Lisfranc Surgery

LISFRANC SURGERY

The Lisfranc ligament runs between two bones in the middle of the foot called the medial cuneiform and the second metatarsal. The place where these two bones meet is called the Lisfranc joint. The name comes from French surgeon Jacques Lisfranc de St. Martin (1790-1847), who was the first physician to describe injuries to this ligament.  

Tearing of the Lisfranc ligament and other ligaments around the Lisfranc joint can lead to instability and disruption of the joints in the middle of the foot. The goals of Lisfranc surgery are to put the bones back into their original position and restore the foot's normal alignment.

SURGERY
Your foot and ankle orthopaedic surgeon will make the first incision on the top of the foot in a line between the big toe and second toe at the middle of the foot. They will carefully protect the tissues to minimize risk of injury to tendons or nerve structures. The joints are realigned and held in position temporarily with wires. Your surgeon will realign the medial cuneiform to the base of the second metatarsal and then realign the other joints around this joint. An X-ray will verify that the joints are aligned. A second incision often is necessary for more severe injuries. This second incision is typically made on the top of the foot but more toward the little toe side.

A series of screws or plates placed beneath the skin will help hold the bones in place. One of the screws often placed is known as a "home run" screw. It runs between the medial cuneiform and the second metatarsal bones. This screw mimics the path of the injured Lisfranc ligaments. Some injuries require wires to be left in place. These wires are left partially exposed outside of the skin.

A fusion surgery involves a similar technique. The main difference is that the cartilage is removed from the joint surfaces prior to inserting plates or screws. The goal is to make the bones grow together to eliminate arthritis.

COMPLICATIONS
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

With Lisfranc surgery there is a nerve that runs very close to the site of the incision. Injury of this nerve can result in numbness. If numbness occurs it typically is not painful and the foot recovers with time. Another common problem after a Lisfranc injury is the development of post-traumatic arthritis in the joints of the middle of the foot. This is due to degeneration of cartilage in the area of the injured joints. This can lead to pain and stiffness in the middle part of the foot.

FREQUENTLY ASKED QUESTIONS
  • Will the plates and/or screws stay in my foot forever?

    The hardware that is placed during surgery is sometimes removed 4-6 months after surgery. Hardware placed for a fusion typically is not removed unless it becomes bothersome.

  • Should I have my recently injured foot realigned, or do I need it fused?

    This is a debated topic. A patient typically will do well with realignment of the bones for simple Lisfranc injuries. More substantial injuries that result in obvious displacement of the joints or fracture involving the joint surfaces may be better treated with a fusion. Other factors to consider include your age and any existing foot arthritis. Discuss your treatment options with your foot and ankle orthopaedic surgeon to find the best solution for your problem.

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Information provided by American Orthopedic Foot and Ankle Society (AOFAS) via FootCareMD.com
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