Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 21, Issue 6, pp 1434–1446 | Cite as

Lisfranc injuries: an update

  • Kyriacos I. Eleftheriou
  • Peter F. Rosenfeld
  • James D. F. Calder


Lisfranc injuries are a spectrum of injuries to the tarsometatarsal joint complex of the midfoot. These range from subtle ligamentous sprains, often seen in athletes, to fracture dislocations seen in high-energy injuries. Accurate and early diagnosis is important to optimise treatment and minimise long-term disability, but unfortunately, this is a frequently missed injury. Undisplaced injuries have excellent outcomes with non-operative treatment. Displaced injuries have worse outcomes and require anatomical reduction and internal fixation for the best outcome. Although evidence to date supports the use of screw fixation, plate fixation may avoid further articular joint damage and may have benefits. Recent evidence supports the use of limited arthrodesis in more complex injuries.


Lisfranc injury Midfoot injury Midfoot fracture Midfoot sprain 


  1. 1.
    Ahmed S, Bolt B, McBryde A (2010) Comparison of standard screw fixation versus suture button fixation in Lisfranc ligament injuries. Foot Ankle Int 31(10):892–896PubMedCrossRefGoogle Scholar
  2. 2.
    Aitken AP, Poulson D (1963) Dislocations of the tarsometatarsal joint. J Bone Joint Surg Am 45-A:246–260PubMedGoogle Scholar
  3. 3.
    Alberta FG, Aronow MS, Barrero M, Diaz-Doran V, Sullivan RJ, Adams DJ (2005) Ligamentous Lisfranc joint injuries: a biomechanical comparison of dorsal plate and transarticular screw fixation. Foot Ankle Int 26(6):462–473PubMedGoogle Scholar
  4. 4.
    Arntz CT, Veith RG, Hansen ST Jr (1988) Fractures and fracture-dislocations of the tarsometatarsal joint. J Bone Joint Surg Am 70(2):173–181PubMedGoogle Scholar
  5. 5.
    Aronow MS (2011) Joint preserving techniques for Lisfranc injury. Tech Orthop 26(1):43CrossRefGoogle Scholar
  6. 6.
    Brin YS, Nyska M, Kish B (2010) Lisfranc injury repair with the tightrope device: a short-term case series. Foot Ankle Int 31(7):624–627PubMedCrossRefGoogle Scholar
  7. 7.
    Buzzard BM, Briggs PJ (1998) Surgical management of acute tarsometatarsal fracture dislocation in the adult. Clin Orthop Relat Res 353:125–133PubMedCrossRefGoogle Scholar
  8. 8.
    Calder JD, Whitehouse SL, Saxby TS (2004) Results of isolated Lisfranc injuries and the effect of compensation claims. J Bone Joint Surg Br 86(4):527–530PubMedGoogle Scholar
  9. 9.
    Cantu RV, Koval KJ (2006) The use of locking plates in fracture care. J Am Acad Orthop Surg 14(3):183–190PubMedGoogle Scholar
  10. 10.
    Chandran P, Puttaswamaiah R, Dhillon MS, Gill SS (2006) Management of complex open fracture injuries of the midfoot with external fixation. J Foot Ankle Surg 45(5):308–315PubMedCrossRefGoogle Scholar
  11. 11.
    Chesbrough RM (2002) Strategic approach fends off charges of malpractice program provides tips for avoiding litigation. Diagn Imaging 24(13):44–51Google Scholar
  12. 12.
    Chilvers M, Donahue M, Nassar L, Manoli A 2nd (2007) Foot and ankle injuries in elite female gymnasts. Foot Ankle Int 28(2):214–218PubMedCrossRefGoogle Scholar
  13. 13.
    Chiodo CP, Myerson MS (2001) Developments and advances in the diagnosis and treatment of injuries to the tarsometatarsal joint. Orthop Clin North Am 32(1):11–20PubMedCrossRefGoogle Scholar
  14. 14.
    Coetzee JC (2008) Making sense of Lisfranc injuries. Foot Ankle Clin 13(4):695–704 ixPubMedCrossRefGoogle Scholar
  15. 15.
