Lisfranc Injury Is Not Always Career-Ending Now


PITTSBURGH, Pa. (Ivanhoe Newswire) — A Lisfranc injury or fracture is named after the French doctor who first described it in the 1800’s. These days, Lisfranc is more common among athletes who are up on their toes like soccer players, gymnasts, and dancers. Orthopedic specialists are working to keep athletes in the game.

Sixteen year old Lindsey Buczkowski is at home on the soccer field.  She’s played since she could walk and she’s had her share of bumps and bruises. But during a big game last October, Lindsey crashed into two of her opponents; one of them stepped on her lower leg.

“So my foot stayed in place but my big toe was going in the direction with the rest of my body, and it tore the ligaments in the middle of my foot.” Lindsey shared.

Diana Buczkowski, Lindsey’s mom, said “by the time we got over to the side our athletic trainer came over to us and said ‘I think it’s pretty bad.”

Lindsey’s foot swelled. Orthopedic specialists diagnosed a Lisfranc injury.

MaCalus Hogan, MD, an Orthopedic Specialist at the University of Pittsburgh Medical Center said, “Anyone who is doing a lot of high impact running and jumping, there is a risk there.” (Read full interview)

Doctor MaCalus Hogan inserted a metal plate and five screws to support Lindsey’s foot while the ligaments healed. In many cases, the hardware stays in the foot, ending an athlete’s career.

“It had been her life,” Diana told Ivanhoe.

In some cases, specialists are now opting to remove the plates and screws. Lindsey jumped at the chance to play again.

“She was young, athletic, very strong, the chances of her returning were higher,” Doctor Hogan said.

Five months after her injury, doctors removed the hardware. Lindsey swam, exercised and trained at least two hours a day for another five months to strengthen her damaged foot. In August, she was cleared to play with no restrictions.

“She’s doing great. I hear more about how well she’s doing than I even see her, so that’s a positive,” Doctor Hogan continued.

“It’s exciting though. I’m thrilled to be watching her again,” Diana shared.

Doctors say Lisfranc injuries are often misdiagnosed. Bruising on the bottom of the foot is usually one sign that this injury has occurred. Even with proper treatment or surgery, doctors say patients may be prone to arthritis in the foot as they age.

Contributors to this news report include: Cyndy McGrath, Field and Supervising Producer; Hayley Hudson, Assistant Producer; Kirk Manson, Videographer, Roque Correa; Editor.

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BACKGROUND: Lisfranc injuries or midfoot injuries occur when the bones in the midfoot are broken or the ligaments that support that area are torn. Severity of the injury site can vary from simple to extremely complex and may involve many joints and bones in the midfoot. Lisfranc injuries are often mistaken for simple sprains, especially when the injury results from a straightforward twist or fall. However, Lisfranc joint injuries are not just a simple sprain that can be walked off. It is a severe injury that may even require surgery to treat, and take many months to heal. The midfoot is critical for walking and in stabilizing the arch. While a person walks, the midfoot transfers the force generated by the calf muscle to the front of the foot. The midfoot joint complex is called the Lisfranc joint after French surgeon Jacques Lisfranc de St. Martin who served in the Napoleonic army in the 1800s.


DIAGNOSING: These kinds of injuries can occur from a simple twist and fall, and are classified as low-energy injuries. They can be commonly found in soccer and football players, and often seen when someone stumbles over the top of the foot as it is flexed downward. Symptoms to look out for that may indicate a Lisfranc injury include swelling and pain in the top of the foot, bruising on the top and bottom of the foot (bruising on the bottom is highly suggestive of a Lisfranc injury), or pain that worsens when walking, standing, or pushing off the affected foot. The pain may be so severe that crutches are required for the person to get around. After talking with a doctor about symptoms and concerns, they will examine the foot and ankle. Specific things they may look for include bruising along the bottom, tenderness to pressure, pain with a stress examination, pain with a “piano key” test or when the move the toes up and down to determine what causes pain, and single limb heel rises. Imaging tests may also be ordered to confirm the diagnosis, including X-rays, MRI scans, and CT scans.



TREATMENT: Treatment for a Lisfranc fracture will depend on the severity of a person’s injury. It may be treated with ice, rest and elevation of the injured foot. A doctor may recommend using crutches to help relieve pain that can occur with standing or walking. More severe injuries may require a person to wear a cast for up to six weeks, keeping the foot immobilized to give it a chance to heal correctly. X-rays may be taken to monitor progress and see if surgery is required. For the most severe Lisfranc injuries, surgery is required. Internal fixation is where the bones of the foot are repositioned and held in place with screws or plates in order to heal. Alternatively a person may undergo fusion treatment, which is less common than internal fixation. The cartilage around the joint is removed before the screws are added in this case; being the goal of the procedure is to fuse the bones to the midfoot to create a single bone.  If this occurs, the patient will likely not be able to bear weight on the foot for up to eight weeks after the surgery, and will require a cast. The pins and plates may be removed upon doctor recommendation about four to six months after surgery.




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Doctor Q and A

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