Lisfranc Ligament: a Common Injury in Athletes

As you are well aware, any sporting activity can lead to negative consequences, such as an accident or injury. It’s easy to imagine, for example, an offensive lineman in football falling on his teammate’s foot. This typical scenario can sometimes result in an injury involving the Lisfranc ligament. Depending on the degree, this can range from a less serious sprain/strain to a more serious fracture. 

The Lisfranc ligament is very small, it connects the medial cuneiform to the second metatarsal and provides stability to the foot when it is loaded or rotated. A sneaky way to damage this short ligament is by involuntarily rotating the foot. Think of the cyclist with clip-in shoes who falls off his or her bike while their foot is stuck on the pedal, or the wakeboarder who falls into the water with his foot still attached to the board. Regardless of how foot pain occurs, it should never be ignored and a health care professional should be consulted promptly. 

Diagnosing a Lisfranc Ligament Injury

The podiatrist will immediately suspect a Lisfranc ligament injury if the foot shows signs that are noticeable to the naked eye. In less obvious situations, the patient may complain of pain on weight-bearing or bruising in the forefoot and/or midfoot. All of these scenarios should lead to an x-ray, as the risk of Lisfranc ligament damage is a distinct possibility. The objective when doing an x-ray is to find signs of instability at the Lisfranc joint or a distance of more than 2 mm between the first and second metatarsal. For a better diagnostic impression, the podiatrist can ask the patient to put his or her foot on a support for a few seconds, if this gesture is bearable. 

An ultrasound can also be used to assess the integrity of the Lisfranc ligament, both statically and dynamically, by performing a weight-bearing maneuver. If any of the above signs cannot be seen, but the suspicion remains, a magnetic resonance image (MRI) is usually the next step. The goal is to quickly find the problem and manage the injury to avoid complications and future chronic pain. 

The Treatments

Once it is confirmed that the patient’s Lisfranc ligament is stretched or partially torn, a plan of action is designed to jump start the healing process. The most effective method, which we recommend in most cases, is complete immobilization of the foot for approximately 6 weeks. In the event of a complete tear of the ligament, the patient will likely need to undergo surgery. This option will also be considered when the patient has waited too long to be treated. 

After the inflammation has subsided and the Lisfranc ligament has returned to normal, we recommend rehabilitation. This should be planned according to the patient’s daily routine and sporting activities. 

Once again, prevention is better than cure, so act quickly before an injury worsens. An injury to the Lisfranc ligament can affect the athlete’s future quality of life, if it’s not taken care of at an early stage. Our goal is always to get you back on your feet so you can return to playing your favourite sport as quickly and safely as possible.