Spring Is Here: Lisfranc (LF) Updates

by Vince Vacketta, DPM

Today is the first official day of Spring, bringing an increase in sports activities and, consequently, more LF injuries. Even in 2025, the management of LF injuries remains a topic of debate among foot and ankle surgeons. Common controversies include choosing between primary arthrodesis (PA) and open reduction and internal fixation (ORIF), as well as the role of routine hardware removal. 

PA vs. ORIF and return to sport (RTS)

A recent systematic review and meta-analysis evaluated 603 athletes with LF injuries who underwent either PA or ORIF. The study focused on RTS and evaluated the prevalence of RTS, time to RTS, and complications. The findings showed no statistically significant differences in the two groups, except for time to RTS, which favored the ORIF group by roughly 10 weeks.

Hardware removal

The management of hardware in LF ORIF continues to be a polarizing topic amongst surgeons. A recent study involving 188 patients who underwent LF ORIF explores different approaches to hardware management: routine removal (41 patients), removal upon patient request (28 patients), and leaving intact (42 patients). The study found no statistically significant differences in the mean American Orthopedic Foot & Ankle Society scores among the groups. Interestingly, patients who had routine hardware removed exhibited the lowest mean scores.

Takeaway

These LF debates seem endless. For athletes, ORIF might offer quicker RTS. Decisions about hardware removal should be predicated on the patient’s symptoms.