Lisfranc Injury: Type of Dislocation of the Foot
Ever heard of a Lisfranc dislocation? Probably not as it is an uncommon type of sports injury. They say you learn something new everyday, well that is exactly what I did when a rugby player came hobbling in to the practice with his dislocated foot sports injury. In this case I needed to pull out my AECC radiology textbook “essentials of skeletal radiology” to try learn more about this type of foot dislocation injury.
Since I had never seen this type of rugby injury before I thought I would share with you today the interesting information I found and learnt about: what is a Lisfranc dislocation.
Table of Contents
Who Discovered the Lisfranc Injury
Lisfranc dislocation is named after a French surgeon in Napoleans army, Dr Jacques Lisfranc.
Dr Lisfranc found a novel way of amputating the gangrene soldiers feet between the midfoot and forefoot. They named the supportive ligament between the two bones in the foot after him, Lisfranc ligament. The funny thing is that Dr Lisfranc didn’t know about or name the Lisfranc type dislocation condition. However, it happens to be where the foot dislocation occurs is why it was named after him.
What is a Lisfranc Dislocation?
Technnically the dislocation of the foot bones happens between the cuneiform bones and the 1st-5th metatarsal bases.
You can see the anatomical area I’m talking about on the anatomy of the foot anatomy diagram below. It is the area circled in red. This anatomical landmark is also known as the Lisfranc joint or the tarsometatarsal joint.
This is Lisfranc joint area is where the tansverse arch of your foot is situated. This means that it is normally a very strong part of the foot. It is a rare area of the foot to be able to dislocate the bones. Apparently it accounts for only 0.2% of all fractures.
How Does the Fracture Happen?
In my interesting sports injury case it was a young 18-year old guy who had been playing a rugby match.
The patient said he was rugby tackled by two players whilst one had stood on his foot in the tackle. The patient knew something was wrong instantly with his foot because all his toes felt funny and it was very sore.
The foot, apparently, at the time of onset didn’t look any different except that it was swollen and there was an instant bruise that appeared on the outside of his midfoot. His parents took him for a foot and ankle x-ray and that is when a radiologist confirmed a Lisfranc dislocation.
From my reading, apparently, the other common times this type of are foot fracture/dislocation occurs is from a car accident and when equestrian riders get their feet stuck in the stirrups from a horse riding accident.
The Symptoms Felt
The main symptom is pain in the foot and not being able to stand on it after. There would be some visible blue bruising on the foot and swelling very fast around the foot. This was just like the rugby player.
Everything You’ll Need to Know Videos
In this following educational video from medical doctor, Dr Nabil Ebraheim, you’ll learn a ton more about:
- Anatomy of the Lisfranc ligament,
- What makes up the four tarsometatarso joint complex and if they are rigid or mobile,
- Where the deep peroneal nerve and dorsalis pedis artery run,
- The direct and indirect mechanism of injury,
- Concern about secondary complication condition called compartment syndrome of the foot,
- Why surgery is needed in all cases for concern about arthritis of the foot,
- The three types of Lisfranc injuries classifications: Quene & Kuss, Hardcastle, and Meyerson,
Fracture Treatment Options
As mentioned in the video above the only option for my patient was foot surgery. I have another video showing an example of a Lisfranc surgery. WARNING this is surgery so watch if you wish.
When the toes are visibly dislocated on the foot x-ray then pins are needed to stabilise the foot again.
It would mean he would be off that foot for a long time and there was no more rugby for him for the year. An orthopaedic surgeon with an interest in the foot and ankle would be the best consultant for treatment of this type of foot injury.
Have you ever had a Lisfranc dislocation/fracture in your foot? I would love to know how yours happened and how it has gone since. Let me know with a comment below.