Are you experiencing sharp pain in the top of your leg? It could be a Lisfranc Injury!

Sometimes, even a seemingly small incident can turn into a big problem, right? Imagine that you were nervously walking down a flight of stairs and missed a step, or you suddenly tripped and twisted your ankle while playing cricket with your friends. If the top of your leg, that is, the part that goes from the bridge to the toes, is very painful, swollen, and maybe even blue, you may have a condition called a Lisfranc Injury. This is something to be careful about, because if not treated properly, it can cause problems later on. So let's talk about this in more detail, shall we?

What is a Lisfranc Injury?

Simply put, at the top of your foot, where the long bones that connect to your toes (we call these ``metatarsal bones'' ), the joint that connects those bones to the other small bones (tarsal bones) in the middle of your foot is called the Lisfranc joint . It's like a little bridge. Any damage to this joint – whether it's a fracture, a dislocation, or a tear or strain in the ligaments (strong bands that hold bones together) around the joint – is considered a Lisfranc Injury.

Imagine the Kandy road as a major junction on the way to Colombo. If that junction gets disrupted, the entire traffic will be disrupted, right? In the same way, this Lisfranc joint is very important for the proper functioning of our foot. If this little place is not working properly, you may not only have difficulty walking, running, jumping, but also just standing.

Are there different types of this disorder?

Yes, this Lisfranc joint can be divided into several types depending on how it is damaged. That is, this classification is based on which part of your joint was damaged and how the damage occurred.

• Lisfranc dislocation: This is when the bones in the joint shift from one place to another, much like two sets of railroad tracks shifting.
• Lisfranc fracture: This is a specific type of broken foot. One or more bones in the Lisfranc joint may break. Sometimes, they may break into smaller pieces.
• Lisfranc sprain / Ligament tear: This is when the ligaments around the joint are overstretched, or partially or completely torn. It's like a rubber band snapping when you pull it too hard.

Sometimes one or more of these types can occur together. For example, a fracture may be accompanied by a ligament tear.

What are the symptoms of this? How does it feel if it happens?

When you have a Lisfranc Injury, symptoms usually appear on the top of your foot, near where you tie your shoelaces. Check to see if you have any of these:

• Bruising and discoloration: The top of the leg may turn blue or purple. In particular, some people may also notice bruising on the sole of the foot . This is a characteristic of a Lisfranc Injury.
• Severe leg pain: The pain can be unbearable, especially when trying to stand, walk, or move your leg. Some people may feel a stabbing or burning sensation even when just standing.
• Swelling: The top of the leg, and sometimes the entire foot, can become very swollen, like a balloon being blown up.
• Difficulty putting weight on the foot: Standing or walking with your foot on the ground can feel very difficult. Some people may not be able to put their foot on the ground at all.

If you have one or more of these symptoms, don't just dismiss it as something simple, okay?

Why is this happening? What are the reasons for this?

Lisfranc injuries are often caused by accidents. Simply put, when the front part of the foot (toe side) is pressed against the ground, if the heel side suddenly twists or turns, this Lisfranc joint can be damaged.

• Falls and Slips: This can happen from things like falling down stairs, slipping on something like oil, falling into a pothole, etc. Sometimes, even if you trip a little while stepping off a curb, this can happen.
• Sports injuries: This joint can be injured when suddenly changing direction, jumping, or colliding with another person, especially in sports like football, rugby, and basketball. Some players are more likely to get their upper body twisted if their cleats get stuck in the ground.
• Direct trauma: Things like having a heavy object fall on the leg (e.g., a brick, a heavy box), getting the leg stuck in a car accident, or falling from a height (e.g., from a ladder) can also cause severe damage to this joint.

Imagine, Nilanthi Akka was walking down the stairs at home and twisted her leg after missing the last step. She thought it was a simple sprain. But even after two or three days, the pain and swelling did not subside. It was only when she showed it to the doctor that she learned that it was a Lisfranc Injury.

