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Nov
15
2007

Lis Francs injury...what is it?

By Cpt. Morgan  |  Comments (19) | Hype It Up!  |   Filed Under: Cpt. Morgan Archive | Football | Misc.

When I was sitting watching the Colts play like piss this past weekend, I just kept thinking to myself, "This can't get any worse."  Well, I just have kept my "mind" shut, because as I saw the replay of Dwight Freeney's foot injury, my first thought was, "He's done for the year, that's a Lis Francs."  As the days passed, the reports slowly trickled in, and then finally, the bomb hit..."Dwight Freeney, out for the season...will undergo surgery for Lis Franc's injury."

Many of you are probably asking "what the hell is a Lis Franc's injury."  Luckily the Captain is here to answer all of your questions...


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lisfranccomplex.jpgThe Lis Franc's joint is considered the tarsometatarsal joint.  This is essentially the joint between the small midfoot bones (cuneiforms) and the long forefoot bones (metatarsals) in everyones' feet.  There is a Lis Franc's ligament that connects one of these small bones (the most "inside" of the highlighted portion, also known as the medial or first cuneiform.) with the second metatarsal, and typically this is what is injured in a Lis Franc's dislocation or injury. This ligament runs at an angle, when it is injured, the first metatarsal and some of the small midfoot bones can seperate from those metatarsals and tarsal bones normally next to them....This probably sounds like a bunch of medical jargon, and because of this, it is much easier to explain with x-rays and pictures...the one to the right is a normal foot with labels...It shows the "Lis Franc's joint", and how the alignment should normally be...

 

 

 

 

mech of injury.jpg

A common mechanism of injury in order for a Lis Franc's dislocation to occur is one in which the person is planted on the ball of their foot and a force is directed straight down the leg.  An easy way to visualize this is when someone presses on the break pedal in a car, the pedal is only on the ball of the foot and if there is a further force straight down the leg centered towards the heel, then a Lis Franc's injury or dislocation can result. 

 

I believe with Freeney, he had the ball of this foot on the ground and someone fell on the back of his leg.  The drawing to the left is a representation of the mechanism of injury of a Lis Franc's injury and what happens with the joints.  Notice the planting of the ball of the foot and the axial load straight down.

 

lisfranc.jpg

lisfranc.gifThe x-ray to the left is one that has had a Lis Franc's injury  Notice the large gap between the first and second metatarsals (the long bones).  These should fit snuggly right next to each other...this is only one of several types of injuries to the LIs Franc's joint, all varying in severity and levels of dislocation...There are a few ways to repair this, generally it involves several wires and/or screws.  An example of this is to the right, representing the Lis Franc's injury(not the same patient as the one on the left).  Surgical management's goal is to realign and fixate the joints...

 

Post-operatively, it really depends on the severity of the orginal inury, but I would say typically it involves a hard leg and foot cast with no weight bearing for at least 8 weeks...On top of this there is extensive rehab which would take several months...Dwight Freeney will not be seeing a football field for quite sometime, definitely don't expect to see him at the very least until next season...

I hope this helped clear things up with what exactly a Lis Franc's injury is...feel free to post questions and/or comments...

cptmorg@gmail.com

19 Comments
Jack Cobra said

Yeah....that's good stuff there

Bruce Paine said

that's some good bloggin right there.

gianluca said

this is better than web md. Can the captain go over herniated L5 S1 disks next?

I'll tell you what, if you send him an email asking for it, he probably will. He's not only a Captain, but he's also a Doctor (in real life, seriously).

gianluca said

thanks - I was just kidding. Far too many health care professionals have explained it to me already. I just need them to fix it.

Extra P. said

First, it always frightens me to find out that bloggers have life-or-death jobs in real life. How long before we see a photo of the Captain "shootering" over someone's sliced-open body?

Second, we'd all get on board with this surgery if someone would give it a catchy name like "Tommy John". Get Freeney's agent on the phone.

Cpt Morgan said

Excellent idea there Extra P...that will be my next mission...shootering over bloody patients....

grifter said

since this is french name, is it safe to assume that john clayton (and everyone else on TV) is butchering the name?
like, it's supposed to be pronounced "lee fron" or something?

