Lisfranc Ligament: a Common Injury in Athletes

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

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