The Lisfranc joint — the row of small joints between the midfoot and the forefoot — is a part of the foot that few patients have heard of until they injure it. When you do, it has profound consequences: poor recognition leads to long-term pain, gait disturbance, and arthritis. Even with prompt and correct treatment, the recovery is long.

The dorsal bridge plate

One of the modern options for fixing Lisfranc injuries is a dorsal bridge plate — a strong plate that runs across the top of the foot, spanning the disrupted joints and holding the bones in correct alignment while the soft tissue heals. The bone bone-and-ligament reconstruction it supports is robust. The historical practice has been to remove the plate once everything is healed, around 6–12 months later.

What we did

This 2023 paper, on which I was fourth author, looked at 85 consecutive patients treated with dorsal bridge plates for Lisfranc injuries at our major trauma centre, with an average follow-up of 40 months. Crucially, our default was to leave the plate in — not to remove it routinely — and only to take it out if the patient developed plate-related symptoms.

What we found

Mean MOXFQ score 27.0, mean AOFAS 72.6 — functional outcomes comparable to published series where plates were routinely removed. About one in five patients (21%) eventually needed the plate removed because of plate-related discomfort; this was more common in women, likely related to thinner soft-tissue cover over the foot. 9% eventually needed a secondary fusion of the affected joints. Patients whose injury had damaged the joint surface itself (intra-articular involvement) had worse outcomes than those without — an unsurprising finding.

What this means for patients

If you sustain a Lisfranc injury and are offered a dorsal bridge plate, you don’t need a second operation in your diary to remove it. Most patients do well leaving the plate where it is. About one in five will eventually want it out for comfort. Discuss the realistic prospect of secondary fusion if your injury involved the joint surface.