Lisfranc (Midfoot) Ligament Injuries

What are ligament injuries?

Ligament injuries occur frequently in all parts of the body, though some are more well known than others – most of us have sprained an ankle, or know someone who as ruptured their ACL. Ligaments are connective tissues that travel between bones and provide structural stability to our joints and skeleton. The ligament structures of the midfoot – while not well know – support the arches in our feet and are critically important to the function of the foot.

Diagram of the Lisfranc (midfoot) joint complex
The Lisfranc joint complex includes the bones and ligaments that connect the midfoot and forefoot. Lisfranc injuries include ligament strains and tears, as well as fractures and dislocations of bone (far right). Image courtesy of AAOS.

What causes midfoot ligament injuries?

Some joints have a lot of inherent stability based on the structure of the bones and tissues of the joint. The ankle, for example, has a high degree of structural stability due to the specific way its bones fit together. Midfoot joints, on the other hand, have very little inherent stability.  The bones of the midfoot are somewhat like two square blocks next to one another that rely heavily on their connecting ligaments to maintain stability.  When these ligaments are disrupted the resulting pain and instability can limit a person’s ability to function normally.  People will often struggle to push off and change direction, rendering them unable to exercise or play sports.  The primary ligament of the midfoot, the Lisfranc ligament, is named after Napoleon Bonaparte’s surgeon, as many soldiers on horseback would injure this area if they fell off a horse with their foot stuck in the stirrup.

How are these injuries treated?

Lisfranc injuries, like many others, come in grades of severity, relating to the degree of injury of the midfoot ligament. A sprain of the ligament can often be treated with supportive care, meaning a walking boot for a period of time with a period of transition to a stiff soled shoe. These injuries can frequently be slow to recover to 100%. More severe injury to the ligament, and any demonstrable instability, often will necessitate surgical treatment. Surgical treatment involves surgically stabilizing the area and can be accomplished with screw or suture button fixation of the area of instability and, in some instances, even with fusion of the affected joints. Although these injuries can vary quite a bit in their severity, good outcomes are often obtained and are an expectation after these injuries, although it can take quite some time to fully recover and return to pre-injury function.