Over the past weekend my marketing director texted me and told me she injured her left foot on her last day in Cabo. It sounded like it could be a sprain or fracture so I told her to ice it and I would examine and X-ray it when she returned to work the next day.
When I examined her foot there was significant swelling. Her pain was localized at her 3rd and 4th metatarsal bones at the point where it joins the midfoot. We call these the Lisfranc joints.
Although frequently found in athletes, a Lisfranc injury can also occur with a simple twist and fall as was the case with my marketing director. She fell off of a step as she was leaving to return home to Seattle.
The biggest concern in a case like this is tearing of the tissues or ligaments that join the bones which can produce instability. The X-ray would reveal whether she had partial to total dislocation of one or more joints and/or a fracture.
Upon X-ray there was normal alignment at the midfoot with no dislocation or fracture. To determine the level of damage to the tissues or ligaments we would need to do an MRI. In her case since the swelling was already going down, the tissues will likely heal with proper treatment. A worse case would likely require surgery.
The treatment is the same as if it had shown a small fracture without displacement. My recommendation in this situation is to:
immobilize the foot in order to let it heal
use a mid-calf boot
add crutches if the pain isn't reduced
re-examine after 2-3- weeks
refer for physical therapy if needed, or return to normal shoes if not
If you think you've sprained or broken your foot it could be a Lisfranc injury. Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.
Follow Dr. Berg on Facebook.