If you follow sports, you may have heard the term Lisfranc Injury thrown around recently with the injury to Houstan Texans quarterback Matt Schaub.
Lisfranc is an often misdiagnosed injury because of its rarity. It essentially is an injury to the 2nd metatarsal head. Often times the metatarsal head is displaced dorsally. There will be swelling, pinpoint tenderness along the tarsometatarsal joint and the inability to bear weight. When these three symptoms are present, be suspicious. Another good guideline is that these three are still present 5 days after initial injury.
The Lisfranc joint complex is very important as this transfers energy from the midfoot to forefoot. Without a stable midfoot you will not be getting up on your toes and plantar flexion will not be effecient.
On evaluation, besides palpating for tenderness along the tarsometarsal complex, check the dorsal pedis artery as it passes over this area. The forefoot can also be pronated while the hindfoot is stabilized. This will cause pain. The athletes/patient ability to get up on their toes should also be checked. When xrays are warranted, a weight bearing radiograph should be used as a non weight bearing xray will often not show any displacement.
The mechanism of injury is often a fall. There can also be a strike or impact to the foot. Indirectly, the foot can be stationary but the force of the body produces enough torque through rotation into the Lisfranc complex.
There can be various grades of injury from mild sprain to and avulsion fracture. The treatment is anything from non weight bearing boot for 6-8 weeks to surgery where a screw is put in.