What is a Lisfranc Injury?

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If you follow the NFL, especially if you are a fantasy football junkie like me, then you have heard the term Lisfranc injury a lot the past few years.  Over the course of the last few weeks, there have been three high profile players that have been diagnosed with a Lisfranc: Cedric Benson, running back for the Packers; Santonio Holmes, wide receiver for the Jets; and Ryan Kalil, center for the Panthers.  Cowboys running back Demarco Murray got an MRI Monday for a suspected Lisfranc injury.  Last year, Raiders running back Darren McFadden and Texans quarterback Matt Schaub both missed time with the same injury.  This injury isn’t limited to football players.  Locally, University of Louisville guard Preston Knowles ended his college career when he sustained this injury in the first round of the NCAA tournament his senior year.

So what is a Lisfranc injury?  It is an injury to Lisfranc’s joint, which connects the metatarsal bones, the long bones in the foot, to the tarsal bones, the smaller bones in the mid-foot.  These bones are connected by strong ligaments that help to support the arch of the foot during weight bearing.  If the ligaments are stretched or torn, then the foot may become unstable which initially causes pain, but can also lead to long-term arthritis and degenerative changes in the small joints of the mid-foot if the ligaments aren’t allowed to heal properly.  Severe injuries may involve fractures of the bones in addition to the ligament injury.  The injury usually occurs with a twisting force or torque on the foot when it is planted and the ankle is plantarflexed (tip-toe position).

This is considered a very serious foot injury due to the potential devastating long-term effects if not treated properly or if the injury is missed.  It can be seen in high energy trauma such as motorcycle or car accidents, but it is seen much more frequently now in high-speed sports such as football.  This is due mostly to the nature of the sport, which involves planting and twisting on the foot in cleats and the high likelihood of the foot being stepped on during play.

If the injury is mild and the ligaments are only sprained or partially torn, then treatment consists of a period of immobilization (sometimes 8 weeks or more) in a boot or cast and non-weight bearing with crutches.  This allows the ligaments to heal and restores the stability of the midfoot joint.  If the injury is more severe and the joints are out of place on X-ray or if there are fractures involved, then surgery is usually performed to stabilize the joints with temporary pins or screws to allow the ligaments to heal in the proper positions.  Very severe cases involve joint fusion and permanent screws or plates.

For athletes, a Lisfranc injury can be a season-ending injury.  However, with proper treatment the athlete can make a full recovery.  Take Darren McFadden for example, who missed most of last season for the Raiders (I remember clearly since he was on my fantasy football team) and is back this year and appears to be 100%.  The injuries that occur in sports are usually at the opposite end of the spectrum as those that are seen in high-energy trauma, and the outcomes are generally much better.

Where does the name come from? The Lisfranc joint and Lisfranc ligament in the foot as well as the injury to these structures bear the name of Jacques Lisfranc, a French surgeon in Napoleon’s army in the early 1800’s.  He is remembered for developing an amputation of the foot through this joint that could be performed quickly on soldiers in the field.  It was necessary for open injuries of the feet that occurred frequently when a soldier got a foot caught in the stirrup when being thrown or knocked from their horse.  Thankfully today the term Lisfranc refers to the ligament injury much more commonly than the amputation.