    Cosculluela PE, Ebert AM, Varner KE (2009) Dorsomedial bridge plating of Lisfranc injuries. Tech Foot Ankle Surg 8(4):215CrossRefGoogle Scholar
  16. 16.
    Coss HS, Manos RE, Buoncristiani A, Mills WJ (1998) Abduction stress and AP weightbearing radiography of purely ligamentous injury in the tarsometatarsal joint. Foot Ankle Int 19(8):537–541PubMedCrossRefGoogle Scholar
  17. 17.
    Cottom JM, Hyer CF, Berlet GC (2008) Treatment of Lisfranc fracture dislocations with an interosseous suture button technique: a review of 3 cases. J Foot Ankle Surg 47(3):250–258PubMedCrossRefGoogle Scholar
  18. 18.
    Curtis MJ, Myerson M, Jinnah RH, Cox QG, Alexander I (1993) Arthrodesis of the first metatarsophalangeal joint: a biomechanical study of internal fixation techniques. Foot Ankle 14(7):395–399PubMedCrossRefGoogle Scholar
  19. 19.
    Curtis MJ, Myerson M, Szura B (1993) Tarsometatarsal joint injuries in the athlete. Am J Sports Med 21(4):497–502PubMedCrossRefGoogle Scholar
  20. 20.
    Davies MS, Saxby TS (1999) Intercuneiform instability and the “gap” sign. Foot Ankle Int 20(9):606–609PubMedCrossRefGoogle Scholar
  21. 21.
    de Palma L, Santucci A, Sabetta SP, Rapali S (1997) Anatomy of the Lisfranc joint complex. Foot Ankle Int 18(6):356–364PubMedCrossRefGoogle Scholar
  22. 22.
    Deol R, Roche A, Calder JDF (2012) Return to training and playing following acute Lisfranc injury in elite professional soccer and rugby players. Paper presented at the American orthopaedic society for sports medicine, Baltimore, Maryland, July 2012Google Scholar
  23. 23.
    DeOrio M, Erickson M, Usuelli FG, Easley M (2009) Lisfranc injuries in sport. Foot Ankle Clin 14(2):169–186PubMedCrossRefGoogle Scholar
  24. 24.
    Desmond EA, Chou LB (2006) Current concepts review: lisfranc injuries. Foot Ankle Int 27(8):653–660PubMedGoogle Scholar
  25. 25.
    Ebraheim NA, Yang H, Lu J, Biyani A (1996) Computer evaluation of second tarsometatarsal joint dislocation. Foot Ankle Int 17(11):685–689PubMedCrossRefGoogle Scholar
  26. 26.
    English TA (1964) Dislocations of the metatarsal bone and adjacent toe. J Bone Joint Surg Br 46:700–704PubMedGoogle Scholar
  27. 27.
    Faciszewski T, Burks RT, Manaster BJ (1990) Subtle injuries of the Lisfranc joint. J Bone Joint Surg Am 72(10):1519–1522PubMedGoogle Scholar
  28. 28.
    Foster SC, Foster RR (1976) Lisfranc’s tarsometatarsal fracture-dislocation. Radiology 120(1):79–83PubMedGoogle Scholar
  29. 29.
    Haapamaki V, Kiuru M, Koskinen S (2004) Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography. Foot Ankle Int 25(9):614–619PubMedGoogle Scholar
  30. 30.
    Hardcastle PH, Reschauer R, Kutscha-Lissberg E, Schoffmann W (1982) Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Joint Surg Br 64(3):349–356PubMedGoogle Scholar
  31. 31.
    Hatem SF, Davis A, Sundaram M (2005) Your diagnosis? Midfoot sprain: Lisfranc ligament disruption. Orthopedics 28(1):75–77Google Scholar
  32. 32.
    Horton GA, Olney BW (1993) Deformity correction and arthrodesis of the midfoot with a medial plate. Foot Ankle 14(9):493–499PubMedCrossRefGoogle Scholar
  33. 33.
    Johnson JE, Johnson KA (1986) Dowel arthrodesis for degenerative arthritis of the tarsometatarsal (Lisfranc) joints. Foot Ankle 6(5):243–253PubMedCrossRefGoogle Scholar
  34. 34.
