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Lisfrancs Fracture explained by San Francisco Foot Surgeon

Lisfrancs fractures involve the rupture or tearing of a of ligament that stabilizes the midfoot. Sometimes it also includes fractures of the metatarsal bones in the foot. This injury alters the alignment bases of the metatarsal bones and the cuneiform bones. These injuries are very difficult to recognize on xray, and are very frequently missed. In fact, one study (for which Dr. Segler won an award from the American College of Foot and Ankle Surgeons) showed that 98.6% of the x-ray findings suggested of these injuries were missed by board certified Emergency Room Physicians. Unfortunately, these are often debilitating injuries if not properly treated. All fractures of the mid-foot warrant an evaluation by a foot fracture specialist, even if initial treatment has been started in the emergency room.  

Traumatic fractures (also known as acute fractures) are caused by the application of force or trauma. This can be an impact such as a direct blow—like forcefully stubbing your toe, kicking a coffee table or being involved in an automobile accident. When evaluating traumatic fractures it is important for your doctor to determine whether the broken bone is displaced or nondisplaced. In displaced fractures,the bone is not only broken, but it is also moved out of alignment. In this case, it is said to be dislocated. Treatment of these types of fractures depends on the extend of injury, the amount of displacement, and whether or not the joint surface is involved.  Surgery is sometimes required to put the bone back into proper position and stabilize it so it can heal. 

You might have a fracture if you notice any of the following: 

• You heard a loud crack, or sound at the time of the break. 

• “Pinpoint tenderness” (pain or tenderness in the foot at the precise location of injury) at the time the fracture occurs and perhaps for a few hours later. This can be deceiving, because sometimes, the pain goes away after several hours. 

• Deviation or mal-alignment (crooked, misshapen or abnormal appearance) of the foot or toes. 

• Bruising and/or swelling that starts to appear within the first couple of days after the injury. 

• It is absolutely not true that “if you can walk on it, it can’t be broken.” We see people walking into our office with fractures on a regular basis. Because of this, if you suspect you have a fracture, you should get in for an evaluation as soon as possible.  We reserve slots for emergency appointments every day so you won’t have to wait to get taken care of.

Sprains and fractures can have very similar symptoms. But often with a sprain, a broader area of the foot will ache, rather than just a certain point of tenderness. We can easily diagnose the problem and start you on the appropriate treatment. This will help you get back to your activities as fast as possible. Keep in mind that some sprains and dislocations can be severely disabling. Without the right treatment you can develop crippling arthritis. 

 

Potential Problems of Improper Fracture Treatment 

We often see people in the office who will say “I thought that there isn’t anything that can be done for a broken bone in the foot.” This is false. In fact, if a fractured phalanx bone in the toe or a metatarsal bone in the foot is not treated correctly, you can develop serious problems. For example: 

• A permanent deformity in the bone alignment and structure can develop and limit your ability to walk on the foot or even fit into shoes. 

• Arthritis is often caused by an untreated fracture that involves a break in the joint surface. In some cases, when the bone isn’t realigned, an angular deformity develops and causes problems.  

• Chronic foot pain and long-term difficulties with walking.

• Non-union,or failure of the broken bone to heal, can lead to a need for surgery or produce suffering from chronic pain.

Lisfranc's Fracture Treatment 

The best treatment of a midfoot fracture will depend on the specifics of the fracture, but may include: 

• Rest. Sometimes rest is all that is needed to promote healing of a stress fracture of a metatarsal bone. 

• Avoid the activity that led to the fracture

It is important to make sure that you don’t injury the area any further. If running caused the fracture, stop running until you get an evaluation. Don’t make it worse. Sometimes you might have to stay off the foot entirely with the help of crutches or a wheelchair in order to allow it to heal. 

• Immobilization, casting, or stiff shoe. A cast, stiff shoe or fracture walking boot might be needed to protect and stabilize the fractured bone while it is healing. 

• Surgery. Depending upon the extent of the injury, some midfoot fractures will heal much better with surgery to re-align and stabilize the bone. This is the case for Lisfranc fractures. They don't heal without surgery.

• Follow-up treatment. You will receive very particular instructions for treatment after both surgical and non-surgical metatarsal fracture treatment. Physical therapy, strengthening exercises and rehabilitation will help get you back to your athletic activities as quickly as possible.  

Dr. Christopher Segler is an San Francisco Podiatrist and Foot Surgeon who has a special interest in foot fracture patterns. His research on Lisfranc's fractures won an award from the American College of Foot and Ankle Surgeons. He offers second opinion consultations for those patients in San Francisco who have foot pain that just isn't getting better. In many cases he can even evaluate the problem during a house call appointment at your home or office. To find out what might be causing your foot pain, call (415) 308-0388
 

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