Lisfranc Fracture (Metatarsal Shaft Fracture)

Lisfranc joint is a six-bone tarsometatarsal complex made up of the proximal most medial (1-3) metatarsals and their adjoining tarsal bones.




  Initial Treatment
Splint type & position Nondisplaced: lower extremity splint with ankle at 90 degrees
Displaced after reduction: bivalved well-molded SLNWBC
Initial follow-up visit 3 to 5 days
If a cast is applied initially, cast check in 24 hours
Pt instructions Elevation and icing crucial in first 2 to 3 days
No weight bearing until follow-up
Explain signs of compartment syndrome
  Follow-up Care
Cast or Splint type & position Nondisplaced: firm-soled shoe, cast boot or SLWC if the patient is in severe pain
Reduced: SLNWBC
Length of immobilization Nondisplaced: SLWC or boot for 3 to 4 weeks if used; firm-soled shoe for 4 to 6 weeks
Reduced: SLNWBC for 3 to 4 weeks, followed by SLWC for 3 to 4 weeks
Healing time Nondisplaced: 6 weeks
Reduced: 6 to 8 weeks
Follow-up visit interval Every 1 to 2 weeks initially to assess the need for a cast change as it loosens
Every 2 to 4 weeks after cast is removed or if a firm-soled shoe is used
Repeat radiography interval Reduced or unstable: within 7 days to check fracture position
4 to 6 weeks after injury to document healing
Pt instruction Nondisplaced: advance weight bearing as tolerated
Reduced: no weight bearing for first 3 to 4 weeks
Ankle ROM and calf stretching and strengthening after the cast has been removed
Indications for Ortho consult High risk for skin necrosis
Open fractures
Vascular injury
Compartment syndrome
Fracture dislocation
Intraarticular fractures
Displaced, unable to reduce
Multiple metatarsal fractures
ROM, range of motion; SLNWBC, short-leg non-weight bearing cast; SLWC, short-leg walking cast.