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Military personnel sustaining Lisfranc injuries have high rates of disability separation
  1. George C Balazs1,
  2. MG Hanley1,
  3. GJ Pavey1 and
  4. J-PH Rue2
  1. 1Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  2. 2Department of Orthopaedics and Rehabilitation, United States Naval Academy, Naval Health Clinic Annapolis, Annapolis, Maryland, USA
  1. Correspondence to Dr George Christian Balazs, Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA; gcbalazs{at}


Objectives Lisfranc injuries are relatively uncommon midfoot injuries disproportionately affecting young, active males. Previous studies in civilian populations have reported relatively good results with operative treatment. However, treatment results have not been specifically examined in military personnel, who may have higher physical demands than the general population. The purpose of this study was to examine rates of return to military duty following surgical treatment of isolated Lisfranc injuries.

Methods Surgical records and radiographic images from all active duty US military personnel treated for an isolated Lisfranc injury between January 2005 and July 2014 were examined. Demographic information, injury data, surgical details and subsequent return to duty information were recorded. The primary outcome was ability to return to unrestricted military duty following treatment. The secondary outcome was secondary conversion to a midfoot arthrodesis following initial open reduction internal fixation.

Results Twenty-one patients meeting inclusion criteria were identified. Median patient age was 23 years, and mean follow-up was 43 months. Within this cohort, 14 patients were able to return to military service, while seven required a disability separation from the armed forces. Of the 18 patients who underwent initial fixation, eight were subsequently revised to midfoot arthrodesis for persistent pain.

Discussion Military personnel sustaining Lisfranc injuries have high rates of persistent pain and disability, even after optimal initial surgical treatment. Military surgeons should counsel patients on the career-threatening nature of this condition and high rates of secondary procedures.

  • Lisfranc Injuries
  • Military Personnel
  • Return to Duty

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  • Twitter Follow George Balazs at @gcbalazs

  • Contributors GCB: assisted in project conception and design, responsible for obtaining institutional review board approval for study, conducted data analysis and primary drafter of manuscript. MGH: assisted in project conception, primarily responsible for data collection, assisted with manuscript drafting, edited and approved final manuscript. GJP: assisted in project conception and design, assisted with data collection and analysis, edited and approved final manuscript. J-PR: responsible for and guarantor of the overall project and submission, primarily responsible for project conception and design, edited and approved final manuscript submission.

  • Disclaimer The views expressed in this article are those of the authors and do not reflect the official policy of the United States Department of the Army/Navy/AirForce, Department of Defense, or U.S. Government.

  • Competing interests None.

  • Ethics approval Walter Reed National Military Medical Center Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.