Midfoot Injuries (Lisfranc Injuries): Treatment Options

Midfoot Injuries (Lisfranc Injuries): Treatment Options

This video will provide an overview of the treatment options for Lisfranc injuries to the midfoot. It is essential to obtain proper treatment for a Lisfranc joint injury, given its importance to the structure and support of the midfoot. Delays in treating these injuries can impact long-term outcomes as the joint may become chronically unstable.

Treatment without surgery for Lisfranc injuries is reserved for stable injuries, where there is no or very minimal displacement of the normal alignment of the joints. Typically, this is seen with a partial tear of the primary Lisfranc ligament or nearby surrounding structures. This type of injury is typically treated by immobilizing the injured foot in a boot during healing. This will allow the injured area to heal and scar in place before the patient can begin wearing regular shoes and weight-bearing.

Often more x-rays are taken during the 4–6-week period to ensure the injury has not displaced. If treating without surgery, the patient will be advised to rest and elevate the extremity to minimize swelling and improve pain. Treatment with surgery for a Lisfranc injury will be advised for unstable injuries with movement in the joint spaces. Surgery will also be recommended for fractures or breaks in the bone near the complex, especially if they extend into the joint spaces.

The goal of surgery is to stabilize the alignment of the foot until the injured complex scars and heals in place. Traditionally, this has been accomplished through 2 methods: open reduction and internal fixation, known as O R I F, or a fusion of the Lisfranc joint in which the bones are encouraged to heal together surgically. ORIF uses surgical hardware to hold the position of the joints in normal alignment, also called a reduction. The hardware is meant to hold the position until the ligament injuries are healed.

With this method, mild motion may be seen during healing, which can cause hardware to break. Although this may be expected and not always a concern, the hardware is often removed after full healing is seen to prevent this issue. In fusion, hardware is used to hold the joint still until the bone is healed together. Typically, the hardware is left in place. In addition to traditional options, specialized sutures and implants now exist. Due to complications associated with internal screws, such as loosening, disruption to the surface of the joints, and irritation to the nearby structures, there has been a trend towards these newer options.

These supportive suture devices can provide additional support during healing while allowing mild motion that may mimic the movement and structure of the native anatomy. Each surgery has its advantages. The choice will be based on the specific injury and the patient's health and goals. Following any procedure, the patient will remain non-weight-bearing for a short period of time. Physical therapy will be ordered to assist with the transition back to regular activities.