Our blog series continues to follow the return of the AFL, with commentary on common foot, ankle and lower leg injuries. A large part of what we do at Fluid Movement Podiatry, is assist people with the management and rehabilitation of some of the more complex foot and ankle injuries. This post takes a look at the Lisfranc injury, which can certainly have its complexities.
What is a Lisfranc injury?
The Lisfranc joint refers to a specific area of the midfoot made up of a number of bones and ligaments. This area is very important for the overall structure and stability of your foot. It allows large loads to be placed on the foot and enables a strong stable lever to generate propulsion or push off when walking, running and jumping.
An injury occurs when the ligaments supporting this joint are damaged causing joint dislocated or in more significant cases results in a bone fracture. This injury can vary significantly in complexity. From ligament damage effecting only one joint, to multiple joints and bones effected in this area.
This injury as you can imagine, is most common during traumatic accidents such as motor vehicle accidents and skiing injuries. These higher speed and energy incidences often cause the severe injury cases. However, these injuries can still occur at lower speeds and with stresses like a simple fall/landing and twist stress to the foot. With the fast nature of jumping, landing and sharp turning with contact sports, we often see these injuries in sports like AFL & rugby. There have been a number of high profile AFL players who have suffered a lisfranc injury.
Signs and Symptoms
Often people report and present with the following symptoms:
- Pain and swelling across the top of the foot
- Sometimes bruising will be noted on the bottom of the foot
- Pain on direct palpation of the midfoot area
- Functional Limitations – pain walking or balancing
- Difficulty coming up onto toes (heel raises) – compare both sides
Often imaging is used to both identify this injury and also determine its significance.
Please see images above.
The right image shows an increased gap and widening between the 1st and 2nd metatarsals. This is compared to the left image which is an X-ray of a normal foot. The widening indicates that the lisfranc ligament has been damaged. There is a structural decline in the foots normal capacity and integrity.
As you can see lisfranc injuries can be a significant injury and often result in a lengthy recovery. Dane Swan was unable to return from injury despite surgical repair of the joint and he was forced into retirement. The image below shows the significant swelling in Dane Swan’s foot following his injury.
Well known AFL players to suffer a lisfranc injury include:
- Dane Swan – career ending injury
- Rory Sloane – Out for 6 weeks
- Mitch Clarke – Out for 10 weeks
- Daniel Wells – season ending injury
- Matthew Richardson – season ending injury
Treatment and Management
Depending on the severity of the injury it may require a period of complete rest. This will involve offloading the foot with crutches and/or a moon boot to allow the ligaments and bone to heal. More severe injuries require extended time on the sidelines, with some requiring surgical repair.
Often a combination of imaging including X-ray, CT scan and MRI are used to determine the severity and complexity of the injury. These will be used to determine the best course of treatment and management. These scans will be used to determine if surgery is required to pin and stabilise the joint.
Non-surgical management would include a period of complete rest and offloading. This is followed by a gradual transitional period out of the cam walker aided by the use of foot strapping, and ankle brace/support. Sometimes an orthotic support is used to assist in managing the loads going through the midfoot. It can be used to support the lisfranc joint (midfoot area) for the short term recovery period and possibly used for more long term management.
Fundamental to the long term success of returning to sport and activity is a progressive strengthening and loading program. This will focus on resorting mobility, intrinsic foot strength and endurance, while also addressing more global strength, postural control and balance. This would progress to a graduated loading plan to simulate stresses the foot and leg will be under when returning to the persons’ activity/sport of choice. With AFL this would involve jump to land training, agility sessions (twisting, turning and cutting drills), speed work (acceleration and deceleration drills). These would slowly be altered to involve a mild form of body contact stress to further simulate the in game demands.
These images are examples of surgical repair of the lisfranc joint:
I hope you’ve enjoyed this post on Lisfranc injuries. As you can see these are a complex injury and need to be managed appropriately. Please feel free to contact us if you have any questions. Stay tuned for more posts from Fluid Movement Podiatry.
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Stay safe and activity
Stuart and Ben
Fluid Movement Podiatry
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