What is a Lisfranc Injury?

What is a Lisfranc injury, who is most at risk for this problem, and how can it be treated? While relatively rare in the general population, this injury is a major problem for athletes, especially football players. And, if not treated quickly and effectively, it can result in lasting complications and loss of functionality. So, how can you fully recover and stay in the game? Keep reading to find out!

How Serious is a Lisfranc Injury?

If you play football, you have a higher risk for getting a Lisfranc injury. In fact, in the general population, about 1 in 55,000 people will suffer a Lisfranc injury. But if you play football? Your risk rises dramatically. In fact, between the 2009 and 2020 NFL seasons, 33 NFL players sustained this injury, with offensive linemen and running backs facing the highest risk. And those statistics don't take into account the many middle and high school football players putting their midfoot at risk every time they hit the turf.

Making matters more challenging for athletes? This injury is both hard to diagnose and hard to heal. For that reason, it's important to recognize the symptoms of this sports injury. That way, you can seek immediate treatment. And avoid getting sidelined for extended periods of time.

What is a Lisfranc Injury?

A Lisfranc injury affects the Lisfranc or tarsometatarsal joint. But this term actually describes several joints in your midfoot. They work together to connect your front and back foot, surrounding the cuboid bone and cuneiform bones. And, together, the bones and joints stabilize your foot when you move. As a result, a Lisfranc injury makes walking difficult. Even worse for athletes, it makes playing physical sports like football almost impossible.

Football and The Midfoot: A Toxic Relationship

Why is a Lisfranc injury such a common football problem? It all has to do with unnatural foot movements. Basically, this injury occurs when your foot is planted, but applied forces cause it to rotate. (In that way, it's similar to a turf toe injury.)  Most often, this problematic movement comes when players need to suddenly change directions. Or when they get tackled, causing their midfoot to twist while stuck on the ground.

Symptoms and Diagnosis

Lisfranc Injury symptoms include sharp midfoot pain that makes weight bearing very difficult. The foot will also swell and show bruises, mostly on the bottom of the foot. While we can often diagnose this injury with a physical exam and oral history, you may also need X-rays, an ultrasound, MRI or CT scan to detect a less severe injury.

Can You Move Your Toes with a Lisfranc Injury?

In addition to the symptoms we just described, it will be diffiucult to stand on your tiptoes. Doing so will put too much stress on your midfoot, and you will likely notice immediate pain, even if you've sustained a minor injury. Additionally, if you try to move your toes up and down, you'll also experience pain, again because of the added pressure to your injured midfoot.

Treatment: Can Lisfranc Heal Without Surgery?

With a stable injury, we can treat the foot with six-to-eight weeks of immobilization. (That could mean a cast or walking boot.)  Following this period, we'll most likely recommend physical therapy to help regain lost strength. And to get you back into competitive shape, without risking reinjury.

In many cases, the only way to treat a Lisfranc injury is with surgery. During this procedure, we stabilize your joints so the foot can heal. This could mean using screws and plates, or it could mean fusing your joints together. After surgery, your treatment plan will still require six-to-eight weeks of non-weight-bearing immobilization, as well as physical therapy. Luckily, this surgery has a high success rate, with this study from the Kansas Journal of Medicine proving that most athletes who have this procedure are to return to their sport withing 30 weeks of their surgery. And, when they get back in the game, their feet have regained an average of 87% of previous functioning.

How long does it take to recover?

How long does it take for Lisfranc injuries to heal? Well, the answer truly depends on the severity of your initial injury. With a minor injury, when you only sustain a strain, your could heal fairly quickly, in about eight weeks. However, if your injury requires surgical repair, you'll need to heal for a minimum of four months. And your recovery could last a full year.

What are the long term effects of a Lisfranc injury?

Even if you heal completely, your foot could experience lasting effects after suffering a Lisfranc injury. With proper care, you should be able to return to your pre-injury activity level. But you may experience lingering pain or stiffness, and weakness may be a problem as well. Going forward, you may have a higher risk for developing arthritis in your midfoot arthritis, along with chronic pain, or a flat foot deformity.  Additionally, if your injury goes undiagnosed or treated for too long, pressure could build up in the area, causing damage to your foot's nerves, blood vessels and muscles.

Whether or not you need surgery, it's important for you to understand the seriousness of this sports injury. Regardless of your treatmen plan, you won't be able to play football again for at least 10 weeks following your injury. Now, we know that hearing those words is miserable for athletes. But we hope that doesn't make you try and play through the pain because, the longer you wait to seek care, the longer that down time will be. So, at the first sign of a Lisfranc injury, schedule an immediate appointment with Dr. Alvin Cowans. He'll get you off the bench and back in action as soon as it is safely possible to do so!