Background: Lisfranc complex consists of bony and ligamentous elements which contribute to provide structural support to the transverse arch. Lisfranc injuries often result from direct or indirect and high or low velocity impacts. In a nondiabetic patient, high velocity indirect impacts cause axial loading or rotation on a plantar-flexed foot. Historically these types of injury are extremely rare, with a reported incidence of one per 55,000 cases annually and contribute to approximately 0.2% of all fractures. Diagnosis relies on radiographic imaging that demonstrates diastasis of the first and second metatarsal with avulsion. Treatment depends on the severity of the condition, however most reliable for this particular case was the use of K-wires and open-reduction and internal-fixation.
Case presentation: A 20-year-old African American woman presented to the community hospital with left foot pain, described as severe and throbbing, hours after going on a waterslide at an amusement park. Her left food showed decreased range of motion and weak pulses compared to the right foot. There was tenderness to palpation without signs of infection or inflammation. Radiographic CT imaging showed an oblique and communited fracture of the respective first and second metatarsal joints. An operative repair was subsequently scheduled for a placement of two screws and two K-wires to stabilize the joints. Post-operatively, no complications were observed, and the patient was advised to follow up in the clinic and schedule physical therapy to regain normal activities.
Conclusion: A high-index suspicion for tarso-metatarsal injuries is recommended for patients with signs of edema, forefoot tenderness and plantar ecchymosis. Standard radiographs, which include CT, X-ray, and MRI, should be obtained to include three views of the foot. However, there is a lack of consensus in the literature regarding surgical treatment, complications, functional outcomes of Lisfranc injuries. More studies are needed to clarify a definitive treatment for patients with ligamentous injuries.
Nickul N Shah and James DeMeo