Lisfranc Injuries: What Have We Learned Since Napoleon’s Era?

Trauma to the tarsometatarsal (TMT) joint complex is named after the French surgeon of Napoleon’s era, Lisfranc, who initially described amputation through the midfoot for injuries sustained in battle. Today, Lisfranc injuries encompass a wide spectrum of trauma, from high-energy accidents to lower-energy twisting injuries. Despite advances in treatment, Lisfranc injuries may result in pain, disability, and diminished function for many patients. An overview of the evaluation and treatment for Lisfranc injuries is presented, including a review of the functional anatomy, the mechanism and classification of injuries, and a summary of described treatment recommendations. Lastly, we describe our treatment algorithm outlining a stepwise approach to evaluating and treating Lisfranc injuries. The use of adjuvant imaging studies and stress examination with fluoroscopy are discussed. A comprehensive evaluation, as outlined, allows the surgeon to better understand the personality and severity of each injury, and helps to guide treatment. We believe this approach will help to optimize outcomes for Lisfranc injuries.