Lisfranc Injuries
The joint in the midfoot that connects the metatarsal bones to the tarsal bones is known as the Lisfranc joint. This joint expands across the entire width of the foot. It was first described by Jacques Lisfranc de St. Martin, a French surgeon serving in the Napoleonic Army. The joint was first described in reference to amputations through the joint.
Since the 19th century, much has been learned about the Lisfranc joint, including injuries to it. Lisfranc injuries are a commonly missed injury, and may result from both direct (such as dropping a heavy object on the foot) or indirect (twisting the foot) forces. Most commonly, Lisfranc injuries are seen in the hospital following motor vehicle accidents.
A Lisfranc injury may describe a sprain, dislocation, or fracture, or any combination of these events. Fractures may occur as either breaks in the bones surrounding the joint, or as tiny avulsion fractures. These avulsion fractures occur when the ligaments become detached from the bones, and pull off small pieces of bone with them.
Symptoms of a Lisfranc injury will typically include pain and swelling in the midfoot. There may be associated bruising on either the top or the bottom of the foot. In severe cases, particularly in cases of fracture, it may be extremely painful to put weight on the foot.
Diagnosis of Lisfranc injury begins with an examination by a foot and ankle surgeon. The injury can commonly be missed, and can often be confused with other types of sprains and fractures. X-rays are usually required to evaluate the extent of the injury. A surgeon may also evaluate the integrity of the ligaments and joint to assesss whether they have been damaged. This is usually done under anesthesia.
With symptoms of a Lisfranc injury or any other type of serious injury to the foot, it is important to see a foot and ankle specialist as soon as possible. The injury can be assessed and evaluated, and a treatment plan can be devised. If it is not possible to see a doctor immediately, the foot should be elevated, and ice should be applied to the area in intervals. Typically, it is recommended that ice be applied for twenty minutes every hour after a traumatic injury such as a Lisfranc injury. This can help relieve some of the swelling, and may help to reduce the pain.
Non-surgical management of Lisfranc injuries may involve immobilization with a cast. The use of crutches may also be helpful in keeping weight off of the area. Anti-inflammatory medications, such as ibuprofen, are often used to manage swelling. Ice and elevation are usually continued as needed, and physical therapy may be required after the injury has healed.
Surgical management of Lisfranc injuries is often required. This is typically due to a prolonged instability of the joint following injury. This instability may lead to a loss of balance, loss of function, pain, swelling, and an increased progression of arthritis at the joint.
Surgery for Lisfranc injuries may involve fusion of the injured joints, with either temporary or permanent screws. Pins may be used to hold the bones in place while they heal. Only a foot and ankle surgeon will be able to determine the best method of correction following a Lisfranc injury.
No comments:
Post a Comment