Lisfranc Injuries

The Lisfranc Joint
The Lisfranc joint is the point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. This is important for maintaining proper alignment and strength of the joint.

How Do Lisfranc Injuries Occur?
Injuries to the Lisfranc joint most commonly occur in automobile accident victims, military personnel, runners, horseback riders, football players and participants of other contact sports, or something as simple as missing a step on a staircase.

Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot.

Types of Lisfranc Injuries
There are three types of Lisfranc injuries, which sometimes occur together:

·     Sprains. The Lisfranc ligament and other ligaments on the bottom of the midfoot are stronger than those on the top of the midfoot. Therefore, when they are weakened through a sprain (a stretching of the ligament), patients experience instability of the joint in the middle of the foot.

·     Fractures. A break in a bone in the Lisfranc joint can be either an avulsion fracture (a small piece of bone is pulled off) or a break through the bone or bones of the midfoot.

·     Dislocations. The bones of the Lisfranc joint may be forced from their normal positions.

Symptoms
The symptoms of a Lisfranc injury may include:

·     Swelling of the foot

·     Pain throughout the midfoot when standing or when pressure is applied

·     Inability to bear weight (in severe injuries)

·     Bruising or blistering on the arch are important signs of a Lisfranc injury. Bruising may also occur on the top of the foot.

·     Abnormal widening of the foot.

Diagnosis
Lisfranc injuries are sometimes mistaken for ankle sprains, making the diagnostic process very important. To arrive at a diagnosis, the Doctors at Hosey Foot and Ankle Center will ask questions about how the injury occurred and will examine the foot to determine the severity of the injury.

X-rays and other imaging studies may be necessary to fully evaluate the extent of the injury. The surgeon may also perform an additional examination while the patient is under anesthesia to further evaluate a fracture or weakening of the joint and surrounding bones.

Non-surgical Treatment
Anyone who has symptoms of a Lisfranc injury should see a foot and ankle surgeon right away. If unable to do so immediately, it is important to stay off the injured foot, keep it elevated (at or slightly above hip level), and apply a bag of ice wrapped in a thin towel to the area every 20 minutes of each waking hour. These steps will help keep the swelling and pain under control. Treatment by the Doctors at Hosey Foot and Ankle Center may include one or more of the following, depending on the type and severity of the Lisfranc injury:

·     Immobilization. Sometimes the foot is placed in a cast to keep it immobile, and crutches are used to avoid putting weight on the injured foot.

·     Oral medications. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

·     Ice and elevation. Swelling is reduced by icing the affected area and keeping the foot elevated, as described above.

·     Physical therapy. After the swelling and pain have subsided, physical therapy may be prescribed.

When is Surgery Needed?
Certain types of Lisfranc injuries require surgery. Our Doctors will determine the type of procedure that is best suited to the individual patient. Some injuries of this type may require emergency surgery.

 

Black Toenails

A black, purple, or brownish discoloration under or involving a toenail is frequently due to trauma to the toe nail, such as when something is dropped on the toe. The color results from a blood clot or bleeding under the nail, and may involve the entire nail or just a small portion of it. This can be very painful when the entire nail is involved, and may need medical attention to relieve the pressure caused by bleeding under the toenail.

Although it is very rare, a more serious cause of black toenails is malignant melanoma. Since early diagnosis and treatment of melanoma improves the chances for a good outcome, it is important that all black toenails be evaluated by our doctors to rule out this cause.

Other rare causes of black toenails include fungal infections, chronic ingrown nails, or health problems affecting the rest of the body.

Nail Fungus

A fungus is an organism that lives in warm moist areas. Fungus of the toenails is a common problem that can affect people of all ages, although it most commonly affects individuals who are older. 

Toenail fungus often begins as an infection in the skin called tinea pedis (also known as athlete’s foot). The fungus often starts under the nail fold at the end of the nail. Over time it grows underneath the nail and causes changes to its appearance, such as a yellow or brownish discoloration. It can also cause thickening and deformity of the toenail. 

Many people have difficulty with their toenails and need assistance in caring for them. Hosey Foot and Ankle Centers can diagnose the cause of toenail problems and recommend treatments.

Running Injuries

Whether an athlete is a recreational, competitive, or elite runner, foot and ankle health is essential for optimal performance.  Runners are susceptible to overuse injuries including heel pain (plantar fasciitis), Achilles tendonitis, sesamoiditis, neuromas, MPJ capsulitis, stress fractures, posterior tibial tendonitis (or PTTD), and calcaneal apophysitis in children/adolescents.  Evaluation by the podiatrists at Hosey Foot and Ankle Centers will help the athlete determine the underlying cause of pain and the best course of treatment. Custom orthotic devices are often used for treatment of these conditions.