Lisfranc Injuries in Sport

The Diagnosis and Initial Management of Injury to Lisfranc’s Joints in the Primary Care Setting in South-Eastern Ontario : How are we Doing?

“…The challenges of recognizing the significant nature of this injury, despite its sometimes deceptively innocuous mechanism, have been theorized in the literature and were practically demonstrated by this study [1,3] despite the fact that pcps felt comfortable diagnosing and managing this injury, they were inaccurate in both making the diagnosis and then managing the subsequent injury. There are several possible explanations for this result.…”

“…Unsuspecting injuries, which can be a result of a rotational mechanism, (e.g. the midfoot rotating over the edge of a street curb while a patient suffers a low energy mechanical fall) can result in significant ligamentous injury to the tmt joint complex [1,3] such lowenergy trauma can then lull the initial treating physician, which is often a primary care physician (or pcp), into a false sense of relative security. This can lead to the misdiagnoses of patients with a lfi.…”

“…Although much research has been aimed at the accuracy of various imaging modalities, the results of operative fixation, and the poor outcomes after missed diagnosis, [1,[3][4][5][6][7][8][9] little study has gone into assessing what role pcps potentially play in the missed diagnoses of subtle lfis. The purpose of this cross-sectional survey study was to assess the level of knowledge and comfort in assessing subtle lfis by pcps in southeastern Ontario, Canada.…”

“…this is due, in most part, to the stability imparted on the midfoot by its anatomy [2]. This can result in a near anatomic radiographic relationship of the nonweight-bearing midfoot, even in the face of significant ligamentous disruption [1,3] adding to the subtly of the injury is the low energy mechanism that can accompany this deceptively devastating injury. Unsuspecting injuries, which can be a result of a rotational mechanism, (e.g.…”

“…This can lead to the misdiagnoses of patients with a lfi. It is therefore paramount for any initially treating physicians, including pcps, to maintain an extremely high level of suspicion when a patient complains of inability to weight bear on a painful, swollen midfoot after suffering a minor rotational mechanism of injury [3].…”