced from the ankle. This injury is named after the French surgeon Jacques Lisfranc de St. Martin, who noticed this fracture pattern among cavalrymen in 1815 after the War of the Sixth Alliance.
Cause
The midfoot contains five bones that form the arch, namely the cuboid bone, the navicular bone, and three cuneiform bones, and are connected to the base joints of the five metatarsal bones. Lisfranc injuries involve damage to these joints and typically involve damage to the ligaments between the cuneiform bone and the bases of the second and third metatarsal bones. These ligaments are known as the Lisfranc ligaments.
The primary cause of Lisfranc injuries is excessive kinetic energy exerted on the midfoot, often occurring in traffic accidents or industrial accidents.
Diagnosis and examination
Diagnosing a Lisfranc injury is relatively easy in the case of a high-energy injury to the midfoot, such as a fall from a height or a traffic accident. It is usually accompanied by midfoot deformation and obvious X-ray abnormalities. But diagnosis is more challenging in the case of low-energy accidents, such as a sprain while running or a fall by an American football player.
A typical X-ray will reveal a gap between the bases of the first and second toes.
Classification of injuries
Lisfranc injuries can be divided into three categories:
- Ipsilateral type: All five metatarsal bones are displaced in the same direction.
- Isolated: One or two metatarsal bones are separated from the other metatarsal bones.
- Divergent type: The metatarsal bone is displaced in the sagittal or coronal plane, and may also involve fractures of the midcuneiform and scaphoid.
Treatment methods
Treatment options include surgical and non-surgical treatments. One study noted that in athletes, if the dislocation does not exceed 2 millimeters, it can be treated with a cast for six weeks, during which time the injured limb must not bear weight. In most cases, early surgical repair of the bone fragment is recommended.
For severe Lisfranc injuries, open restoration and internal fixation (ORIF) is the best treatment.
Rehabilitation process
Rehabilitation of a Lisfranc injury includes strengthening exercises and mobility training after the initial healing phase. More and more people are using EMS foot massagers to promote muscle activity, reduce stiffness and improve blood flow in the affected foot. Their effectiveness depends on correct use and approval from a medical professional.
Historical background
During the Napoleonic Wars, Jacques Lisfranc de St. Martin encountered a soldier who had suffered damage to the blood vessels in his foot and secondary gangrene after falling from his horse. He subsequently had an amputation at the mid-toe joint, hence the name of that area becoming the "Lisfranc joint". Although Lisfranc does not describe a specific mechanism of injury or classification scheme, a Lisfranc injury today refers to a dislocation or fracture-dislocation injury of the metatarsal joint.
Differences from other fractures
It is important to note that Lisfranc injuries may also be misdiagnosed as other types of foot fractures, such as Bosworth fracture, Chopart fracture-dislocation, Jones fracture, and March fracture. Although these injuries are different, they sometimes have similar symptoms and imaging findings clinically.
While we maintain active lives, have you learned how to effectively prevent and respond to Lisfranc injuries, a horrific injury that can lead to long-term disability?
