What is Lisfranc Midfoot Injury

Lisfranc midfoot injury is a break (fracture), separation (dislocation), or sprain involving the bones and joints in the middle of your foot. Your midfoot is made up of a cluster of small bones (tarsals) that attach to the long bones going to your toes (metatarsals).

Strong bands of tissue (ligaments) attach the bones of your midfoot to each other. A Lisfranc midfoot injury can include:

• Ligament damage or tears.
• Bone fractures.
• Dislocations.
• A combination of these injuries.

This type of injury can cause foot pain and instability. The condition can range from mild to severe.

What are the causes?

This condition may be caused by:

• An injury that twists your foot forcefully.
• Tripping or falling over your foot.
• Falling from a height.
• A hard, direct hit or a crushing injury to your foot.

What increases the risk?

This condition is more likely to develop in athletes who participate in:

• Contact sports, especially while wearing cleats, like in football.
• Activities in which your foot is loaded in a pointed position like dance and gymnastics.

What are the signs or symptoms?

Symptoms of this condition include:

• Foot pain that gets worse with standing or walking.
• Foot swelling.
• Bruising on the top or bottom of the foot.
• Pain when pressing on the top or bottom of the foot (tenderness).
• Seeing or feeling a new bump on the top of your foot.

How is this diagnosed?

This condition is diagnosed based on your symptoms and medical history, especially if you recently had an injury. Your health care provider will also do a physical exam to check for bruising under your foot and move your toes to test for pain. You may be asked if you can stand up on tiptoe. You may also have imaging studies done, including:

• X-rays.
• CT scans.
• MRI.

How is this treated?

The first treatments for ligament injuries that do not cause instability or dislocation of the midfoot are usually nonsurgical. These may include:

• Using a boot or cast to keep your foot still and protect it while it heals (immobilization). You may need to wear this for at least 6 weeks or as told by your health care provider.
• Using crutches to keep weight off your foot.
• Physical therapy to improve motion and strength.
• Medicine for pain.

Surgery is the treatment for fractures, dislocations, and unstable ligament injuries. This may include ligament repair, joint fusion, or a procedure to stabilize the fracture using screws or plates. After surgery, you will have to wear a cast and eventually have physical therapy.

Follow these instructions at home:

If you have a boot:

• Wear the boot as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the boot if your toes tingle, become numb, or turn cold and blue.
• Do not let your boot get wet if it is not waterproof.
• Keep the boot clean.

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Do not let your cast get wet if it is not waterproof.
• Keep the cast clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your boot or cast is not waterproof, protect it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area.
  • If you have a removable boot, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between the bag and your skin or between the bag and your cast.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a boot or cast on your foot.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

Safety

• Do not use the injured limb to support your body weight until your health care provider says that you can. Use your crutches as told by your health care provider.

General instructions

• Do not put pressure on any part of the cast until it is fully hardened. This may take several hours.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Make sure to use equipment that fits you.
• Use footwear that is appropriate for your athletic activity and the playing surface.
• Be safe and responsible while being active to avoid falls.

Contact a health care provider if:

• Your pain medicine and rest are not helping.

Get help right away if:

• Your foot becomes very painful or numb.
• Your toes become very pale or turn blue.