Introduction Injuries at the Lisfranc joint are noted to occur at an incidence rate of 14 per 100,000 persons a year.
Injuries at the Lisfranc joint are noted to occur at an incidence rate of 14 per 100,000 persons a year. Up to 20% of Lisfranc injuries are misdiagnosed or missed altogether on initial evaluation. Illustrated Lisfranc Joint Complex The Lisfranc joint or tarsometatarsal joint is an important stabilizer of the midfoot, connecting the five metatarsals with the 3 cuneiforms and cuboid.
Illustrated Lisfranc Joint Cross-Section The Lisfranc ligament is a combination of three individual ligaments within the joint complex: interosseus, dorsal and plantar ligaments. The interosseus ligament (considered the “Lisfranc ligament proper”) is the strongest of the three and connects the 2 nd metatarsal with the medial cuneiform. Lisfranc injuries occur with high energy trauma such as MVAs but more commonly with low energy trauma seen in sports-related injuries or falls/missteps.
The mechanism of action often results from a compressive axial force applied onto a plantar-flexed foot such as a competitor stepping on the plantar-flexed foot of an opponent. Diagnosis Patients will likely present with tenderness or swelling around the Lisfranc joint area. Patients may be unable to plantar-flex with the affected foot.
A clinical exam sign that can be visualized is plantar ecchymosis which is suggestive of a Lisfranc ligament injury. Plantar ecchymosis at the mid-foot is strongly suggestive of Lisfranc injury. One special test to aid in diagnosis of a lisfranc ligament is a pronation-abduction test.
The test is performed by stabilizing the hindfoot and simultaneously pronating and abducting the forefoot to elicit pain. Pronation-abduction test A Lisfranc joint squeeze test can also suggest a Lisfranc ligament injury. The test is performed when the examiner places the palm on the dorsum of the midfoot and applying a compressive force with the thumb and digits.
If you are experiencing symptoms that may be related to diagnosing a lisfranc ligament injury, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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