Atypical Lisfranc Injuries Extending beyond the Tarsometatarsal Joint—Challenges and Management in a Retrospective Cohort of Seven Cases

Background: Lisfranc injuries are complex disruptions of the tarsometatarsal joint complex. Although frequently missed or misdiagnosed, timely and appropriate treatment is crucial to prevent long-term complications such as chronic pain, deformity, or arthritis. A rarer subset of these injuries extends beyond the tarsometatarsal joints, involving the intercuneiform joints, cuboid, naviculocuneiform, and other adjacent articulations. There is limited literature addressing the management of these rarer injury patterns. Inadequate treatment can result in significant midfoot instability or severe arthritis. This study examines a patient cohort with such injury patterns and their surgical outcomes. The aim of the study is to shed light on technical challenges and management of these complex injuries. Materials and methods: A total of 7 patients with atypical Lisfranc injury patterns were studied retrospectively from January 2023 to January 2025. Diagnosis was made on radiographs and/or computed tomography (CT) scan as well as intraoperative stress tests for instability. Surgical fixation was individualized, and patients were followed up for a mean period of 26 weeks (range: 24–30 weeks), after which implant removal was done. Foot and Ankle Disability Index (FADI) was used to assess the functional outcome. Results: All patients had stable plantigrade foot and radiological consolidation after their follow-up period. Average FADI score was 86.57 with a p-value (paired t-test) <0.0001, showing significant improvement. Conclusion: Lisfranc injuries pose significant challenges when it comes to diagnosis and treatment, particularly in the case of atypical subtypes involving the intercuneiform and naviculocuneiform joints, cuboid, and other adjacent joints. It is crucial that treatment approaches be highly individualized, tailored to the unique needs of each patient, and based on thorough clinical and radiological evaluation.