Causes and risk factors
Fracture of Lisfranc can be caused either by low energy injury or high energy injury. Like many other fractures, road accidents are the main cause of Lisfranc fractures. Low energy fractures are caused due to simple injuries like twisting of ankle or simple missing a step while climbing up or down from the staircase. Stumbling down with a foot flexed can also lead to Lisfranc fracture. These fractures are more commonly seen in individuals involved in sports like soccer, horse riding, or football. High energy injury can occur due to direct fall from height. It can lead to multiple fractures of the bones or can also lead to dislocations.
Clinical presentation:
The patient can either present with simple complaints of sprain or it can be a dislocation or breakage of single or multiple bones. Unlike any other fracture, pain is the predominant feature which is aggravated by movement, hence restricted movement is seen. Swelling at the foot, particularly at the top of the foot is seen. Walking and standing aggravates the pain. Deformity of the foot is seen. It becomes abnormally wide. The patient is unable to bear weight. On examination, tenderness is present. Bluish red discoloration can be seen at the bottom of the foot.
Investigations:
This type of fracture is often misdiagnosed. They are often considered as ankle sprains. Diagnosis is done on the basis of the symptoms narrated by the patient and the physical examination carried out by the orthopedic doctor. Investigations which are done are x-ray of the affected foot. Routine x-rays or specialized digital x-rays can be advised; however, in most of the cases the x-ray can be negative. In such cases, CT scan of the bone is effective.
Treatment:
Rest and elevation of the affected area is the first step to be implemented. Analgesic, or nonsteroidal anti-inflammatory drugs are advised by the orthopedic doctor. Until symptoms are resolved, or for approximately a period of 4-6 weeks, a cast is applied to the foot. Immobilization for that period is advised. In cases of dislocations immediate surgical repair within 12-24 hours is needed. Some surgeons prefer closed reduction with K-wires. Open reduction and internal fixation is done. Physiotherapy exercises are advised as recovery begins.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up with the symptoms. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints. Certain yoga exercises can also be helpful in strengthening the muscles.
