Bunkbeds, Ballet, Horses...and Feet!

Long ago, soldiers fought while riding horses. The speed and height of a horse helped them gain an advantage during battle. But fighting on top of a horse was dangerous, too. Soldiers kept getting hurt after they fell off their horse. A foot would get trapped in a stirrup, twist as the soldier fell, and the small bones in their foot would slide out of place. Jacques Lisfranc (say LIZ-frank) was a surgeon in France in the 1800’s. He could see this happening over and over, but he didn’t know how to help the soldiers. All he could do was to describe to other doctors what he saw. Eventually, they began to call it by his name: a Lisfranc Injury.

Have you ever put together a puzzle? Pieces fit together and snap into place. When the pieces are right, they only fit one way. Each of your feet is made up of 26 bones. These bones fit together like pieces of a jigsaw puzzle. Most of the bones in your foot do not move, but the bones in your toes move all the time. This movement means they’re more likely to get injured. It also means that the bones beside them are more likely to get injured as well. When you injure your foot, sometimes one of the bones pops out of place. It’s like a jigsaw piece that suddenly doesn’t fit!

The bones just behind your toes are called metatarsals (say meh-ta-TAR-sul). When these bones slide out of place, it’s the same injury that Jacques Lisfranc first identified in his soldiers.

There aren’t many soldiers riding horses anymore, but doctors and surgeons today see this same injury happening in many ways. One of the nicknames for it is a “Bunkbed Injury,” because it often happens when people jump off of a bunkbed. Landing badly after a fall can cause your toes to move away from where they’re supposed to be.

Another common way to get this injury is through sports. Usually, the ligaments in your foot are good at holding bones in place. However, shoes used in sports can force your toes to stay in one place while the rest of your foot turns in another direction. Ouch.

Ballet dancers often wear pointe shoes. The area around the toes is very stiff in these shoes. Pointe shoes can trap a dancer’s toes while they move the rest of their foot in a different direction. This causes a Lisfranc Injury. Football and soccer players wear cleats. When these players turn sharply, a movement known as cutting, the toes of the cleats can get stuck in one place. Artificial turf, which holds cleats more strongly than natural grass, may play a part in creating these injuries, too.

Long ago, Jacques Lisfranc didn’t know how to help his soldiers other than to cut off their foot, which is called an amputation. Luckily, today doctors have many less drastic ways to help their patients!

A doctor might tell a patient with a mild injury to rest and not put any weight on their foot. Someone who has a more severe injury may need surgery and then rest. Injuries that are the most severe may require wire or metal pins to help the bones stay in place. Once the bones are no longer moving, the ligaments can start to heal. Getting better takes a long time. Ligaments heal slowly.

Whether falling off a horse, jumping off a bunkbed, or playing sports — treatment has come a long way since Jacques Lisfranc treated his soldiers.