Lisfranc injury
This article describes the case of a 34-year-old man diagnosed with Lisfranc injury. The patient presented to the emergency with complaints of sudden onset of pain in his right foot after landing a jump during a game of handball. Physical examination showed swelling and bruising on the dorsum of the right food. The patient was also unable to bear weight on the affected foot.
A radiograph of the foot showed lateral displacement of the first to fifth metatarsal bones from the cuneiform bones and the cuboid. For further examination, doctors advised a computed tomography of the right foot which was significant for lateral and dorsal dislocation of the first to the fifth metatarsal bone, including a fracture of the first through fifth metatarsal bones. CT scan findings were also significant for fractures of the first and second proximal metatarsals.
Diagnosis
The findings were consistent with the diagnosis of Lisfranc injury. Lisfranc injury is defined as an injury to the tarsometatarsal joint complex. The severity of the injury can range from soft-tissue damage to fracture with displacement. However, the injuries are a rare finding and may be misdiagnosed because of other distracting injuries on the radiograph. The injury can be mistaken for a sprain, especially in cases of straightforward twists and falls. The presence of even minor foot pain should give rise to suspicion for the condition.
The injury was surgically repaired and the patient had an uneventful recovery without any post-operative complications. He was called back for a follow-up after 10 weeks. Examination showed that he could fully bear weight on the foot. At 6 months follow-up his gait was normal.
Lisfranc injuries are often a result of broken bones or torn ligaments in the midfoot. The severity may, however, vary widely, from simply injury of the midfoot joint to a complex injury of many midfoot joints and broken bones. The fracture-dislocations were named after French surgeon Jacques Lisfranc de St. Martin, who observed these injuries in cavalry soldiers serving in the Napoleonic army in the 1800s. The injury is not like a simple sprain that can be “walked off” but, may require surgery and might even take several months to heal.
Source: NEJM