Who is more likely to develop it? What are the risk factors?

Anyone, at any age, can develop a Lisfranc injury. However, some people are at a slightly higher risk.

• People with conditions that damage or reduce sensation in the feet: People with diabetes (`(Diabetes Mellitus)`) are especially at risk. This is because diabetes can weaken the nerves in the feet (`(diabetes-related neuropathy)`). This can lead to a loss of sensation in the feet. Even a small injury may not be felt properly, so it can become larger and develop into a condition like this. Also, diabetes can cause a decrease in blood supply to the feet (`diabetes-related foot conditions`).
• People who do physically demanding work: People who work in the construction industry, those who lift weights, and those who stand all day are at risk.
• People who play competitive or contact sports: As mentioned earlier, this is commonly seen in football and rugby players.
• Some people are also said to be at slightly higher risk if they are born with a high-arched foot.

What will happen if this is not treated properly? Are the complications dangerous?

This is something we need to pay close attention to. A Lisfranc injury, if not treated properly and promptly, can lead to serious complications later on. Don't just assume, "It's just a sprain, it'll heal on its own."

Remember: A Lisfranc Injury, especially one with a fracture, can cause long-term pain and loss of function in the foot if not treated properly.

The main complications that can occur are:

• Arthritis: When the soft part of the affected joint called cartilage is damaged, over time, arthritis can develop. The joint becomes swollen, stiff, and painful.
• Chronic pain: Even though the condition is thought to be "cured," some people may continue to have pain. This pain can occur while walking or working.
• Collapsed arches and other foot deformities: The Lisfranc joint helps maintain the arch of the foot. When this joint is damaged, over time the arch of the foot can collapse and the foot can become flat. The shape of the foot can also change.
• Compartment Syndrome: This is a rare but serious condition. The pressure inside the tissues of the leg can increase, cutting off blood supply. This requires immediate treatment.

How does a doctor diagnose this? What tests do they do?

When you go to see a doctor with leg pain, the first thing he or she will ask you is how it happened, what you were doing when it started hurting, and how you feel now. It's very important that you tell him or her exactly what happened.

Then the doctor will examine your leg carefully.

• Check for swelling and bruising.
• They touch different parts of the foot, trying to pinpoint the exact location of the pain.
• The stability of the foot is checked. Sometimes the doctor will gently touch your foot to see if the bones are moving or if there is any abnormal movement.

After the physical examination, one or more imaging tests, such as these, may be done to confirm exactly what is wrong:

• X-ray of the foot: This is the first thing to look for. It can check for broken bones, dislocated joints, or changes in the spacing between bones. Sometimes, your doctor may ask you to stand with weight on your foot (a weight-bearing X-ray). Some Lisfranc injuries are not visible on an X-ray without weight on the foot.
• An MRI (Magnetic Resonance Imaging) scan: This can clearly see damage to ligaments, cartilage, and soft tissues. It can also detect small bone fractures that are not visible on an X-ray.
• A CT (Computed Tomography) scan: This helps to see the damage to the bones, and how the bones are broken (especially if they are broken into multiple pieces), in a more clear, three-dimensional (3D) view. This is often done before surgery.

How is it treated? What can be done?

There are several treatments for a Lisfranc injury. Your doctor will determine which treatment is right for you based on the severity of the injury, how far the bones have been displaced, and the damage to the ligaments.

• Ice and elevate the leg (RICE - Rest, Ice, Compression, Elevation): This is the first thing to do.
• Rest: Rest your leg. Minimize walking and standing as much as possible.
• Ice: Try to keep your leg elevated above your heart as much as possible. You can keep it elevated with pillows. Wrap an ice pack in a thin cloth and apply it to the injured area for about 15-20 minutes. Do this several times a day. Do not apply ice directly to the skin, as it can burn the skin.
• Compression: The doctor may recommend applying an elastic bandage to control swelling.
• Elevation: Keep your legs elevated above the level of your heart with pillows. This will help reduce swelling.

