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  • Q&A with Australian Health Practitioners

    Is surgery necessary for a Lisfranc fracture?

    I have fractured the second metatarsal in my foot, however it is aligned with the rest of the bone. Nothing was identified in two x-rays that were taken- it only showed up in a CT scan. The doctor suggested surgery to make sure it heals properly. However, I am not sure I want the procedure. Will the injury heal by itself?
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  • Dr Simon Zilko

    Orthopaedic Surgeon

    Dr Simon Zilko - Foot & Ankle Orthopaedic Surgeon Dr Simon Zilko is a locally and internationally trained consultant orthopaedic surgeon who specialises in all … View Profile

    Lisfranc complex injuries are generally significant injuries, even when fractures or displacement appear to be very minimal on xrays or CT scan. Many times these injuries are mistaken for midfoot sprains, but in fact they are much more serious and often take many months to heal, with or without surgery.

    The xrays and CT scan you have had are unlikely to have been weight-bearing or stress images, so any dynamic instability (ie like when you walk) cannot be appreciated with these studies. Generally only stable Lisfranc injuries with incomplete tearing of the Lisfranc ligament and no displacement are suitable for non-operative treatment in a cast.

    Any injuries with frank diastasis (ie gapping at the medial cuneiform-2nd metatarsal junction) definitely need open reduction and internal fixation with screws/plate. In your case, with a demonstrated fracture involving the Lisfranc complex but no malalignment on XRs/CT, I would obtain stress radiographs, usually in an operating theatre under sedation. If the Lisfranc complex demonstrates instability, then it would need to be reduced and internally fixed.

    Late complications of an unstable Lisfranc complex include midfoot collapse and arthritis, and these are generally preventable with good early treatment involving stabilisation.

    These links both provide good info from the American Orthopaedic Foot and Ankle Society and the American Academy of Orthopaedic Surgeons.

    http://www.aofas.org/PRC/conditions/Pages/Conditions/Lisfranc-Injury.aspx

    http://orthoinfo.aaos.org/topic.cfm?topic=A00162

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