High- and Low-Energy Lisfranc Injuries: A Prospective Study of Functional Outcomes and an Algorithm Based on Trauma Kinetics

Introduction Lisfranc joint injuries remain a diagnostic and therapeutic challenge due to their low incidence, variable presentation, and potential for long-term functional impairment. This study aimed to evaluate functional outcomes in patients with high- and low-energy Lisfranc fracture-dislocations using a standardized treatment algorithm based on trauma kinetics and chronicity. Methods We conducted a prospective descriptive case series including 32 adult patients treated at a tertiary referral center in southwestern Colombia between January 2021 and June 2023. Injuries were classified using the Myerson system for high-energy trauma and the Nunley-Vertullo system for low-energy ligamentous injuries. A clinical decision-making algorithm was applied to guide surgical or conservative management. All patients were followed for a minimum of 12 months, and outcomes were assessed using the Visual Analog Scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score, return-to-work status, and need for footwear modification. Results Of 32 patients, 21 sustained high-energy injuries (all treated surgically), and 11 sustained low-energy injuries (10 treated conservatively). At six months, mean VAS scores decreased from 8 to 2 in the high-energy group and from 6 to 3 in the low-energy group. Mean AOFAS scores were 78 and 81, respectively. Return-to-work rates were 100% and 73%, respectively. Permanent footwear adaptation was required in 9% of cases. Conclusion A treatment algorithm based on injury kinetics and chronicity offers a reproducible and structured approach to the management of Lisfranc injuries. The favorable outcomes observed in this series support its clinical utility, particularly in high-volume trauma settings.