Ī thorough investigation of the mechanism of trauma and a clinical examination of the foot are essential. The two main mechanisms of injury are direct forces (crush injuries, fall from and height) and indirect forces (bending and torsion of the tarsus). High-energy injuries are more common than low-energy injuries which in most cases involve sports activities, usually occurring during football, gymnastic and running. Lisfranc joint injuries are more frequent in the third decade of life and men are 2 to 4 times more likely than women to incur these injuries, possibly because they participate more frequently in high-speed activities. Lisfranc injuries appear rare and account for 0.2% of all fractures, with approximately 20% of cases remaining undiagnosed or diagnosed late. The name is attributed to a French surgeon of the Napoleonic era, which in 1825 was the first to describe injuries and amputations at this level of the foot.

The term “Lisfranc injuries” refers to a range of midfoot and tarsometatarsal (TMT) joint lesion that can vary from a simple single joint injury to a complex lesion that disrupts multiple different joints with multiple fractures, depending on the severity of the trauma. However, the severity of the injury and a quick diagnosis are the main determinant of the biomechanical and functional long-term outcomes. There is no superiority of one technique over the other, but what determines the post-operative outcomes is rather the anatomical reduction. Different surgical procedures have been proposed from closed reduction and percutaneous surgery with K-wire or external fixation (EF), to open reduction and internal fixation (ORIF) with transarticular screw (TAS), to primary arthrodesis (PA) with dorsal plate (DP), up to a combination of these last 2 techniques. Displaced injuries have worse outcomes and require surgical treatment with the two main objectives of anatomical reduction and stability of the first three cuneiform-metatarsal joints. In stable lesions and in those without dislocation, conservative treatment with immobilization and no weight-bearing is indicated for a period of 6 weeks. The major current controversies in literature concern the management and treatment. MRI is the gold standard for ligament injuries. CT scan is useful to detect nondisplaced fractures and minimal bone sub-dislocation. First level of examination is X-Ray performed in 3 projections. Plantar region ecchymosis is highly peculiar.

Clinically presenting with evident swelling of the midfoot and pain, often associated with joint instability of the midfoot. Therefore serious complications such as post-traumatic osteoarthritis and foot deformities are not uncommon. Up to 20% of Lisfranc fractures are unnoticed or diagnosed late, above all low-energy trauma, mistaken for simple midfoot sprains. A quick and careful diagnosis is crucial to optimize management and treatment, reducing complications and improving functional outcomes in the middle and long-term. Depending on the severity of the trauma can range from purely ligamentous injuries, in low-energy trauma, to bone fracture-dislocations in high-energy trauma. Lisfranc complex injuries are a spectrum of midfoot and tarsometatarsal (TMT) joint trauma, more frequent in men and in the third decade of life.

Lisfranc ligament tear