Conway McLean, DPM, Journal columnist

Injuries can happen to anyone, but certain activities entail much higher risk. Think of a firefighter as opposed to the hazards of a secretary. There are obstacles of various sorts for most of us, from a patch of black ice to a broken bottle on the street. Professional athletes are prone to specific types of injury, depending on their sport. Football players are subjected to large, physical forces. This often leads to damaging certain structures, popular items like the knee and ankle.

A rash of foot injuries have occurred over the last few years to several high profile athletes. A sizable percentage of them not only missed considerable playing time but some never returned to prior levels of performance. The injury being referenced here occurs not infrequently in football but can occur to your average Joe. The joint and ligament involved in this are the Lis-franc ligament and joint.

Named after a French physician who studied this part of the body, the ligament runs from the base of the 2nd metatarsal bone over towards the bone that abuts the base of the 1st. This structure helps to secure the forefoot, which is basically the metatarsal bones, to the middle part (appropriately called the midfoot). Consequently, the Lisfranc ligament is very important in stabilizing the arch of your foot.

The Lis-franc joint is composed of the bases of the metatarsal bones and the four bones composing the midfoot. This is the top of the arch of the foot and is subjected to tremendous physical stress. Disturb the anatomy with a torn ligament or a displaced joint, and pain and problems will predictably result.

With just the right sharp, sudden twisting motion of the foot, like those made while engaged in the sport of football, the Lis-franc ligament can be damaged. With this specific motion, with considerable forces involved, the ligament may be stretched, torn, or otherwise damaged. Or a tiny piece of the metatarsal bone can be pulled off.

With sufficient force, resulting in enough ligament damage, the foot becomes grossly unstable. Visible deformity may be seen where the outer part of the forefoot moves away from the inner half. A key component of this topic is the variability in the specifics of this injury. Is the ligament torn or stretched? Are the joints towards the outside of the foot affected? These are critical factors in treatment, although the first question is recognizing the presence of a Lis-franc injury.

People are good at ignoring their bodies, consequently many acute injuries go unreported and undiagnosed. Even when of the milder type, significant long-term complications may ensue with trauma to the Lis-franc joint. An inability to push off with the affected foot will alter gait and often cause symptoms elsewhere.

When someone presents to the office with a history of a traumatic event causing pain to the middle part of the foot, it is important to get an accurate, detailed history. With a Lis-franc sprain, there is pain when pushing off with the foot or with more use of the part, as in a long workday. Predictably, sports performance is negatively affected (coaches are never happy to hear their star athlete has a Lis-franc injury).

This can be an acutely painful problem, but an essential part of this discussion is the variable nature of the extent of injury. Some people experience a mild “tweaking” of the ligament and so have milder symptoms. This also usually means the signs of Lis-franc injury are less obvious and more likely to be missed. The more severe the damage, the greater the separation between the first metatarsal bone and the rest of the metatarsals, the easier the diagnosis.

The information obtained by questioning the patient about the injury and subsequent symptoms will often supply everything needed to make a presumptive diagnosis. X-rays are required with a unique finding of a small piece of bone seen between the base of the 1st and 2nd metatarsal bone being nearly diagnostic. Clinical evaluation should include movement of the toes up and down, which will trigger pain for the individual with a Lis-franc injury. Further imaging tests such as an MRI or CT scan can be helpful.

The story of treatment for a Lis-franc injury is often one of frustration, of a continued inability to perform athletic activities without pain. Again, the treatment, the symptoms, the recovery, all factors are dependent on the amount of damage and the nature of structures affected. A sprain of the ligament typically requires a cast or cast boot to be worn for several weeks. Physical therapies aimed at reducing swelling and improving blood flow can be helpful, but unprotected stretching and strengthening is not recommended.

Any time you are talking about arch function and improving it, foot supports and custom foot orthotics should be part of the conversation. A detailed analysis of how the mechanics of the foot have been affected by the injury will provide key data about reducing stress to the damaged region. Of course, any time damaged tissue is under discussion, regenerative techniques should be included.

A significant fracture or disarticulation will more than likely require surgical intervention. This is not an insignificant operation and usually requires screws, wires, or plates to secure the bones. The rehabilitation process to recover from this surgery can take many months, often half a year, with no weight bearing allowed for almost 2 months.

Although the professional athlete is evaluated by the best specialists money can buy, the Lis-franc injury to an everyday citizen is too often misdiagnosed and inadequately treated. The key to a diagnosis is a high index of suspicion, being familiar with this pathology and knowledgeable of its presentation. Seeing a specialist in care of the foot may be required to arrive at an accurate determination.

Although the joint doesn’t move much, it is an important body part. Chronic pain and disability in this articulation can interfere with weight bearing and reduce your quality of life. Think you may have suffered one of these? Get it checked out since you don’t want to live with an untreated Lis-franc’s injury.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.