The Lisfranc joint, or tarsometatarsal articulation of the foot, is named for Jacques Lisfranc (1790–1847), a field surgeon in Napoleon’s army. Lisfranc described an amputation performed through this joint because of gangrene that developed after an injury incurred when a soldier fell off a horse with his foot caught in the stirrup. The incidence of Lisfranc joint fracture–dislocations is one case per 55,000 persons each year. Thus, these injuries account for fewer than 1 percent of all fractures. Lisfranc sprains, dislocations, and/or fractures are often missed or misdiagnosed. It has been estimated that as many as 20 percent of Lisfranc joint injuries are missed on initial x-rays.
Lisfranc joint fracture–dislocations and sprains are seen in sports, but can also be caused by high-energy forces in motor vehicle crashes, industrial accidents and falls from high places. Occasionally, these injuries result from a less stressful mechanism, such as a twisting fall. Since Lisfranc joint fracture–dislocations and sprains carry a high risk of chronic disability, health care providers should maintain a high index of suspicion for these injuries in patients with foot injuries characterized by marked swelling, tarsometatarsal joint tenderness and the inability to bear weight.
Early diagnosis of a Lisfranc joint injury is imperative for proper management and the prevention of a poor functional outcome. Post-traumatic arthritis is the most common complication of Lisfranc joint injury. This complication is directly related to the degree of separation/dislocation of the involved tarsometatarsal joint(s). Knowledge of the degree of injury to these components will determine whether this injury should be treated nonoperatively or surgically. In either case, Lisfranc injuries are often slow to heal and require competent management for the best outcome