A Lisfranc injury represents a serious disruption of the tarsometatarsal joints in the midfoot. This injury primarily occurs at the interface between the medial cuneiform bone and the base of the second metatarsal. The term "Lisfranc injury" encompasses both ligamentous injuries and fractures.

Epidemiology

Lisfranc injuries are relatively rare and often go undiagnosed due to their subtle presentation. They account for approximately 0.2% of all fractures. The incidence is higher in populations engaged in high-impact sports or physically demanding activities. Males are more commonly affected than females, and the peak incidence occurs in the third decade of life.

Aetiology

Lisfranc injuries typically result from direct or indirect forces applied to the foot. Direct forces include crush injuries, such as a heavy object falling on the foot. Indirect forces involve twisting injuries where the foot is plantarflexed and a rotational force is applied, as often seen in sports injuries.

PC

Patients with a Lisfranc injury may present with:

• Midfoot pain that worsens with weight-bearing or palpation
• Difficulty or inability to bear weight
• Swelling and bruising on the dorsal aspect of the midfoot
• Deformity or malalignment of the foot may be seen in severe cases

Differential Diagnosis

The following conditions may mimic the presentation of a Lisfranc injury:

• Metatarsal fractures: Pain, swelling, and inability to bear weight. Deformity may be present.
• Ankle sprains: Presents with pain, swelling, and difficulty in weight-bearing, but localized to the ankle rather than the midfoot.
• Navicular fractures: Similar symptoms to Lisfranc injury, but tenderness is usually localized to the navicular bone.