OverviewBreaking one or more bones in the midfoot is not very common. In fact, only about one out of every 100 broken bones involves the midfoot.
Atop the arch, the midfoot has unique anatomy: It is where the tarsometatarsal joints come together, and is interlaced with ligaments (connectors between bone and tendons) and tendons (connectors between bone and muscle), as well as nerves, blood vessels and other tissues. The unique structure helps to transfer the load you place on your heel to the more supple and flexible forefoot as you move forward.
A fracture in which bone or bones’ broken ends have shifted away from each other is a displaced fracture. This fracture usually requires reconstruction to stabilize the bone(s) and realign the displaced ends.
Joint reconstruction for Lisfranc fractures can occur shortly after an injury – or months or even years later. Delayed treatment suggests that the original injury was misdiagnosed as a sprain or other minor injury, or the patient didn’t consider the injury severe enough to seek treatment.
Procedural DetailsThe goal of joint reconstruction for Lisfranc foot fractures is to return the bone(s) as closely as possible to their original position and to preserve the normal function of the area’s multiple joints.
One or more incisions is made along the top of the foot near the joint(s) to be treated. The surgeon carefully examines the joints for bone or cartilage fragments. If the injury is old, the doctor will first confirm whether excessive arthritis or scar tissue has formed, which could adversely affect the surgery’s success. Clamps and screws are used to realign the bones. A fluoroscope, a type of X-ray machine that captures internal structures in real time, often is used to help guide the surgeon as he or she manipulates instruments.
In some severe Lisfranc injuries, a tendon graft is needed to stabilize the repaired joint. After the bone ends are realigned, a tunnel is drilled through the end of the second metatarsal (the long bone to the outside of the big toe). A small tendon from the bottom of the foot can be cut and threaded up through the tunnel, looped over the metatarsal then re-sewn onto itself. Alternately, the new tendon can come from a donor or be made of synthetic material.
After surgery, you will spend about six weeks in a non-weight-bearing cast. You’ll then wear casts that bear progressively more weight over the next six to 10 weeks. Depending on your circumstances, early motion and light weight-bearing exercises might be prescribed to help decrease muscle atrophy and joint stiffness. You should not undertake exercise or weight-bearing activities following Lisfranc surgery without your doctor’s approval.
MedicationsYou may receive antibiotics prior to surgery to help lessen the chance of post-surgical infection. After the surgery, pain medication may be prescribed.
ConsiderationsReconstruction is the surgical approach for most patients who do not have severe arthritis, which can develop over time in untreated Lisfranc fractures. In cases of severe arthritis or deformity due to injured nerves or poorly healed, untreated injuries, joint fusion (arthrodesis) or the creation of an artificial joint (arthroplasty) are potential repairs.
EffectivenessThe sooner the surgery occurs after the original injury, the greater the likelihood of success. Study results vary but consistently associate longer delays with lesser outcomes.
Risks involved with reconstructive surgery for midfoot fractures
All surgery carries risk of both post-operative infection and the use of anesthesia. The joint-reconstruction surgery might not fully restore function or fully relieve pain. In cases where the reconstructive surgery didn’t work as well as the surgeon anticipated, joint fusion might be the next step.
Risks of not having reconstructive surgery for midfoot fractures
Poorly treated or untreated Lisfranc fractures often lead to chronic debilitating pain and arthritis that can impede daily activities.
UrgencyIt is imperative to see a doctor as soon as possible after an injury to the top of the foot, even if you think it’s a slight sprain. Lisfranc injuries and fractures can be subtle and hard to diagnose. The longer the delay of treatment, the harder it is to correct or reduce subsequent complications. If your doctor suspects a Lisfranc fracture, asking for a referral to an orthopaedic specialist could help prevent long-term and painful consequences.