Lisfranc injuries (midfoot)

The foot is a complex structure of our body constituted by 26 bones, more than 30 joints and several ligaments that maintain joint stability. From the anatomical point of view, the foot is typically divided into 3 main areas, the forefoot, midfoot and the rearfoot. The Lisfranc joint complex is constituted by several articulations of the midfoot, specifically the tarsometatarsal joints. Lisfranc injury (also known as Lisfranc fracture or Lisfranc dislocation), is an umbrella term used to describe multiple conditions affecting the Lisfranc joint complex, such as fractures, subluxations, dislocations, sprains, joint widenings, or crashes. These injuries are relatively uncommon and the typical injury mechanisms consist of high-energy impacts, including collisions with external bodies such as vehicle crashes, objects falling on the foot, or impacts with the ground after a fall. Low-energy injuries are also possible, especially when combining ankle plantarflexion (tiptoe position) with a twisting motion. This type of injury mechanism is typical in multidirectional sports such as soccer, basketball, volleyball, etc. As for other fractures, low-energy Lisfranc injuries can happen more easily in older populations, or in subjects affected by specific conditions that make the bone more fragile (e.g.: osteoporosis). Patients with this injury typically complain of pain in the midfoot, especially when weight-bearing or actively using the foot in daily life activities (e.g.: walking, running, kicking, etc.), swelling and limited functioning. Based on the clinical presentation, Lisfranc injuries can be managed either conservatively or surgically.