Posts for: December, 2011
A few weeks ago, Houston Texans starting quarterback Matt Schaub sustained a LisFranc injury effectively ending his season.
What is the Lisfranc Joint?
The Lisfranc joint is the point at which the metatarsal bones (the long bones that lead up to the toes) and the tarsal bones (the bones in the arch, which include the cuneiform bones) connect. The Lisfranc ligament is a thick band of tissue that joins two of these bones. It is important for maintaining proper alignment and strength of this joint.
How do these injuries occur?
Lisfranc injuries occur as a result of trauma to the midfoot. In the case of a football player, a Lisfranc injury most commonly occurs when the forefoot is planted on the ground with the heel in the air. A downward or twisting force on the heel causes stress on and potential damage to the foot. Other common causes of this injury are Motor vehicle accidents and falls from a height.
How are these injuries diagnosed?
A Lisfranc injury is initially diagnosed based on the history and description of the injury. A patient may describe the immediate onset of pain in the midfoot region. There may be difficulty or even an inability to put weight on the injured foot. Over the course of the ensuing days, swelling and bruising often occurs, and on a physical exam, the injured patient will be tender over Lisfranc's joint.
Further evaluation begins with x-rays of the foot. When an injury occurs that involves a fracture in this region, a CT scan or MRI are best for evaluating the complex bony detail of the region. MRI in particular is helpful in detailed evaluation of the ligaments, and it can see bruising in the small bones of the foot, which indicates an acute injury.
If testing determines that the injury is stable, with the bones still in their proper orientation, a Lisfranc injury may be treated with a period of non-weightbearing followed by gradual return to normal activites.
If the injury is unstable, surgical treatment is warranted. Surgery typically involves rigidly stabilizing the injured joints. The specific midfoot joints that are stabilized depend on the specific ligaments that are injured and may vary somewhat on a case-by-case basis. The majority of the time, stabilizing the injured region requires the placement of screws and in some cases wires. By holding the involved joints rigid, the torn ligaments are allowed to heal.
Postoperatively following a typical Lisfranc joint repair, the patient must be non-weightbearing on the operative foot for about 6-8 weeks. Subsequently, the amount of weight bearing allowed is gradually increased over the next few weeks, followed by physical therapy. The hardware used to stabilize the injury is also removed.