Treatment Options

A continuum of injury occurs and varies from an isolated joint injury (typically the second tarsometatarsal joint) to more extensive joint complex injury. Treatment strategy varies from simple immobilization for simple ligamentous/capsular strains to complex reconstruction with internal fixation for extensive fracture/dislocations. The means to achieve the most suitable outcome remains controversial.

Faciszewski et al19 retrospectively studied the long-term outcomes of 15 "subtle" injuries of the Lisfranc joint. "Subtle" injuries were defined as those with a 2- to 5-mm diastasis between the first and second metatarsal bases. Athletes comprised one third of the series. Thirteen of 15 injuries were treated with cast immobilization; the remaining two underwent open reduction and internal fixation. Five of the 13 patients treated with immobilization eventually underwent arthrodesis due to pain and deformity.

After review of their series, Faciszewski et al emphasized the value of weight-bearing radiographs. Long-term outcomes were noted to be dependent on an arch height assessment determined by a weight-bearing lateral radiograph. Surgical repair was recommended when significant arch loss was present. Moreover, the measurement of metatarsal diastasis (if < 5 mm) documented by weight-bearing anteroposterior radiographs was thought to have little predictive value with regard to outcome.19

Treatment strategies continue to evolve. There is a growing consensus for anatomic, rigid fixation of any diastasis of the articular complex to permit ligamentous healing to occur20,21 (Fig. 70-9). Nonetheless, anatomic repair does not ensure normal midfoot function.20 Chronic pain and impairment of athletic performance are not uncommon sequelae following the more advanced injury subtypes. Furthermore, post-traumatic arthritis develops in approximately one fourth of patients.

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