Fracture-dislocation of the midfoot (lisfranc injury)

[Tanya Shivari]

A Lisfranc injury is a fracture and/or dislocation of the midfoot that disrupts one or more tarsometatarsal joints. Diagnosis is by x-rays and often CT. Treatment requires referral to an orthopedic surgeon and usually open reduction and internal fixation or sometimes fusion of the midfoot.
(See also Overview of Fractures.)
Lisfranc injuries are common. The usual mechanism is a direct blow or an indirect twisting force applied to a foot in plantar flexion (eg, fall on a foot in plantar flexion), as may occur in football players, motorcyclists, and horseback riders.
The Lisfranc joint complex consists of the 5 tarsometatarsal joints that connect the forefoot and midfoot. There are multiple ligaments in this complex. The Lisfranc ligament itself is the ligament that attaches the base of the 2nd metatarsal to the 1st cuneiform. Lisfranc complex injuries vary widely in severity from strains to dislocation of one or more tarsometatarsal joints with or without fracture. When fracture occurs, it often involves the 2nd metatarsal (see figure Fracture of the 2nd metatarsal base with tarsometatarsal joint dislocation). Lisfranc injuries often cause instability of the midfoot.