Lisfranc-Injuries are very complex injuries. Lisfranc-injuries are often misinterpreted, misdiagnosed or underdiagnosed.
A lot of (sub)luxated bones and joints can be involved in a Lisfranc injury. This makes it difficult to diagnose the precise injury. Are all luxations in the picture? Can a complete diagnosis be formulated?
And a complete diagnosis is essential for a proper treatmentplan!
A different perspective can be helpful to be able to ‘get all the pieces together’.
What is the difference in the perspective presented on this website?
1. First change of perspective:
When something can be viewed from two sides, the question is which direction we choose as our perspective. It might be useful to examine from both sides. How is determined in which direction the bones moved and dispositioned? Which points do we choose as a reference? And are those clear and unchanging reference points?
The Lisfranc- jointline is the Tarsometatarsal-jointline. This TMT-jointline is the serie of joints between the metatarsals and tarsal bones. A joint is formed where two bones meet.
Do not get fooled by a optical illusion or a biased assumption.
In the literature and in video’s about Lisfranc- injuries it is taught the Lisfranc-injury has to do with metatarsals being luxated, subluxated or displaced.
But are these displacements the primary effect of the injury?
Or are, in some cases, these displacements caused by other displacements in the tarsal area?
How can be determined where the displacement(s) started?
Which mechanism worked on the foot?
Would is be possible to recognize a new, not yet described mechanism?
2. A technical perspective:
The foot is a very complex and genius mechanism. The entire foot consists of arches which enable the foot to adjust to (uneven) surfaces, to carry weight, to jump, climb and dance. We should all be amazed about the architecture of the foot, because it is such a profound bio-mechanical construct.
Technicians are trained to work with cross-sections. Radiographic image from different dimensions is what cross-sections are for an engineer. It enables the observer of the image to compare the different parts of the structure in relationship to each other.
More about the technical view on this page.
See the injured foot in the image below.
3. A change of perspective in treatment.
Lisfranc-injuries can be treated with ORIF (Open Reduction Internal Fixation) or with a Primary Artrodesis.
However, Lisfranc-injuries are often overlooked when they are initially presented at the Emergy Room. Particularly when it is a purely ligamentious injury. Therefore a lot of these injuries are not treated on time or not treated at all. By the time the injury is noticed and luxations are present, it might be too late for an operation.
In the case-study presented on this website the injury was totally untreated. The patient was sent home with no medical care other than a piece of pressure bandage.
With a conservative treatment, (if possible at all with such a serious injury), healthcare practitioners should
consider if non-invase treatment could be an option? A useful tool will be introduced on this website.
4. A patients perspective:
The patients perspective contains ‘inside information’ which here means: information from within the foot. There is a lot to gain from the patients perspective. The foot itself tells where it hurts. The pain shows where the foot might have been damaged and the bones got displaced.
So, please, listen to the patients story! This should be obvious, but unfortunately it isn’t always.
For some patients these untreated injuries have lifelong, disabeling consequences.