• Immobilization of the leg:
• If the injury is not too serious, meaning the bone is not too far out of place, your doctor may put a boot or cast on your leg. This will last for about 6 to 8 weeks. It is not a good idea to put any weight on your leg during this time. You will need to use crutches to walk. This will help reduce the weight on your leg, keep the joint in place, and stop you from putting too much weight on your leg.

• Lisfranc surgery:
• Many Lisfranc injuries, especially if the bones are displaced or the joint is unstable, require surgery. The surgeon will repair your Lisfranc joint, move the bones back into place, and insert devices such as plates and screws into your foot to hold them in place.
• After surgery, you will need to be non-weight-bearing for about a month or two. After that, you may need to wear a boot or cast for a few months.
• Once the joint has healed well, usually after 4-6 months, the doctor may perform another minor surgery to remove the pins and hardware that were inserted. Not everyone has these removed, it is up to the doctor to decide.

• Painkillers: Your doctor may prescribe painkillers to help reduce pain and swelling. You can use over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, diclofenac) or acetaminophen (e.g., acetaminophen). However, check with your doctor before taking these for more than 10 days. Your doctor may also prescribe a stronger painkiller. Your doctor will tell you how often to take them and how often to take them.

How long does it take to recover?

It can take several months, or even a year, for a Lisfranc injury to fully heal and for you to be able to return to normal activities and sports. This really varies from person to person. It depends on many factors, including what type of injury you have, how severe it is, whether you had surgery, your age, and your general health.

The most important thing is that everyone's body heals at a different rate. So talk to your doctor about your treatment schedule and recovery process. Rest, take your medications, and exercise as your doctor tells you to.

• Nonsurgical treatments: The leg will usually be immobilized (in a boot/cast) for about 6 to 8 weeks. After that, you will need to do some physical therapy (PT) . A physical therapist will help you gradually regain range of motion, strength, and balance in your leg joints.
• Lisfranc surgery: You will need to wear a boot or cast for about 3 to 4 months after surgery. Your surgeon will tell you when you can start putting weight on your leg and when you can start physical therapy (PT). PT is a very important part of this.

Can you walk with a Lisfranc Injury?

You may be able to walk a little while you have a Lisfranc injury, especially if the injury is not too severe. However, if you have pain or other symptoms, do not force yourself to use your leg. If you continue to use your leg, even a minor injury can become more serious and require surgery. It is important to be patient until it heals properly.

While wearing a boot or cast, you may be able to walk as your doctor tells you to (possibly with crutches). However, strenuous physical activities such as running, jumping, and lifting weights should be avoided. Ask your doctor or physical therapist what activities you should avoid and what you can do until you are well.

When should I see a doctor?

If you have symptoms of a Lisfranc injury (such as the aforementioned pain and swelling) and they don't improve after a few days of rest and ice, you should definitely see a doctor as soon as possible. Especially if:

• If you can't stand with your legs heavy.
• If you can't walk properly.
• If the shape of the foot seems to have changed.
• If there is a bruise on the sole of the foot.

If symptoms recur or worsen after immobilization or surgery, if you develop a fever, or if there is pus coming from the wound, tell your doctor immediately.

The most important message to take home!

Think about it, maybe you just rolled your leg down a flight of stairs, or maybe you got injured in a major accident like a car accident. Whatever the cause, if you have unusual pain, swelling, or bruising in your leg, it's best to see a doctor as soon as possible rather than dismissing it as "just a sprain."

A Lisfranc Injury, especially one with a Lisfranc fracture, can lead to serious problems (such as chronic pain and arthritis) that can affect your life later if not treated promptly.

So, if you have a problem with your feet, take care of it. Seeking medical advice right away will help you recover quickly and prevent future complications. Your feet are very important to you, so take care of them!

` Lisfranc Injury, foot pain, leg disorders, joint dislocation, bone fracture, foot swelling