■ ■ ■ Description

Lisfranc’s fracture-dislocation is an injury to the middle part of the foot such that the ligaments of the mid-foot are sprained, with or without loss of normal alignment of the bones and joints and with or without fracture (broken bones). The mid-foot bones, ligaments, and muscles are of key importance in shock absorption, force transmission, and maintenance of the arch of the foot.

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■ ■ ■ Common Signs and Symptoms

• Sharp pain, especially with standing or walking on the injured foot

• Tenderness, swelling, and bruising at the injury site

• Numbness or paralysis from swelling in the foot, causing pressure on the blood vessels or nerves (uncommon)

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■ ■ ■ Causes

This injury is usually the result of a direct blow, a twisting injury, or landing wrong on the foot and ankle. It may occur when your foot is planted and flexed on your toes and someone lands on your heel or when another player is standing on your foot as you fall back and are pulling your foot away.

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■ ■ ■ Risk Increases With

• Participation in contact sports, sports that require jumping and landing (basketball, volleyball), or sports in which cleats are worn on shoes and sliding occurs

• Previous foot or ankle sprains or dislocations or repeated injury to any joint in the foot

• Poor physical conditioning (strength and flexibility)

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

  • Foot and ankle strength and flexibility

  • Cardiovascular fitness

• For participation in jumping (basketball, volleyball) or contact sports, protect vulnerable joints with supportive devices, such as wrapped elastic bandages, tape, braces, or high-top athletic shoes; for sports that require cleats or spikes on the athletic shoe, use cleats or spikes of appropriate length for the sport and the turf or field conditions.

• Wear proper protective equipment and ensure correct fit.

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■ ■ ■ Expected Outcome

With appropriate treatment and normal alignment of the bones and joints of the mid-foot, return to sports is attainable; however, it may require a minimum of 8 to 12 weeks. Residual pain and stiffness of the mid-foot are not uncommon after this injury.

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■ ■ ■ Possible Complications

• Prolonged healing or recurrent dislocation if activity is resumed too soon

• Nonunion (fracture does not heal)

• Malunion (heals in a bad position)

• Chronic pain, stiffness, or swelling of the foot

• Excessive bleeding in the foot, causing pressure and injury to nerves and blood vessels (rare)

• Unstable or arthritic joint following repeated injury or delayed treatment

• Future surgery to fuse the joints of the mid-foot due to chronic pain or stiffness

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■ ■ ■ General Treatment Considerations

If the bones are in appropriate alignment (position) and the sprain is mild, initial treatment consists of ice and elevation of the injured foot and ankle at or above heart level to reduce swelling. Crutches and medications help to relieve pain. Later, a stiff-soled shoe and arch support (orthotic) may be required. Immobilization by splinting, bandaging, casting, or bracing for 2 to 8 weeks is usually recommended to protect the joint while the ligaments heal. For severe sprains, dislocations, and fractures that are displaced (not in appropriate alignment), surgery is recommended to restore and maintain the joint to its normal position. The foot is usually immobilized for variable amounts of time (depending on the severity of injury) after surgery. After immobilization (with or without surgery), stretching and strengthening of the injured and weakened joint and surrounding muscles (due to the injury and the immobi- lization) are necessary. These may be done with or without the assistance of a physical therapist or athletic trainer.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Strong pain relievers may be prescribed as necessary. Use only as directed.

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■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Pain, tenderness, or swelling worsens despite treatment

• You experience pain, numbness, or coldness in the foot

• Blue, gray, or dusky color appears in the toenails

• Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)