Cayuga Health: Repairing a sudden foot injury got this high school junior back in the game (sponsored content)

Prompt treatment for a mid-foot injury got Max Franco back to his team sports at Homer High School thanks surgical care from Alec Macaulay, MD, at Cayuga Orthopedics

Max Franco. (Photo provided by Cayuga Health).

(Sponsored Content from Cayuga Health)

Max Franco’s plans for his junior year on Homer High School’s varsity sport teams got a jolt when he injured his foot during gym class. The pain was from a torn ligament along his midfoot that needed medical attention, and Max got the care he needed from Alec Macaulay, MD, an orthopedic surgeon at Cayuga Orthopedics.

Sports can strain even the young ligaments of teen athletes like Max, who plays on his school’s varsity football, basketball, and baseball teams. Max’s injury happened in seconds, tearing the ligaments at the junction of the forefoot and the midfoot, where a cluster of small bones form an arch on the top of the foot. It’s called a Lisfranc injury, named after a French surgeon who served in the Napoleonic army in the 1800s and treated foot injuries in cavalry soldiers.

The severity of Lisfranc injuries can vary widely — from a simple injury involving one midfoot joint to a complex injury involving dislocations of joints and broken bones, says Dr. Macaulay. In Max’s case, no foot bones were broken.

Alec Macaulay, M.D. (Photo provided by Cayuga Health).

While avoiding broken bones is fortunate, the lack of fractured bones may prompt a patient to assume the injury is a simple sprain that can be “walked off” and not seek proper treatment. When untreated, a Lisfranc injury can result in chronic pain, damage to nerves, blood vessels, and muscles in the foot, and problems with foot alignment. In many cases, arthritis can develop months or years after the injury. Even a simple Lisfranc injury may take many months to heal and may require surgery to treat.

After his injury, Max got prompt medical attention that included a thorough examination by Dr. Macaulay. In addition to examining and manipulating Max’s injured foot, he ordered X-ray images of both feet. By comparing the images, the injured foot’s X-ray showed a wider gap between the joints of the midfoot than on the uninjured foot. The gap was where the ligament had torn when Max injured his midfoot.

To treat the injury, Dr. Macaulay helped the torn ligaments heal by stabilizing the joint between the unstable midfoot bones. A suture passing through a tunnel drilled into the bone held the bones in place so that the ligament could heal. The suture was tightened against titanium buttons on each end to pull the torn ligaments and the bones together.

“The technology is relatively new and eliminates the use of screws and plates to stabilize the foot and allow the ligament to heal. That method requires a second surgery to remove the hardware after the injury heals. This suture-button approach eliminates that extra surgery,” Dr. Macaulay says.

About two months of wearing a non-weight-bearing cast or removable boot followed the surgery. Another few weeks of weight bearing in a removable boot and physical therapy completed the rehabilitation and put Max back on the field for Homer’s varsity baseball team.

What causes Lisfranc injuries?

Low-energy Lisfranc injuries may occur in sports when one player lands on the back of another player's foot while the foot is flexed downward in the push-off position. More severe injuries occur from trauma, such as a high fall or a motor vehicle accident that can cause multiple foot fractures and joint dislocations.

How common are Lisfranc injuries?

Lisfranc injuries may go undiagnosed and are less frequently reported than broken bones. Injuries to the Lisfranc joint most commonly occur in automobile accident victims, military personnel, runners, horseback riders, and contact sports participants. Lisfranc injuries occur because of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot or missing a step on a staircase.

What Is the Lisfranc Joint?  

The joint is a complex group of bones and ligaments in the midfoot that forms the arch where the five midfoot bones meet up with the smaller bones that connect to the heel and ankle. The Lisfranc ligament is a tough band of tissue that joins two of these bones. This is important for maintaining proper alignment and strength of the joint.

What does a Lisfranc injury feel like?

A Lisfranc injury can cause pain and tenderness in the midfoot, especially on the top of the foot near the instep. The pain may increase when putting weight on the foot, especially when standing, walking, or applying pressure. Proper diagnosis and treatment are often needed to prevent further injury.

Dr. Alec Macaulay is an orthopedic surgeon with Cayuga Orthopedics and serves on the medical staff of Cayuga Medical Center and sees patients in Ithaca and Cortland. His clinical interests include both the surgical and non-surgical treatment of athletic injuries, arthritic conditions, and musculoskeletal trauma. He specializes in surgery of the knee, ankle and foot and can be reached at (607) 272-7000.