This week NY Jets’ Santonio Holmes sustained a debilitating foot injury that has since been diagnosed as a Lisfranc injury. Holmes will be out for a year recovering from the injury. But what exactly is a Lisfranc injury? Here are some commonly asked questions about Lisfranc injuries from Dr. Silverman.
What is a Lisfranc injury?
The Lisfranc injury involves tearing to the strong midfoot ligaments.
How does it happen?
The most common pattern involves an ankle pointed downward with the toes planted (Ballet dancers call it demi-pointe). Like all injuries, you break in the weakest place. In that position, the weakest location is the midfoot joints. Other patterns (like Holmes’s injury) involve twisting the foot while under pressure.
How do you diagnose it?
Classic signs include: pain across the midfoot, acollection of blood creating a circular bruise on the bottom of the arch of the foot, and difficulty walking.
How commonly is it missed?
All the time. This is one of the most commonly overlooked foot and ankle conditions.
How is it treated?
Any instability must be stabilized surgically. Doctors argue for and against immediate fusion of the joints. I believe in evaluating on a case-by-case basis. I fuse joints that are badly damaged and only stabilize joints that have intact joint surfaces. If the joint is not unstable then the minor sprain can be treated in a walking boot.
What happens when it’s not treated completely (or missed altogether)?
If this injury is not identified and treated in time the foot eventually collapses and twists into a complicated arthritic flatfoot. This is much harder to treat.
How much time do you have to catch it?
I have identified unstable Lisfranc joint ligament injuries less than 1 year following the initial injury and have been able to “recreate” the injury and stabilize the joint. This only works when deformity has not developed. Once the foot is deformed (sometimes as quick as 6 weeks from an injury), fusion is the best option.
Lance Silverman, MD
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