Lisfranc injury refers to a fracture or dislocation of the bones or torn ligaments in the Lisfranc joint in the midfoot region. The name is derived from Jacques Lisfranc de St. Martin, a 19th-century French surgeon who observed this type of injury frequently during his time in the Napoleonic army.

To elaborate, Lisfranc's joint is a group of small bones on the top of the foot that form an arch from which five metatarsal bones extend. A series of ligaments that run across and down the foot hold these bones in place. There is no connective tissue between the first and second metatarsals, making a Lisfranc joint injury more likely in that area.

Bone structures and Lisfranc ligament are important for transferring calf muscle force to the forefoot as well as supporting and stabilizing the arch of the foot.

As previously stated, there is no ligament that connects the first and second metatarsals. This makes them more prone to Lisfranc fracture or dislocation from a simple twist or fall. More specifically, a stumble over the top of the foot with the foot flexed downward, such as when stepping in a hole, is frequently the cause of mid-foot injury. (Learn more about common foot problems.)

This type of Lisfranc injury is common among soccer and football players, as well as in sports that use equipment with bindings that pass over the metatarsals, such as wakeboarding, snowboarding, or windsurfing.

More severe Lisfranc foot injuries, such as multiple fractures, torn ligaments, or dislocated bones, are usually the result of direct, high-energy trauma, such as a fall from a great height, dropping a heavy object onto the foot, or being in a car accident.

The following are some signs of a Lisfranc foot injury:

• Foot pain at the top
• Swelling
• Foot bruising at the top and bottom
• Tenderness in the midfoot

The pain from a Lisfranc sprain, fracture, or dislocation usually worsens when standing or walking, and in some cases, the pain is so severe that one cannot put weight on the foot.

If not treated, this condition can lead to flat feet, arthritis, or compartment syndrome, a condition characterized by a buildup of pressure in the muscles that can damage nerve cells and blood vessels over time.

When a Lisfranc injury MRI or physical exam reveals that there are no fractures, major joint dislocations, or complete ligament tears in the mid-foot, the condition can usually be treated by following the steps of RICE and strictly adhering to the doctor's instructions not to put weight on the foot for six weeks. During this time, the individual must wear a non-weight-bearing cast.

Following that time, the patient will most likely be moved to a weight-bearing removable cast boot or a Lisfranc injury foot orthotic, such as a rigid arch support. Exercises may also be recommended as part of Lisfranc rehab to help the foot regain strength and range of motion.

However, if a Lisfranc's fracture or joint subluxation (dislocation) is present, or a ligament has been severely torn, surgery will most likely be required to realign the joint and return the bone fragments to their normal position. There are several ways to accomplish this, including:

• Internal fixation surgery
• Fusion surgery

A surgeon uses plates, pins, wires, and screws to repair a Lisfranc foot fracture or dislocation via internal fixation. Some or all of the surgical hardware will need to be removed three to five months after the surgery.

A "welding" process is used to fuse the bones together so that they heal as a single bone in the fusion type of Lisfranc surgery. Pins and screws are commonly used to aid in this process and to allow foot function. For more information on this topic, watch a video that explains what a Lisfranc injury is and how it is repaired surgically.

The Lisfranc injury rehab period for either type of surgery is lengthy, with the patient typically wearing a non-weight-bearing cast boot for six to eight weeks before transitioning to limited weight-bearing and walking with the assistance of a walking boot or a Post Op Shoe.

The patient will eventually return to wearing shoes. When this happens, the person will most likely require a rigid arch support or a stiff-arched shoe until he or she is fully recovered. In addition, no impact activities will be permitted until all surgical hardware has been removed from the foot.

After the significant period of inactivity required for Lisfranc injury recovery, physical therapy will be required to restore full range of motion and strength to the foot.