Bryan Vopat, MD, an orthopedic sports medicine physician at The University of Kansas Health System Sports Medicine and Performance Center, explains Lisfranc injuries. While it's a small part of the body, the injury can cause major problems for athletes.
Q: First, what is a Lisfranc injury?
A: It's an injury to a ligament at the bottom of the foot. The anatomy of the foot is very complicated; it's similar to the complicated anatomy of the hand.
The best way to describe it is to think of a Roman arch. Every arch has a keystone in the center, which holds the arch in place. This injury damages that keystone and shifts the bones. If it's not treated properly, over time it can cause the entire arch to collapse.
Q: How does such an injury occur?
A: A Lisfranc injury can happen by landing on what we call the plantar flexed foot, which means that your toes are pointed downward. This can happen from jumping or even reaching back and hitting your foot at just the right angle.
Q: Who's at risk for a Lisfranc injury?
A: Really, any athlete in any sport. Football, basketball and volleyball players, as well as gymnasts and ballet dancers are at risk. Really, any time a person pushes off from their toes, this injury can occur.
Q: What are the symptoms and how do you diagnose the injury?
A: Diagnosis can be tricky – literature suggests a Lisfranc injury is missed between 25% to 30% of the time. Generally, there's pain as well as bruising or swelling on the bottom of the foot.
Q: How do you treat it?
A: If it's a mild injury, it can be treated in a cast and take around six weeks to properly heal. As it becomes more progressively severe, it might require surgery. Surgery can take six months to a year to totally heal.
We've found in our research that people who came back quicker actually did worse than the ones who let it heal up in time.
Q: You mention research. Have you conducted research into Lisfranc injuries?
A: Yes. My colleagues and I realized that many people have this injury. We had all heard that if we did not reduce these injuries there was a good chance the athlete wouldn't do well afterwards. By "reduction," I mean that the bones are placed back together to recreate the arch in the foot.
But we didn't have proof. So, we decided to study players at the NFL Scouting Combine who had experienced this injury and then try to relate this to college and high school athletes.
We found that if athletes had been treated properly, they were able to make their NFL debut accordingly and play over several years. But if the injury hadn't been treated properly or treated at all, the athletes were unlikely to make it back to the NFL.
Q: So, what's up with the name?
A: The first physician who described injuries to this ligament was named Jacques Lisfranc de St. Martin!