    Kaar S, Femino J, Morag Y (2007) Lisfranc joint displacement following sequential ligament sectioning. J Bone Joint Surg Am 89(10):2225–2232PubMedCrossRefGoogle Scholar
  35. 35.
    Kalia V, Fishman EK, Carrino JA, Fayad LM (2012) Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. Skeletal Radiol 41(2):129–136PubMedCrossRefGoogle Scholar
  36. 36.
    Komenda GA, Myerson MS, Biddinger KR (1996) Results of arthrodesis of the tarsometatarsal joints after traumatic injury. J Bone Joint Surg Am 78(11):1665–1676PubMedGoogle Scholar
  37. 37.
    Kuo RS, Tejwani NC, Digiovanni CW, Holt SK, Benirschke SK, Hansen ST Jr, Sangeorzan BJ (2000) Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg Am 82-A(11):1609–1618PubMedGoogle Scholar
  38. 38.
    Lattermann C, Goldstein JL, Wukich DK, Lee S, Bach BR Jr (2007) Practical management of Lisfranc injuries in athletes. Clin J Sport Med 17(4):311–315PubMedCrossRefGoogle Scholar
  39. 39.
    Lee CA, Birkedal JP, Dickerson EA, Vieta PA Jr, Webb LX, Teasdall RD (2004) Stabilization of Lisfranc joint injuries: a biomechanical study. Foot Ankle Int 25(5):365–370PubMedGoogle Scholar
  40. 40.
    Lu J, Ebraheim NA, Skie M, Porshinsky B, Yeasting RA (1997) Radiographic and computed tomographic evaluation of Lisfranc dislocation: a cadaver study. Foot Ankle Int 18(6):351–355PubMedCrossRefGoogle Scholar
  41. 41.
    Lui TH (2007) Arthroscopic tarsometatarsal (Lisfranc) arthrodesis. Knee Surg Sports Traumatol Arthrosc 15(5):671–675PubMedCrossRefGoogle Scholar
  42. 42.
    Ly TV, Coetzee JC (2006) Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg Am 88(3):514–520PubMedCrossRefGoogle Scholar
  43. 43.
    Mann RA, Prieskorn D, Sobel M (1996) Mid-tarsal and tarsometatarsal arthrodesis for primary degenerative osteoarthrosis or osteoarthrosis after trauma. J Bone Joint Surg Am 78(9):1376–1385PubMedGoogle Scholar
  44. 44.
    Marks RM, Parks BG, Schon LC (1998) Midfoot fusion technique for neuroarthropathic feet: biomechanical analysis and rationale. Foot Ankle Int 19(8):507–510PubMedCrossRefGoogle Scholar
  45. 45.
    Meyer SA, Callaghan JJ, Albright JP, Crowley ET, Powell JW (1994) Midfoot sprains in collegiate football players. Am J Sports Med 22(3):392–401PubMedCrossRefGoogle Scholar
  46. 46.
    Milankov M, Miljkovic N, Popovic N (2003) Concomitant plantar tarsometatarsal (Lisfranc) and metatarsophalangeal joint dislocations. Arch Orthop Trauma Surg 123(2–3):95–97PubMedGoogle Scholar
  47. 47.
    Mulier T, Reynders P, Dereymaeker G, Broos P (2002) Severe Lisfrancs injuries: primary arthrodesis or ORIF? Foot Ankle Int 23(10):902–905PubMedGoogle Scholar
  48. 48.
    Myerson MS, Fisher RT, Burgess AR, Kenzora JE (1986) Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle 6(5):225–242PubMedCrossRefGoogle Scholar
  49. 49.
    Nithyananth M, Boopalan PR, Titus VT, Sundararaj GD, Lee VN (2011) Long-term outcome of high-energy open Lisfranc injuries: a retrospective study. J Trauma 70(3):710–716PubMedCrossRefGoogle Scholar
  50. 50.
    Nunley JA, Vertullo CJ (2002) Classification, investigation, and management of midfoot sprains: lisfranc injuries in the athlete. Am J Sports Med 30(6):871–878PubMedGoogle Scholar
  51. 51.
