Why a different perspective?
Lisfranc injuries are highly complex. They are often misinterpreted, misdiagnosed, or underdiagnosed. A multitude of (sub)luxated bones and joints can be involved in a Lisfranc injury, making it challenging to pinpoint the exact nature of the damage. Are all luxations accounted for? Is a comprehensive diagnosis possible?
A complete diagnosis is critical for an effective treatment plan!
A different perspective can help to “piece everything together”.
What is the difference in the perspective presented on this website?
1. First change of perspective:
When an issue can be viewed from two sides, the question arises: which direction should we choose as our perspective? It might be beneficial to examine it from both angles. How can we determine the direction in which the bones moved or shifted? What are the reference points we use, and are these points stable and unambiguous?
The Lisfranc joint line refers to the Tarsometatarsal joint line, which is the series of joints between the metatarsals and tarsal bones. A joint is formed where two bones meet.
Do not be misled by optical illusions or biased assumptions.
In the literature and videos discussing Lisfranc injuries, it is commonly taught that these injuries involve the luxation, subluxation, or displacement of the metatarsals. But are these displacements the primary consequence of the injury? Or are these shifts, in certain instances, caused by other displacements occurring in the tarsal area?
How can we identify where the displacement(s) originated?
What mechanism affected the foot?
Could it be possible to uncover a new, previously undescribed mechanism?
2. A technical perspective:
The foot is an incredibly complex and ingenious mechanism. Its arches allow the foot to adapt to uneven surfaces, bear weight, jump, climb, and dance. We should marvel at the architecture of the foot, given its remarkable biomechanical design.
Technicians are trained to analyze cross-sections. Radiographic images from different dimensions hold the same significance for engineers. These cross-sections allow the observer to compare various parts of the structure in relation to one another.
More about the technical view is available on this page.
See the injured foot in the image below.
3. A Shift in Treatment Perspectives
Lisfranc injuries can be managed either through ORIF (Open Reduction Internal Fixation) or Primary Arthrodesis. However, these injuries are commonly overlooked when patients first present to the Emergency Room, especially in cases involving purely ligamentous damage. As a result, many injuries remain untreated or are addressed too late. By the time luxations become apparent, surgical intervention may no longer be viable.
In the case study featured on this website, the Lisfranc injury went completely untreated. The patient was discharged with no medical care beyond a simple pressure bandage. In such serious cases, conservative treatment (if deemed possible at all) raises the question: Could non-invasive methods be a viable option?
A valuable mechanical tool designed to reposition bones will be introduced on this website.
4. A patients perspective:
Understanding the patient’s perspective offers invaluable insights—what could be described as “information from within the foot.” The patient can identify the pain’s location, indicating areas of potential structural damage or bone displacement.
It’s crucial to listen attentively to the patient’s account. While this may seem self-evident, it is unfortunately not always routine practice.
For some patients, untreated Lisfranc injuries result in life-altering, disabling consequences. Capturing their narrative and correlating it with clinical findings is an essential step toward improving care.
5. Advancements in Diagnostic Tools
Recent breakthroughs in diagnostic imaging have significantly enhanced the ability to detect Lisfranc injuries. High-resolution CT scans and MRI imaging are now essential in cases suspected of ligamentous damage. These technologies provide detailed visualizations, capturing both bone displacement and soft tissue integrity.
The accuracy of these imaging techniques can reduce the prevalence of misdiagnosed or untreated injuries. Early implementation of advanced diagnostics allows healthcare professionals to determine the most appropriate intervention—whether surgical or conservative—thereby improving patient outcomes.
By utilizing these tools and approaches in tandem with the patient’s perspective, medical practitioners can better address the complexities of Lisfranc injuries. This website aims to highlight such advancements, supported by case studies and visual aids.