Everything You Need to Know About a Lisfranc Injury

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.

  • 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.

  • 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.
  • 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.
  • 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.
  • 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.

  • 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.

  • A: The first physician who described injuries to this ligament was named Jacques Lisfranc de St. Martin!

Bryan Vopat, MD, talks about why a lisfranc injury needs to be treated properly.
The reason we did this study looking at NFL players was because we started realizing that a lot of people have this. We wanted to see how they did in the NFL, how it affected their performance in the NFL. And we would try to relate this to also other athletes as well in both college and high school and see how they could perform. We always heard that if we did not reduce these, there's a good chance they wouldn't do well afterwards. However, we didn't have a whole lot of proof in athletes that this actually occurred. By looking at this study, it showed that if you didn't have the proper treatment that these patients weren't actually able to play. By reduction, I mean that the bones are placed back together that you recreate the arch in their foot. If those bones aren't placed back together, if there's a small gap between them by not having fixed or not being treated appropriately, then that's when they have issues afterwards and they are unable to go back to playing.

Bryan Vopat, MD, discusses how a lisfranc injury is diagnosed.
The diagnosis can be tricky. The lisfranc injury can be missed 25 to 30 percent of the time in the literature. You have to have a high rate of suspicion. If people have bruising on the bottom of their foot, that's a very common thing to know that you have a lisfranc injury. We diagnose it then, using x-ray and looking at CT scans and then doing a very close physical exam, usually with a foot and ankle or in sports vet specialist. And a lisfranc injury is a very painful injury the degree of painfulness can be different from person to person. Some people can have just where they feel like a sprain. Other people, they have a huge swelling of their foot it goes from purse to purse. But, in general, it is very painful. It's difficult to walk afterwards.

Bryan Vopat, MD, talks about what causes lisfranc injuries.
You can have a lisfranc injury by landing on what we call plantar flexfoot, which is your toes are pointed down and it can either be a jump versus just reaching back wrong, hitting the foot just in the right position where this ligament will tear. You can see this in quarterbacks, linemen, wide receivers, defensive backs, volleyball, basketball players. It can happen in almost any sport.

Bryan Vopat, MD, discusses lisfranc injuries, the types of athletes that suffer them and how they occur.
A lisfranc injury is an injury in your middle of your foot. It's almost a sprain to an important ligament that's in the arch of your foot. With any arch like the Roman arches, there's a key stone that's in the middle. That key stone holds everything in place. When you injure you this lisfranc injury, it causes that key stone to be shifted and you lose the arch in your foot. We see this in athletes a lot. We see this in NFL players and football players and volleyball players. I just treated a volleyball player with it just recently. They can occur when people end up pushing hard on their toes. They can injure this ligament, which causes their entire arch over time to collapse, if it's not treated appropriately.

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