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High- and Low-Energy Lisfranc Injuries: A Prospective Study of Functional Outcomes and an Algorithm Based on Trauma
Daniel F Kafury1, Jorge Hernandez2, Carlos E Ramirez3
1School of Medicine, Universidad Icesi, Cali, COL.
Cureus
|February 3, 2026
Summary
A new treatment algorithm for Lisfranc injuries, based on trauma energy and timing, shows promising functional outcomes. This structured approach improves pain scores and return-to-work rates for patients with high- and low-energy Lisfranc injuries.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Foot and Ankle Surgery
Background:
- Lisfranc joint injuries present diagnostic and therapeutic challenges.
- Variable presentations and potential for long-term impairment necessitate standardized management.
Purpose of the Study:
- To evaluate functional outcomes in high- and low-energy Lisfranc fracture-dislocations.
- To assess a standardized treatment algorithm based on trauma kinetics and chronicity.
Main Methods:
- Prospective descriptive case series of 32 adult patients.
- Classification using Myerson (high-energy) and Nunley-Vertullo (low-energy) systems.
- Treatment guided by a clinical decision-making algorithm; minimum 12-month follow-up.
Main Results:
- High-energy injuries (n=21) treated surgically; low-energy (n=11) mostly conservatively.
- Significant VAS score reduction and good AOFAS Midfoot Scores (78 and 81) at 6 months.
- High return-to-work rates (100% high-energy, 73% low-energy); 9% required footwear adaptation.
Conclusions:
- A treatment algorithm based on injury kinetics and chronicity provides a structured approach to Lisfranc injuries.
- Favorable functional outcomes support the clinical utility of this algorithm.
- This approach is particularly valuable in high-volume trauma settings.
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