Lisfranc Injury: What’s causing the pain in the middle of the foot?

You have a specific joint along the middle of your foot called the Lisfranc joint. In simple terms, it’s where the long bones of your feet (metatarsals) meet your tarsal bones that are present in the third of your foot closest to your ankle. 

The bones at this Lisfranc joint are connected by a tough band of tissue (ligament) that keeps the bones aligned in the right place (instead of popping up and down whenever!). It also helps to strengthen this area of the foot, which is vital for arch stability and for walking. 

Injuries at the Lisfranc joint can come in the form of sprains, fractures or dislocations. Thankfully, this type of injury isn’t all too common, but is definitely something that our podiatry team comes across from time to time and can be extremely debilitating for a patient if left untreated.

It should be noted that Lisfranc injuries can be overlooked or misdiagnosed if your practitioner is unfamiliar with this problem. All our clinical staff at The Podiatrist specialise in leg and foot function and injury, so know how to spot this problem and how best to help you recover. 

So, how could I have sustained a Lisfranc injury?

Lisfranc injuries typically occur either directly or indirectly. Direct injuries are the most common, caused by excessive force being applied to the end of the foot. This tears the supporting ligaments and can dislocate or fracture a bone, examples of direct injury causes include:

• A heavy object falling on the foot
• Falling from a high height
• Car accidents
• Kicking a hard object, particularly if it’s stationary

Indirect injuries result from overloading (putting excessive pressure through) the midfoot, which often occurs through either twisting the foot abnormally, or from impact to the midfoot. Anything that twists and overloads the midfoot can cause a Lisfranc injury, like:

• Running where twisting of the foot and falling occurs
• Missing a step on a staircase

What do Lisfranc injuries feel like?

Painful! You’ll likely know that something has gone wrong quickly after sustaining the injury, and may start to feel:

• Midfoot pain, tenderness or throbbing
• Swelling or redness
• Bruising on the bottom of the foot after a couple of hours
• Pain on standing, weight-bearing and physical activity

How should these injuries be treated?

The first thing you want to do is reduce your pain and discomfort. We recommend using the PRICE (protection, rest, ice, compression, elevation) principles. Avoid any movements that cause pain, including walking on the injured foot, as much as possible. Ice, compression and elevation will help reduce your swelling, which will reduce your pain and help you feel more comfortable.

Your treatment will then depend on how severe the injury to your Lisfranc joint is – which we’ll be able to give you an idea of when you come in to get it assessed and diagnosed. Getting your foot seen to if you have midfoot pain is a must as there are many causes of midfoot pain, and different causes require different approaches to treatment.

Your care will differ depending on whether you’ve sustained a ligament sprain, fracture or dislocation. Midfoot sprains do take significantly longer to heal than regular ankle sprains, so don’t put pressure on your recovery.

When standing, the midfoot supports approximately 2-3 times a person’s body weight, so reducing this pressure and minimising weight-bearing at the midfoot is a key part of your treatment. We’ll focus on isolating the damaged structures of the foot and giving them time to heal, then slowly re-introducing weight-bearing and strengthening. Your care may include:

• A range of full and partial casts and boots
• Crutches
• Orthotics to offload pressure as the injury heals
• Footwear assessment to ensure shoes are helping and not hindering recovery
• Physical therapy as the foot heals to strengthen affected muscles

Severe injuries where the joint is unstable may require surgical intervention. There are a number of different surgical options and we can refer you for a consultation with a surgeon to discuss the best one for you. 

What’s the verdict – how long will it take to recover?

If you’re going to take away one thing from reading this information, let it be this: Lisfranc injuries do take a while to heal and you are very susceptible to re-injury if you return to regular activities too early and end up overloading your midfoot again. 

Conservative treatment may involve restricting the foot to a variety of boots for up to 3 months before switching to custom orthotics beyond this. Athletes may require a recovery period of 6-12 months before returning to competitive activity.

We understand how important it is to be able to walk and play without pain so if you’re worried about your feet or you’ve suffered an injury – whether it’s painful or not – we’d love to help. We’ve been helping our community in Toowoomba & Darling Downs for over 20 years. To book an appointment, call us on (07) 4638 3022 or book your appointment online here.

References:

• [1]Seybold JD, Coetzee JC. Lisfranc injuries: When to observe, fix, or fuse. Clinical Sports Medicine 2015;34(4):705–23
• [2]Baquie P, Fooks L, Pope J, Tymms G. The challenge of managing mid-foot pain. Australian Family Physician 2015;44(3):106–11
• [3]Welck MJ, Zinchenko R, Rudge B. Lisfranc injuries. Injury 2015;46(4):536–41
• [4]Seybold JD, Coetzee JC. Lisfranc injuries: When to observe, fix, or fuse. Clinical Sports Medicine 2015;34(4):705–23