Midfoot Pain – Sprain or Lisfranc Injury?

If you’re involved in sports or activities that involve rapid “cutting” and/or twisting movements, such as football, soccer, basketball, or field hockey, you may be more prone to midfoot injuries. The midfoot area contains a number of small bones, ligaments, and a portion of the metatarsal bones that extend to the toes. In a sprain, there is a twisting movement that causes injury to the ligaments, which will result in swelling and pain.

Sometimes, however, the sprain is more than a simple ligament injury. If any of the bones are fractured, or the ligament is torn (or both), it may be classified as a Lisfranc injury. It’s named after a 19th-century French surgeon Jaques Lisfranc de St. Martin who first described the condition after treating soldiers who had fallen from a horse, but had their foot caught in the stirrup, twisting their midfoot in the process.

What Causes Midfoot Sprain and Lisfranc Injuries?

Both midfoot sprains and Lisfranc injuries are caused by a twisting of the midfoot joint. As described above, this can happen as a result of athletic movements. However, it can also be triggered by other means, including a stumble and fall, bad landing, crush injury, or any other action that can generate a twisting motion. While most of these injuries result in a sprain, those exhibiting fracture or dislocation will be diagnosed as a Lisfranc injury.

Symptoms

The most common symptoms for both types of injuries are:

 

  1. Pain when you walk or stand. This may require the use of crutches if the pain is severe.
  2. The foot can be swollen as a result of the tissue damage.
  3. The top and bottom of the foot may be bruised.
  4. The foot widens abnormally.

Lisfranc injuries can often be misdiagnosed as simple sprains, especially if they aren’t caused by something like a crush injury, which is more likely to cause deformation.

Treatment of Midfoot Injuries

Depending on the diagnosis, midfoot injuries can be treated either non-surgically or through a surgical procedure.

Non-surgical treatment

Most of the time, a midfoot sprain that does not include a completely torn ligament or broken bones in the midfoot does not require surgery. It is a minor injury that is similar to an ankle sprain.

  1. Start with RICE treatment (Rest, Ice, Compress and Elevate). This will help to reduce the pain and the swelling of the foot. You may take acetaminophen for pain, or a non-steroidal anti-inflammatory drug (NSAID) to improve swelling.
  2. For moderate sprains or stable Lisfranc injuries, you may be placed in a non-weight bearing cast for 6 weeks. You must ensure that you do not put weight on your injured foot throughout this period. At this stage, you may need crutches or knee scooter to help you through daily activities while the foot is elevated.
  3. When the pain and swelling have reduced, you may need to use a removable cast, a walking boot, or an orthotic.
  4. The last phase is physical therapy, in order to restore lost muscle strength and tendon flexibility. As your foot continues to heal, you should wear supportive footwear that is stable and protective.

Surgical treatment

A severe midfoot injury with broken bones, dislocation or torn ligaments requires surgery to repair the tears and realign the broken bones. There are two common types of surgeries for Lisfranc injuries: internal fixation and fusion. Both procedures require realignment of bones and ligaments. Internal fixation involves the use of plates, screws or hardware to hold the bones into place. The hardware may be left in permanently if it doesn’t bother the patient, or potentially removed at a later time. Fusion, on the other hand, is the process of welding the bones together to produce a single solid structure. Materials used in the welding will remain in the foot permanently.

After surgery, you should still apply RICE treatment to reduce swelling and to accelerate recovery. You will not be allowed to bear weight on the foot for 6 to 8 weeks. This will allow the foot enough time to recover, as inflammation and pain will take time to decrease. Again, it will be necessary to slowly transition to normal activity, so patients typically undergo physical therapy to restore normal function, balance and strength.

Unlike ankle sprains, which are usually diagnosed correctly, we sometimes see patients at Houston Foot and Ankle Care who have been misdiagnosed elsewhere as suffering from a simple sprain. However, after failing to see the expected improvement they learn that it’s actually a Lisfranc fracture or dislocation. If you’ve twisted your foot or experienced a crush injury that is causing pain or swelling of the mid foot region, call us at (713) 541-3199 to schedule an appointment with Gabriel Maislos, DPM, FACFAS. Dr. Maislos is a Houston podiatrist with experience diagnosing and treating sprains and Lisfranc injuries. Furthermore, he is an experienced podiatric surgeon who can get you back to normal activity as soon as possible.

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Houston Foot and Ankle

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