1. Lisfranc Injuries

2. Anatomy
 Tarso-metatarsal joint
 Midfoot
 Bones held in place by
ligaments.
 No ligament connection
between 1st and 2nd
metatarsals

3. Mechanism of Injury
 Direct trauma/crush
 Twisting
 Plantar flexion with axial loading
 Low or high energy (beware of associated
injuries)

4. Mechanisms

6. Clinical Presentation
 Variable
 Pain, especially with weight bearing activity
 Plantar ecchymosis
 Dorsal tenderness, edema
 Mild discomfort
 Deformity/instability
 High index of suspicion based on
mechanism!

7. Diagnosis
 Physical exam
view X-Ray (AP, lateral, medial oblique)-weight-
bearing films helpful.
 20% of films are negative initially. Repeat films
at 7-14 days, consider CT/MRI.
 Often mistaken as a sprain-when in doubt, splint
and refer to ortho.

8. Fracture/dislocation findings
 The most consistent finding is
misalignment along the medial side of
second MT and second cuneiform.

9. Fracture/dislocation findings

10. Fracture/dislocation findings
 The medial cuneiform-second MT space
should be evaluated for the "fleck sign"
indicating avulsion of the Lisfranc
ligament.

11. Fleck Sign

12. Classification
 Homolateral
 All of the metatarsals are dislocated to the same side
 Usually involves the 2nd through 5th dislocated
laterally
 Divergent
 May be associated with a fracture of the 1st cuneiform
 Usually involves medial displacement of the 1st
metatarsal and lateral displacement of 2nd-5th
metatarsals

13. Homolateral

14. Classification
 Homolateral
 All of the metatarsals are dislocated to the same side
 Usually involves the 2nd through 5th dislocated
laterally
 Divergent
 May be associated with a fracture of the 1st cuneiform
 Usually involves medial displacement of the 1st
metatarsal and lateral displacement of 2nd-5th
metatarsals

15. Divergent

17. Treatment
 Depends on severity
 RICE
 If no dislocation--immobilize and no weight
bearing for 4-8 weeks
 If significant dislocation--closed reduction or
ORIF

18. Complications
 Chronic pain secondary to posttraumatic
osteoarthritis
 Repeated injuries