Conservative Management of Subtle Lisfranc Joint Injury: A Case Report

Abstract

Study Design: Case report. Background: Athletic Lisfranc injuries are characterized by disruption of the soft tissues about the tarsometatarsal joint complex. They are frequently missed on initial consultation due to a paucity of demonstrable physical signs, yet often result in significant disability. This case illustrates the 2 great challenges in managing these injuries: firstly, arriving at an accurate diagnosis and, secondly, determining whether the injury is stable and, therefore, appropriate for conservative management. Case Description: The athlete was a 21-year-old professional basketball player with a recurrent ligamentous injury of the Lisfranc joint. A global approach to evaluation and treatment of the entire lower extremity and pelvis in managing this injury is emphasized. Outcomes: The athlete in this case report made a successful return to his previous level of competition 12 weeks postinjury. At 2-year follow-up he continues to play professionally without any symptoms. Discussion: In selected cases for which patients have no osseous displacement and the ability to run on the toes soon after injury, conservative management of Lisfranc injury may be appropriate. Key features of a conservative approach include recognition of a prolonged recovery time, adequate rest for soft tissue healing, restoration of a normal gait pattern to prevent chronic overstress of injured tissues, appropriate orthotic prescription, and proprioceptive retraining. Ther 2005;35:154-164. J Orthop Sports Phys

Pedobarographic Analysis and Quality of Life After Lisfranc Fracture Dislocation

“…3,12,17 Thus the second aim of treatment is stable fixation after realignment, and therefore conservative treatment is mainly reserved for minimally displaced fracture-dislocations. 32 Plantar pressure and foot position analysis are gaining in interest in various areas of foot and ankle surgery. 23,26 The analysis of changes in plantar pressure loading of the foot following a severe injury can be considered an objective outcome measure which may also provide guidance for patient-specific aftercare.…”

Return to Training and Playing After Acute Lisfranc Injuries in Elite Professional Soccer and Rugby Players

“…6,7,11,17 An error in diagnosis or maltreatment could lead to significant morbidity and could potentially be career ending. 3,11,16,29,30 Where displacement occurs, anatomic surgical reduction is key to improving outcomes. 9,17 Little is reported on the outcome in terms of return to training or competition and possible factors that may influence this process, and currently, no evidence-based guidelines exist on the time to return to training and competition after such injuries in elite soccer and rugby players.…”

Lisfranc Injury in a West Point Cadet

“…4,6,27 Routine radiographs of the foot are often insufficient to detect a Lisfranc injury and may be read as normal in up to 20% to 50% of cases. 19,28 Standing weightbearing radiographs, if tolerated, are strongly recommended since they will help emphasize deformities, especially a subtle Lisfranc diastasis.…”