Mani Ellis & Layne Accident & Injury Lawyers | January 10, 2025 | Personal Injury
Lisfranc injuries affect the middle of the foot and often go undiagnosed, potentially with serious consequences. These injuries are caused by trauma to the foot, whether it’s a direct blow or impact, such as a heavy object falling on the foot, or indirect trauma when the foot is stretched or twisted.
Here is why Lisfranc injuries may be missed and the possible consequences of failing to treat the underlying injury.
What Is a Lisfranc Injury?
The Lisfranc joint complex is located in the middle of your foot, where the metatarsal bones meet the tarsal bones. It includes the ligaments and bones connecting your forefoot and midfoot. The Lisfranc joint, or tarsometatarsal joint, is critical for maintaining the stability of your foot and distributing weight during movement.
A Lisfranc injury, also known as a Lisfranc fracture, occurs when these joints are damaged or dislocated.
There are three types of Lisfranc injuries:
- Fractures or broken bones in the Lisfranc joint
- Dislocations when the bones are forced out of place
- Sprains, which are torn or overstretched ligaments
These injuries commonly occur due to high-energy trauma, like car accidents. They can also happen from a simple misstep on a ladder or a slip and fall accident when the foot twists while bearing weight. Dropping an object on the foot can also cause a Lisfranc joint injury. This is a common cause of midfoot injuries on construction sites.
Lisfranc injuries are most common among athletes, especially those who play high-contact sports with a risk of twisting or falling, like football and soccer. Horseback riders are also at an increased risk.
This type of injury is named for Jacques Lisfranc, a French surgeon who wrote about amputations through the Lisfranc joint. These injuries were common in equestrian times when the foot was caught in the stirrup as a rider fell from a horse.
Why Do Lisfranc Injuries Often Go Undetected?
Lisfranc injuries are frequently missed during initial medical evaluations. This happens for many reasons:
- Lisfranc injuries are uncommon and make up just 0.1% to 0.9% of all fractures. This means physicians may not be looking for them.
- The injury can be very subtle on X-rays. Even a thorough physical exam may not catch the severity of the damage. Lisfranc injuries that involve only the ligaments are the easiest to miss.
- The symptoms, such as midfoot pain and swelling, can be subtle. They may be dismissed by patients and healthcare providers as more minor injuries like sprains.
One study found that 20% to 40% of patients do not receive prompt treatment because Lisfranc injuries are overlooked or misdiagnosed by the initial treating medical provider. These injuries are more likely to be missed by providers who are not foot and ankle specialists.
The Potential Consequences of an Untreated Lisfranc Injury
When a Lisfranc injury is undetected during the initial assessment, it’s called a “missed” injury. Unfortunately, a delay in treatment, especially if it’s for more than six months, is associated with a poor functional outcome. An untreated Lisfranc injury can have debilitating long-term consequences.
Chronic Pain
The instability caused by damaged ligaments or bones can result in ongoing pain. This pain may worsen with physical activity and limit mobility.
Arthritis
Without proper treatment, abnormal joint mechanics can accelerate wear and tear, leading to the loss of cartilage and arthritis in the midfoot joint. This is called post-traumatic arthritis (PTA), a type of osteoarthritis.
Arthritis results in stiffness, swelling, pain, and reduced range of motion. This condition can make walking and standing unbearable.
Arthritis can happen even after successful surgery, but it’s more likely to occur with an untreated Lisfranc injury and more likely to be severe.
Instability and Disability
Missed Lisfranc injuries often result in the bones healing in an abnormal and painful way or persistent joint dislocation. This can affect your gait and cause a limp as well as pain and tenderness. Untreated injuries often result in significant disability. Daily activities like climbing stairs, exercising, or even standing for long periods can become difficult.
The altered gait and pain can even lead to secondary issues like back and knee pain.
Deformity
Sometimes, an untreated midfoot injury causes a valgus deformity. This happens when the bones heal at an angle away from the foot. The deformity can worsen over time.
Poor Surgical Outcome
Lisfranc injuries involving dislocation or fracture usually require surgery. When a serious injury is missed for some time, surgery becomes even more crucial, but the outcome is not as good.
Late reduction, or realignment of a fracture or dislocation, is harder and requires more extensive dissection. It also becomes more likely that a secondary arthrodesis will be needed. This is a procedure to immobilize or fuse the joint.
How Is a Lisfranc Injury Treated?
Minor Lisfranc injuries involving only sprained ligaments may be treated with conservative, non-surgical options like rest, physical therapy, and a walking boot or cast.
Lisfranc joint injuries that involve a fracture and/or dislocation usually require surgery. The sooner the surgery is performed, the better the outcome. While most people hope for a non-invasive treatment, the risks of delaying the necessary treatment can be serious.
There are two broad types of surgery that may be used to treat a Lisfranc injury:
- Internal fixation: This involves the use of screws, plates, or wires to secure and stabilize bones in the correct position.
- Fusion (arthrodesis): This involves permanently fusing bones so they grow together into a single bone to prevent movement.
If surgery is delayed for more than six weeks, the outcome tends to worsen. This is because more extensive dissection is needed, and the delay causes damage to the tissues. The joint malalignment destroys articular cartilage, and the ligament edges are rounded off, which reduces stability.
What To Do After Suffering an Injury To Your Midfoot
If you experience pain or swelling in your midfoot after a fall, crash, or other accident, it’s important to seek prompt medical care. Because these injuries are often missed by emergency physicians and primary care doctors, seek an orthopedic evaluation from a foot and ankle specialist if the pain persists or worsens.
The sooner you receive a proper diagnosis and treatment, the better your chances of a good outcome.
While this injury may seem minor at first, it can permanently affect your quality of life. If you have suffered a Lisfranc injury in an accident and you believe someone else was to blame, you may be entitled to compensation. A personal injury lawyer can help you recover the money you need for proper treatment and your other losses.
Contact the Personal Injury Law Firm of Mani Ellis & Layne Accident & Injury Lawyers for Help Today
For more information, please contact an experienced lawyer at Mani Ellis & Layne Accident & Injury Lawyers to schedule a free initial consultation today. We have convenient locations in Columbus, OH, and Charleston, WV.
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