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Lisfranc (Midfoot) Injury?

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Lisfranc (Midfoot) Injury?

Postby ThuChad » Sat Sep 29, 2012 9:19 am

I was climbing and trail running yesterday here in Oklahoma. I was half way through my run doing a speed descent when I landed on a small rock on the ball of my left foot. My heel went down, my midfoot cupped the rock and my toes also went down around rock but my foot was still pointed in an upward direction. So basically grab a softball, stick your heel on the ground, softball under your midfoot with toes wrapped around it and that's what happened. As my momentum carried through my foot popped and I had instant pain in the midfoot area. I was two miles away from my truck so I popped 4 advil, an emergency pain pill and hobbled out.

It's starting to bruise on the side around to the top. I can semi-walk on it today but it hurts pretty bad. I've been searching the net and found the Lisfranc Injury which closely describes what I'm experiencing. Anyone ever had this? I don't think it's major but definitely a torn ligament or slight fracture. I have a trail race next weekend and it's not looking very good right now. Someone tell me this will go away and I'll be good to run next Saturday. :?
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Re: Lisfranc (Midfoot) Injury?

Postby Vinegaroon » Sat Sep 29, 2012 9:50 am

Ice, NSAIDs, X-Ray on Monday... Bummer. :(
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Re: Lisfranc (Midfoot) Injury?

Postby Canadian_bass » Sat Sep 29, 2012 11:06 am

I'll echo Vinegaroon's comments. I'll give you what I think, but you definitely need to see your MD, an orthopedist specializing in foot-ankle injuries, a physical therapist specializing in foot-ankle injuries or a podiatrist. If symptoms do not substantially improve by Monday an X-ray is probably a good idea. The concern is the ligament stability in that region. Usually Lisfranc injuries/fractures require more force than your describing (think large man stepping on your foot and you twisting away from him while your foot remains motionless). The following information is for your knowledge only and you should consult a physician or physical therapist experienced with foot and ankle injuries.

Regardless of whether the area/ligaments are sprained or torn, the first stage of rehab will be reduce swelling and bruising. Ice, NSAIDs, elevation and compression (wrapping) of the area is appropriate as is reducing weight bearing. As far as the trail race, if there is ligamentous instability from a sprain or tear, or a bone fracture running is probably not the best idea. That joint is a surface accommodating joint; as you dorsiflex (toes toward shin) that joint rotates into inversion (ankle sprain direction); as you plantarflex (pointing your toes toward floor) that joint everts (same direction as overall pronation).

This means if the joint is unstable due to fracture, tear, or sprain the surface ("the floor") needs to be built up in the shoe. This shoe modification would need to not only block pronation but also supination (again think ankle sprain direction) during your running cycle. I would caution you again just using a pronation control shoe or insert orthotic as the long bones of the midfoot (metatarsals) tend to slide away into supination in lisfranc fractures, so you would be giving yourself a false sense of security. If your medical team indicates that you could run a custom temporary orthotic blocking inversion and eversion at the midfoot may provide enough stability to give you a chance to race through the pain. Ideally, this custom orthotic would maintain free rearfoot (heel) inversion/eversion to try to maintain a more normal running cycle.

The best course of action is to rest and rehab it if it sprain, torn, or fractured. Do consult with a medical professional before undertaking any self-care outside of a RICE protocol. Best of luck!

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Re: Lisfranc (Midfoot) Injury?

Postby 14erFred » Sat Sep 29, 2012 5:49 pm

Superb and invaluable medical advice from Canadian_bass. Well done!

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Re: Lisfranc (Midfoot) Injury?

Postby TallGrass » Mon Oct 01, 2012 2:03 am

Keep in mind that some injuries can get worse if not diagnosed and treated. E.g. a non-displaced fracture (cracked through but still in alignment) can be BETTER than a sprain because it will heal 100% in 6-8 weeks with no long term issue unlike soft tissue ones. BUT, if you think it's just a bruise and put enough weight on it to displace it (separate the bone halves), now you could be talking surgery.

As such, I'd second R.I.C.E., keeping all weight off the injured part, and getting to a MD on Monday.
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Re: Lisfranc (Midfoot) Injury?

Postby ThuChad » Mon Oct 01, 2012 7:48 am

Thanks for all the replies. It feels and looks much better today after ice and nsaids. I'm thinking it was just a sprain. I can put 100% of my body weight on it with not much pain. I think I'll wait another day before I decide to go to the doc or not. I'm going to have my Dad, he's a dentist :-D , Xray it today just to make sure nothing is fractured and go from there. I'm pretty sure if I go to the doc he'll tell me not to run regardless... it's hard to give up on a race a week before after months of training.

Thanks again.
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Re: Lisfranc (Midfoot) Injury?

Postby 14erFred » Mon Oct 01, 2012 1:14 pm

Fingers crossed for a favorable outcome.

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