Anonymous said

WOW, Captain...I'm impressed. You put the whole Lis Franc thing in terms the average person could understand and explained how it could have happened as well! Great job!

Off topic, but could you explain to distraught Eagles fans if Donavan McNabb will ever regain his form after his surgery to repair his knees?

Cpt Morgan said

Thanks Anonymous...thats kind of like, "Alias Maximus." Meaning...some guy named Maximus...either way, thank you. With your question about Donavon...it will be worked up...this could be possibly something I do weekly or bi-weekly...and gianluca if you truely want me to go over herniated disks, I will be more than happy to

Wow - i didn't even know the foot bones (metatarsals) were disconnected. I've seen tons of knee x-rays and diagrams but never one of the foot. Now I understand Wayne Rooney's injury too.

Grant said

I had a Lis Franc's type injury. The deer stand failed and I had to jump down 10 feet, which doesnt seem that far, but it was enough. Went to emergency room the night of the injury and the ER doc missed it. Walked on it for 5 weeks and then had to go to Orthopedist of course. 3 screws and 12 weeks on crutches later, the bones were back to almost being in line as they should. 5 years ago. Still bothers me. Very painful.

sr said

I have this fracture. It happened last Memorial Day
and had surgery to fix it with a cast for 2 months and then I tried to get some of the pins removed. I did get the pins removed except 2 which was deep in the bone and my foot looks the same. The swollen never went down and my big toe bone sticks out a little. I am trying to get a specialist for this injury so I can have a normal life. Walking hurts. One good thing is I have a handicap parking sticker.

andyayu said

I also had this Lisfranc dislocation on 10/01/09 , i fell from a height of 2 metres and landed on my right foot . i heard a snap sound and the swelling took juz a few minutes . i was in great pain so went to the emergency department , and all they say tat it is juz a torn ligament, they bandage my foot and i was send home. Eventhough i can see with my own eyes tat my foot look distorted and i walk with a limp, the doctors say tat it will subside. On the 11june the doctor sees me again and finally confirm i had it . 3 screws inserted and now had 2 bear the recovery pain. WHY THE DOCTORS TOOK SO LONG TO DIAGNOSE MY CONDITION, IMAGINE 6 MTH OF PAIN AND NOW PAIN 4 THE RECOVERY AFTER SURGERY .... I AM DAMN PISS WIT THE DOCTORS .....

spesch said

this is a great explanation of this injury i would love to show this t my doctor i would just like my foot to be fixed it has beebn almost two years

Debi Brumbaugh said

I would like you to explain in terms human's can understand more about the recovery of a lis franc fracture. I had a fall on 7/13/09 of a lis franc injury. I fractured the lis franc joint on both sides of metatarsal 2 and also fractured metatarsals 3 and 4. I had surgery with 8 pins and an external fixator which has been on for 3 1/2 weeks. I was told this would remain on with no weight bearing for 8 weeks. Does it require post surgery to remove the pins and external fixator? Is it common to place in boot or hard cast after fixator is removed?

Bruce Paine said

Debi, thanks for the interest, but the podiatrist that created this original post is not often involved with the site and spending most of his time on a busy practice. It is unlikely that you will get a response but I will pass your question along through the channels. I can say that I believe most external fixators can be removed outpatient in a doctor's office and do not necessarily require additional surgery for removal. I believe, though I am only an historian, that there is only passing discomfort in the process and that it is not necessary to put a patient under or even use a local. As far as post-removal immobilization is concerned, I would assume it would be based on a subsequent evaluation of the level of stress the joint can handle. If it heals well, probably not.

Like I said, this is advice is at best suspect and you should consult a physician. I will pass your request on through the ether but I would not count on Cap Morgan as he is rarely available for consultation in these desperate days.

Lynn Harris said

I just wanna know how u code it to get paid by the insurance company????

mom said

Could you please give me a "guestimate" or a prognosis for a healthy 20 year old male who required closed reduction surgery for a lisfranc injury? My son injured his foot, was told by the er doc he had a sprain, walked on it for a month with "medium" pain and then had surgery. He has two pins in his foot. He healed quickly, it has been three months post surgery. However, he is impatient and wonders if he will ever regain his speed and quickness. Is hope lost if he wishes to resume playing in any athletics? Thank you for reading and considering this.


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