My mother's sister (my auntie) came for a visit last week. She told us she had a special kind of foot fracture called a List Frank. What is that? She had a special boot on but kept up with everything we did so it must not be too bad whatever it is.
You are probably referring to a Lisfranc fracture or injury of the midfoot. Most people have a general idea of what is meant by the midfoot -- that area between the base of the toes and the ankle/heel complex.
The proper anatomical term is the tarsometatarsal (TMT) joint. Metatarsals are the long bones of the forefoot. These are the bones of each toe between the ankle (tarsal bones) and the bones we usually refer to as the toes.
Lisfranc injuries describe any injury that occurs at the tarsometatarsal joints. This could be at the base of any of the five metatarsals (toes) or the place where the metatarsals glide against the tarsals (ankle bones). There is also an actual Lisfranc ligament at the base of the second toe. Damage to this ligament can also be called a Lisfranc injury.
Where does the term Lisfranc come from? The French surgeon (Dr. Jacques Lisfranc) who served in Napoleon's army back in the 1800s. He treated a soldier with this type of injury, named it after himself, and the rest is history.
The bones, ligaments, and connective tissue that form the entire Lisfranc area are important in keeping a strong, stable midfoot with a supportive arch. Injuries to this area can cause collapse of the arch, deformity, pain, and loss of foot function. That's why an early and accurate diagnosis is important followed by proper treatment.
For true Lisfranc fractures and/or Lisfranc soft tissue injuries, treatment is aimed at restoring alignment and stability. For simple fractures that do not separate or displace and for which there are no soft tissue injuries, a simple cast may be all that's needed for healing and recovery.
But when the foot is deformed, the patient can't walk on it, and it isn't painful -- it's numb, then surgery may be needed to stabilize the joint.. Instability is the big key in deciding the best treatment because as already mentioned, stable fractures and injuries can still be treated nonsurgically with a cast or walking boot.
When the damage is healed and immobilization is no longer needed, your aunt will be guided in finding the right kind of supportive shoe. A special shoe insert called an orthotic is made and worn whenever weight-bearing. Total recovery time of a stable Lisfranc injury treated conservatively is about four months.
Troy S. Watson, MD, et al. Treatment of Lisfranc Joint Injury: Current Concepts. In Journal of the American Association of Orthopaedic Surgeons. December 2010. Vol. 18. No. 12. Pp. 718-728.
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