    Oosterwaal M, Telfer S, Torholm S, Carbes S, van Rhijn LW, Macduff R, Meijer K, Woodburn J (2011) Generation of subject-specific, dynamic, multisegment ankle and foot models to improve orthotic design: a feasibility study. BMC Musculoskelet Disord 12:256PubMedCrossRefGoogle Scholar
  52. 52.
    Panchbhavi VK, Andersen CR, Vallurupalli S, Yang J (2008) A minimally disruptive model and three-dimensional evaluation of Lisfranc joint diastasis. J Bone Joint Surg Am 90(12):2707–2713PubMedCrossRefGoogle Scholar
  53. 53.
    Pearce CJ, Calder JD (2010) Surgical anatomy of the midfoot. Knee Surg Sports Traumatol Arthrosc 18(5):581–586PubMedCrossRefGoogle Scholar
  54. 54.
    Peicha G, Labovitz J, Seibert FJ, Grechenig W, Weiglein A, Preidler KW, Quehenberger F (2002) The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture-dislocation. An anatomical and radiological case control study. J Bone Joint Surg Br 84(7):981–985PubMedCrossRefGoogle Scholar
  55. 55.
    Perez Blanco R, Rodriguez Merchan C, Canosa Sevillano R, Munuera Martinez L (1988) Tarsometatarsal fractures and dislocations. J Orthop Trauma 2(3):188–194PubMedCrossRefGoogle Scholar
  56. 56.
    Philbin T, Rosenberg G, Sferra JJ (2003) Complications of missed or untreated Lisfranc injuries. Foot Ankle Clin 8(1):61–71PubMedCrossRefGoogle Scholar
  57. 57.
    Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF (1998) Magnetic resonance imaging of the Lisfranc ligament of the foot. Foot Ankle Int 19(7):438–446PubMedCrossRefGoogle Scholar
  58. 58.
    Preidler KW, Wang YC, Brossmann J, Trudell D, Daenen B, Resnick D (1996) Tarsometatarsal joint: anatomic details on MR images. Radiology 199(3):733–736PubMedGoogle Scholar
  59. 59.
    Purushothaman B, Robinson E, Lakshmanan P, Siddique M (2010) Extra-articular fixation for treatment of Lisfranc injury. Surg Technol Int 19:199PubMedGoogle Scholar
  60. 60.
    Raikin SM, Elias I, Dheer S, Besser MP, Morrison WB, Zoga AC (2009) Prediction of midfoot instability in the subtle Lisfranc injury. Comparison of magnetic resonance imaging with intraoperative findings. J Bone Joint Surg Am 91(4):892–899PubMedCrossRefGoogle Scholar
  61. 61.
    Rammelt S, Schneiders W, Schikore H, Holch M, Heineck J, Zwipp H (2008) Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation. J Bone Joint Surg Br 90(11):1499–1506PubMedGoogle Scholar
  62. 62.
    Rankine JJ, Nicholas CM, Wells G, Barron DA (2012) The diagnostic accuracy of radiographs in Lisfranc injury and the potential value of a craniocaudal projection. AJR Am J Roentgenol 198(4):W365–W369PubMedCrossRefGoogle Scholar
  63. 63.
    Richter M, Wippermann B, Krettek C, Schratt HE, Hufner T, Therman H (2001) Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results. Foot Ankle Int 22(5):392–398PubMedGoogle Scholar
  64. 64.
    Root MI (1973) Biomechanical examination of the foot. J Am Podiatr Assoc 63(1):28–29Google Scholar
  65. 65.
    Rosenbaum A, Dellenbaugh S, Dipreta J, Uhl R (2011) Subtle injuries to the Lisfranc joint. Orthopedics 34(11):882–887PubMedCrossRefGoogle Scholar
  66. 66.
    Ross G, Cronin R, Hauzenblas J, Juliano P (1996) Plantar ecchymosis sign: a clinical aid to diagnosis of occult Lisfranc tarsometatarsal injuries. J Orthop Trauma 10(2):119–122PubMedCrossRefGoogle Scholar
  67. 67.
    Sands AK, Grose A (2004) Lisfranc injuries. Injury 35(Suppl 2):SB71–SB76PubMedGoogle Scholar
  68. 68.
