Operative indications and cases to be wary of

The operative indications for a Lisfranc fusion are significantly symptomatic arthritis from the tarso-metatarsal region, which has been inadequately improved by orthotic management.

The extent of joint involvement is best defined with pre-operative CT scans.

It may be necessary to extend the fusion mass proximally either medially or laterally.

Generally Articulations 1-3 and 4-5 are regarded as functional units and best addressed surgically like this.

If all 5 articulations are symptomatic then 4&5 should be dealt with by excision arthroplasty, 1-3 by fusion.

Deformity should also be addressed. A planovalgus midfoot collapse is not uncommon. If correcting such deformity then compressive staples should be used only sparingly on the dorsal surface where they will inherently flatten the longitudinal arches as they compress.