Practical management of Lisfranc injuries in athletes

Foot injuries are common in athletes. Injuries to the midfoot and, particularly, the Lisfranc joint are less common, but they have a high risk of ending the athlete's season or even career. Lisfranc injuries can be difficult to diagnose, and they often lead to a disastrous outcome when missed. Weight-bearing radiographs of the foot are recommended to confirm the diagnosis, although advanced imaging also may be required. Lisfranc injuries with less than 2 mm of diastasis on weight-bearing radiographs can be treated without weight bearing in a short leg cast or a walking boot for 6 weeks. Lisfranc injuries with more significant displacement or instability require operative intervention. Physicians who evaluate athletic injuries should be vigilant not to miss these injuries. Familiarity with the subtle clinical signs of a Lisfranc injury and knowledge of the basic treatment algorithm will help clinicians manage these injuries successfully.