    Sangeorzan BJ, Hansen ST Jr (1989) Early and late posttraumatic foot reconstruction. Clin Orthop Relat Res 243:86–91PubMedGoogle Scholar
  69. 69.
    Sangeorzan BJ, Veith RG, Hansen ST Jr (1990) Salvage of Lisfranc’s tarsometatarsal joint by arthrodesis. Foot Ankle 10(4):193–200PubMedCrossRefGoogle Scholar
  70. 70.
    Shapiro MS, Wascher DC, Finerman GA (1994) Rupture of Lisfranc’s ligament in athletes. Am J Sports Med 22(5):687–691PubMedCrossRefGoogle Scholar
  71. 71.
    Sharma D, Khan F (2002) Lisfranc fracture dislocations—an important and easily missed fracture in the emergency department. J R Army Med Corps 148(1):44–47PubMedCrossRefGoogle Scholar
  72. 72.
    Solan MC, Moorman CT 3rd, Miyamoto RG, Jasper LE, Belkoff SM (2001) Ligamentous restraints of the second tarsometatarsal joint: a biomechanical evaluation. Foot Ankle Int 22(8):637–641PubMedGoogle Scholar
  73. 73.
    Stavlas P, Roberts CS, Xypnitos FN, Giannoudis PV (2010) The role of reduction and internal fixation of Lisfranc fracture-dislocations: a systematic review of the literature. Int Orthop 34(8):1083–1091PubMedCrossRefGoogle Scholar
  74. 74.
    Stein RE (1983) Radiological aspects of the tarsometatarsal joints. Foot Ankle 3(5):286–289PubMedCrossRefGoogle Scholar
  75. 75.
    Tadros AM, Al-Hussona M (2008) Bilateral tarsometatarsal fracture-dislocations: a missed work-related injury. Singapore Med J 49(9):e234–e235PubMedGoogle Scholar
  76. 76.
    Tan YH, Chin TW, Mitra AK, Tan SK (1995) Tarsometatarsal (Lisfranc’s) injuries—results of open reduction and internal fixation. Ann Acad Med Singapore 24(6):816–819PubMedGoogle Scholar
  77. 77.
    Thompson MC, Mormino MA (2003) Injury to the tarsometatarsal joint complex. J Am Acad Orthop Surg 11(4):260–267PubMedGoogle Scholar
  78. 78.
    van Rijn J, Dorleijn DM, Boetes B, Wiersma-Tuinstra S, Moonen S (2012) Missing the Lisfranc fracture: a case report and review of the literature. J Foot Ankle Surg 51(2):270–274PubMedCrossRefGoogle Scholar
  79. 79.
    Vertullo CJ, Easley ME, Nunley JA (2002) The transverse dorsal approach to the Lisfranc joint. Foot Ankle Int 23(5):420–426PubMedGoogle Scholar
  80. 80.
    Watson TS, Shurnas PS, Denker J (2010) Treatment of Lisfranc joint injury: current concepts. J Am Acad Orthop Surg 18(12):718–728PubMedGoogle Scholar
  81. 81.
    Wilson DW (1972) Injuries of the tarso-metatarsal joints. Etiology, classification and results of treatment. J Bone Joint Surg Br 54(4):677–686PubMedGoogle Scholar
  82. 82.
    Wilson MG, Gomez-Tristan A (2010) Medial plate fixation of Lisfranc injuries. Tech Foot Ankle Surg 9(3):107–110CrossRefGoogle Scholar
  83. 83.
    Yamashita F, Sakakida K, Hara K, Senpo K (1993) Diastasis between the medial and the intermediate cuneiforms. J Bone Joint Surg Br 75(1):156–157PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kyriacos I. Eleftheriou
    • 1
    • 2
  • Peter F. Rosenfeld
    • 2
    • 3
  • James D. F. Calder
    • 1
    • 2
  1. 1.Department of Trauma and OrthopaedicsChelsea and Westminster HospitalLondonUK
  2. 2.Fortius ClinicLondonUK
  3. 3.Department of Trauma and OrthopaedicsSt Mary’s HospitalLondonUK

Personalised recommendations