One of the more commonly injured areas in the mid-foot is injury to the Lisfranc joint complex. Injury to the Lisfranc complex can be incredibly painful but isn’t always obvious either. The Lisfranc joint compromises the bases of the first and second metatarsal with the medial and intermediate cuneiform. Specifically, a ligament called Lisfranc’s ligament spans from the medial cuneiform to the second metatarsal base which is illustrated in the image below. This joint is crucial for maintaining balance and stability while walking or running.
What Is a Subtle Lisfranc Injury?
A subtle Lisfranc injury refers to a mild or less obvious injury to the ligaments, tendons, or bones in the Lisfranc joint. It may not involve a fracture or dislocation, but rather sprains, ligament tears, or slight misalignments. These injuries can often be overlooked or mistaken for other less severe conditions, which is why it’s important to pay attention to certain symptoms.
Causes:
Sports Injuries: These injuries are common in athletes who engage in high-impact sports like football, soccer, or basketball, which involve a lot of foot planting, twisting, and turning.
Trauma or Accidents: a fall, direct trauma to the foot, or sudden force can cause stress on the joint.
Overuse or Repetitive Stress: Over time, repetitive stress on the foot from activities like running or jumping can lead to subtle injuries.
Symptoms of a subtle Lisfranc injury:
Pain: pain is typically felt in the middle of the foot or the arch. This pain may be mild at first and worsen with activity. Swelling and Bruising: mild swelling may appear on the top or inside of the foot, with possible bruising.
Difficulty Bearing Weight: pain and discomfort might increase when standing, walking, or bearing weight on the injured foot. The foot may feel weak, and walking may become slightly altered.
Tenderness: The top of the foot, especially around the arch area, may be tender to touch, but there may not be any obvious deformity.
Instability: In some cases, there might be a feeling of instability or a “loose” sensation in the midfoot while walking.
Diagnosis:
Diagnosing a subtle Lisfranc injury can be tricky as the signs and symptoms may not be immediately obvious. The injury might not show clear fractures or dislocations on X-rays, so a few different methods may be used, including physical exams, weight-bearing x-rays, and advanced imaging.
Physical Exam: when examining the foot, paying attention to areas of tenderness, swelling, or instability is key. Your doctor will perform different tests that will help pinpoint what is causing the pain.
Weight-bearing X-rays: In some cases, the injury may not be visible on non-weight-bearing X-rays, so weight-bearing X-rays can help reveal subtle shifts or misalignments in the bones.
MRI or CT Scan: For more subtle injuries that don’t appear on X-rays, an MRI or CT scan may be used to visualize soft tissue damage, ligament tears, or small fractures that could be missed otherwise.
Treatment:
Conservative treatment: In cases of mild Lisfranc injury, conservative treatment may be enough. This often includes rest and ice, immobilization, physical therapy and anti-inflammatory medications.
Surgical treatment: if the injury is more severe or there is joint instability, surgery may be necessary to repair torn ligaments, realign bones, or stabilize the joint.
Recovery:
The recovery time can vary depending on the severity and treatment approach. For mild injuries treated conservatively, recovery may take several weeks (4-6 weeks), while more serious injuries requiring surgery may take 3-6 months or longer to fully heal.
If you suspect a Lisfranc injury or experience persistent pain or difficulty walking, it is important to get a proper diagnosis as a missed injury can lead to further complications down the road. At District Foot & Ankle we will ensure a proper workup and diagnosis in order to help alleviate your pain quicker and avoid any further complications.
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