There are several different types of midfoot fractures that can cause serious problems if not treated correctly. Lisfranc fractures are one of the most common types of these that we see and talus fractures are probably the next most common.
Lisfranc fractures occur at the tarsometatarsal joint and they typically occur when a severe stress is placed on the joint itself. They were classically described when a soldier riding on a horse would fall off the horse with the foot stuck in the stirrup. We probably sees most commonly now in motor vehicle accidents when the foot is forcibly placed on the brake pedal during a car accident.
Treatment for Lisfranc fractures has evolved over the years. Identifying the fracture is one of the most important steps, because if an x-ray is taken nonweightbearing these can be missed, and cause a delay in treatment. A weightbearing x-ray is important so that the diastases or gap between the medial cuneiform and the second metatarsal base is visualized. If there is significant comminution we typically get a CT scan to evaluate how severely the joints around the fracture are damaged. If the joint surfaces are relatively maintained, typically we realigned the foot with either screws, or bridge plating, or soft tissue anchor techniques. If the joints are fractured severely, we now sometimes recommend primarily performing arthrodesis or fusion of the joints to try to give the best long-term possible outcome.
Talus fractures also often occur with high impact events to the foot and ankle. They are typically more readily visualized radiographically and not missed as frequently, but unfortunately the blood flow to the talus can be cut off with some of these fracture types. We think the talus has a poor blood supply overall because much of the surface of the bone is covered with articular cartilage. Anatomic reduction with screws and/or plates is typically necessary for these fractures, but also close follow-up radiographs are important. In the postoperative phase, we are looking for changes in the density of the bone radiographically to give us an indication whether or not avascular necrosis or death of the bone is occurring secondary to lack of blood flow. Unfortunately if this occurs, it can have long-term effects leading to arthritis and needing further surgeries that are often complicated because of the lack of blood flow to the remaining bone.
If you suffer any foot and ankle trauma or other type of pain, call us immediately so we can help you. Our team at Foot and Ankle Institute of Colorado is here to help you with all your family's foot and ankle needs. Call us at 719-488-4664 today so we can help you!
