Introduction

Lisfranc is a skeletal condition in which bones and ligaments are affected due to certain trauma, sports injury, or related crushed injury. Lisfrance repair is concerned with the repair of affected bone or ligament. Lisfrance repair can be done through various approaches, in which Open Reduction and Internal Fixation (ORIF) and Primary Arthrodesis (Fusion) are common surgical procedures.

The prime goal of the repairing procedure is to restore normal anatomical alignment, helpful in maintaining and managing mobility, in turn impacting the coordination of skeletal functioning of the body. Not only helps in motor union but also as a preventive measure for the induction of chronic disorders, in which bone disorders are on top of the list.²

Anatomy of the lisfranc joint complex

The Lisfranc joint complex is a joint in which tarsometatarsal joints are connected, which is mainly responsible for connecting the tarsus and midfoot of the body. It includes:

• 1st–3rd metatarsals articulating with the three cuneiforms
• The 4th and 5th metatarsals are connected to the cuboid bones, which are responsible for proper articulation

Along with bone, ligaments are a part of the joint connecting the medial cuneiform to the base of the 2nd metatarsal, which is crucial in support, coordination, and motility. These ligament attachments are important in the provision of mobility and coordination in the body.⁴

Overview of lisfranc injuries

• Lisfranc injuries are concerned with tarsometatarsal (TMT) joint complex injuries and severe damage, commonly affecting the ligaments and/or bones of the midfoot
• Sprains and ligament tears to fracture-dislocations are severe complications, which are shown in the case of Lisfranc rupture that affects the metatarsals or cuneiform bones
• Most often occur due to high-energy trauma in case of car accidents or severe falls, or low-energy twisting injuries in case of sports injuries

Some highlighting symptoms shown in Lisfranc injuries are 

1. Midfoot pain
2. Swelling
3. Inability to bear weight
4.  Bruising on the plantar surface

Delayed diagnosis can aggravate the condition or may cause chronic instability, midfoot arthritis, and long-term disability.⁴

Surgical repair of lisfranc injuries

Surgical repair is one of the most commonly deployed treatment approaches, with two types being highly common among healthcare providers. ORIF is highly acceptable due to its high recovery rate and a less complicated post-recovery phase in which proper care, along with rehabilitation, can be a good option to ensure improved patient health.³

Causes of chronic pain post-repair

Various causes and multiple factors can contribute to this condition, including the most highlighted ones as follows:

• Post-traumatic arthritis 
• Hardware irritation 
• Residual instability 
• Soft tissue scarring
• Complex regional pain syndrome (CRPS)
• Inadequate rehabilitation 

Many modifiable risk factors are less common, while non-modifiable ones, such as family history and heredity, are more prevalent.

Midfoot instability after lisfranc fixation

Midfoot instability following Lisfranc fixation is a complication that may arise due to improper alignment, hardware failure, or incomplete healing of the ligamentous and bony structures. Radiographic assessment can reveal joint incongruity or hardware loosening. Proper fixation techniques, post-operative care, and early detection of instability are critical for optimal outcomes. In some cases, revision surgery or arthrodesis may be required to restore stability. Long-term instability, if untreated, may lead to post-traumatic arthritis and functional impairment, significantly affecting the patient’s quality of life and mobility.⁴

Diagnostic evaluation

Clinical evaluation is a crucial component for a timely and accurate prognosis, which leads to proper medical decision-making and MDM for planning and implementing a treatment plan properly. In the diagnostic evaluation, the Lisfranc imaging technique is commonly deployed to get an accurate diagnosis and severity of the condition.

Treatment strategies

Treatment of the liscran joint is a complex and challenging one as compared to other conditions. Proper medical decision making MDM is one of the primary components in deciding the treatment according to the individual condition and severity. Here is a brief overview of the most commonly deployed ones in which medication and other approaches are used.²

Conservative management

Conservative management is mainly concerned with the individual condition and severity, which helps in the provision of individualised therapy in which a multidisciplinary care team works cordially to improve quality of life. 

Surgical revision options

Surgical options are considered more acceptable due to the high recovery rate and improved quality of life.

Rehabilitation and long-term outcomes

Rehabilitation is one of the crucial components of bone and joint remodelling, helping in coping with post-surgical recovery. It is crucial in coordination and mobility, leading to improved quality of life, and has long-term effects on the body. It is offered by a physical therapist who provides physical rehabilitation in which exercises, therapies, and manual and machine-assisted therapies are commonly deployed. 

Patient education and follow-up

In traditional management, the last and foremost component that assists in improving overall health in terms of physical, emotional, and mental health is assisted by patient education and counselling, in which pharmacists play a crucial role in offering individual counselling. Psychologists are also part of this counselling, which gives counselling therapies to the suffering individual. Regular follow-up is included and recommended to ensure improvement in mobility. Patient compliance with the recommended treatment is also important in managing the condition effectively, leading to improved health.

Frequently asked questions 

How long does it take to recover after lisfranc surgery?

Recovery may take 3–6 months or longer, depending on severity and adherence to rehab.

Can I return to sports after a lisfranc injury?

Yes, with proper healing and therapy. However, some patients may experience reduced performance or foot fatigue.

What if pain persists after surgery?

Persistent pain could indicate complications like arthritis, hardware issues, or instability. Imaging and clinical review are recommended.

Is a Lisfranc injury lifelong?

With early treatment and care, many patients recover well. Some may develop chronic issues requiring long-term management.

When is fusion preferred over fixation?

Fusion is usually chosen for severe injuries or when joint damage is irreparable. It provides pain relief by eliminating joint movement.

Summary

Lisfranc injuries affect the tarsometatarsal joint complex of the midfoot, often caused by trauma or sports injuries, leading to pain, swelling, and difficulty bearing weight. Surgical repair, mainly through ORIF or primary arthrodesis, aims to restore alignment and function. However, complications such as chronic pain and midfoot instability can arise due to post-traumatic arthritis, hardware irritation, residual instability, or inadequate rehabilitation. Instability may lead to long-term arthritis and mobility issues, sometimes requiring revision surgery or fusion. Diagnosis relies on clinical evaluation and imaging, while treatment includes conservative care, surgical revision, and structured rehabilitation. Patient education, counselling, and regular follow-up are essential for long-term recovery and quality of life.