November 2019 newsletter.
Text from: Running doc’s guide to healthy running (Lewis G. Maharam).
Lisfranc foot injuries occur in the midfoot. They’re named after French surgeon Jacques Lisfranc, who in the 1800s, as a member of Napoleon’s army, first described an injury sustained by mounted soldiers whose foot got caught in the saddle’s stirrup as they got thrown off the horse. Nowadays, the injury happens when stepping into a pothole in the road, twisting the foot, or pushing off with force as a football lineman might do. These injuries can be ligament sprains, dislocations of the joints between the forefoot and midfoot, or fractures of the bones in the midfoot complex.
Anatomically, the Lisfranc joints are between the tarsometatarsal joints involving the cuneiform bone and metatarsal bones, as shown in the figure. Only a small percentage of Lisfranc injuries are fractures or dislocations; most are sprains involving the ligaments.
After palpating the foot, twisting the midfoot and checking the pulse on the top of the foot (because the artery there can sometimes be injured, too), the health care provider will generally order standing and non-weight-bearing X-rays.
Treatment varies depending on whether the injury is a sprain or a fracture. A sprain will usually be treated in a non-weight-bearing cast boot (meaning that you cannot walk on the cast and will have to use crutches) for about 6 weeks. After removal, physical therapy and a very gradual return to sports usually take 8 to 12 weeks. Fractures and dislocations will often require surgery.
Non surgical treatment
Rest – Rest is important to allow the inflamed ligaments to heal. Activities other than running which do not make the pain worse such as swimming or cycling should be done to maintain fitness.
Ice – Apply ice to reduce pain and inflammation. Ice should be applied for 10 to 15 minutes every hour until initial pain has gone then later 2 or 3 times a day and / or after exercise is a good idea.
Stretching and strengthening exercises – Your healthcare provider will prescribe you Stretching and strengthening exercises to enhance the healing process and prevent relapse.
Ultrasound – Use of electrotherapeutic treatment techniques such as TENS or ultrasound may help reduce pain and inflammation.