Lisfranc Injury

Question 1

What is a lisfranc injury?

Answer 1

• Midfoot injury
• lisfranc sprain, fracture and or severe injury
• good clinical diagnosis is failure to single leg raise

Question 2

what is the anatomy of the lisfranc joint?

Answer 2

• Lisfranc is a large oblique lig, from plantar aspect of medial cuneiform to base of 2nd met
• Stabilizes the 2nd met and maintain midfoot arch
• Dorsalis pedis and deep peroneal nerve runs between 1st and second met bases

Question 3

What are the clinical signs and tests you would look for?

Answer 3

• Standing on toes is a good indication of midfoot pain
• Looking for signs of bruising on dorsal or plantar aspect of midfoot
• Piano key sign

Question 4

What are some imaging you would perform to help Diagnosis?

Answer 4

-X-ray
AP WB BF check alignment of 2nd met with med cuneiform, signs of fractures of fleck sign
Oblique view check 3rd 4th and 5th met alignment
Lateral view dorsal displacement of 2nd metatarsal
-CT can be help and MRI can confirm diagnosis of ligament injury

Question 5

What are the DDX?

Answer 5

• Metatarsal base fracture
• Metatarsal stress fracture
• Tarsal fracture

Question 6

What is your management plan for this Injury?

Answer 6

• Cast for 6-8 week or moon boot to offload
• Close follow ups with x-ray each visit to see progress
• Follow up with strength and conditioning
• RICE protocol may be relevant to decrease pain
• Footwear assessment to help recovery and prevent reinjury
• Orthotics to offload pressure as the injury heals

Question 7

What are some taping and medications you would use for this Injury?

Answer 7

• There are taping techniques however seen to be ineffective for treatment
• Medication no required to treat but to relieve pain if patient is healthy can begin NSAIDs or paracetamol?