A Lisfranc injury is a midfoot injury causing the separation of bones and ligaments. It is named after Jacques Lisfranc, a 19th-century French surgeon. Understanding this eponym requires examining the foot’s anatomy and the history of military medicine during the Napoleonic era.
The Anatomy of the Lisfranc Joint Complex
The Lisfranc joint complex is the area in the midfoot where the forefoot bones meet the midfoot bones. Specifically, it is the articulation between the five metatarsal bones, the three cuneiform bones, and the cuboid bone, forming a transverse arch. This junction provides stability, locking the forefoot and midfoot together.
The complex relies on the Lisfranc ligamentous complex. The most important structure is the Lisfranc ligament proper, which connects the medial cuneiform bone to the base of the second metatarsal bone. This connection is the primary stabilizer for the arch center because the first and second metatarsals lack a strong intermetatarsal ligament between them.
This ligamentous arrangement, particularly the strong interosseous component, provides stability during weight-bearing. The second metatarsal base is “keystoned” into the cuneiform bones. This structure, combined with the powerful interosseous ligament, resists forces that cause separation and dislocation. A Lisfranc injury occurs when this central ligament is torn, allowing the metatarsal bones to shift out of alignment.
Who Was Jacques Lisfranc?
Jacques Lisfranc de Saint-Martin (1787–1847) was a highly regarded French surgeon. He received his medical education during France’s military expansion under Napoleon Bonaparte. Lisfranc was known for his skill and speed in performing surgical procedures, which was necessary on the rapidly moving battlefields of the era.
Lisfranc served as an army surgeon during the final phases of the Napoleonic Wars, including the 1813 Campaign of Saxe and the battles of Leipzig and Hanau. His military service exposed him to severe, life-threatening injuries requiring immediate surgical intervention. This experience led him to develop and refine several innovative surgical techniques.
After his military career, he became a professor and chief surgeon at the Hôpital de la Pitié in Paris. Beyond the foot injury, Lisfranc made significant contributions to various surgical fields. He pioneered techniques for the resection of rectal carcinoma and several types of disarticulations, including a well-known method for shoulder disarticulation.
The Historical Context of the Injury’s Naming
The association between Lisfranc and this injury stems from his experience treating soldiers during the Napoleonic Wars. Cavalry was heavily relied upon, and a common trauma was a severe foot injury caused by falling from a horse. The foot often got caught and twisted in the stirrup, causing immense rotational and axial force.
This trauma resulted in a characteristic fracture-dislocation at the tarsometatarsal joint, often compromising blood flow and leading to gangrene. Lisfranc documented this pattern among the wounded soldiers. Since amputation was the only recourse for preventing fatal infection in the pre-antibiotic era, Lisfranc developed and published a method for partial foot amputation.
In 1815, Lisfranc detailed his method for disarticulation at the tarsometatarsal joint. This allowed the surgeon to remove the compromised forefoot while preserving the heel and a functional portion of the foot. His technique was considered a major advancement because it resulted in a more stable stump for walking compared to higher amputations. This widely published surgical procedure, performed at the joint level, led to the entire anatomical area being called the “Lisfranc joint.”
While Lisfranc’s original work described a surgical amputation, the name eventually became an eponym for the underlying injury itself. The term “Lisfranc injury” now refers to any dislocation or fracture-dislocation of the tarsometatarsal joint. This historical link connects modern midfoot trauma to the French military surgeon who first systematized its treatment.