Abstract
The Lisfranc injury to the foot has been well documented for nearly 200 years since first described by Napoleon's surgeon for cavalry riders where the foot was injured by the stirrup. It involves the tarso-meta tarsal junction, predominantly TMT #2 that can include 1 or all 3 classifications from sprain to fracture and dislocation. Published literature recognises that significant forces are involved and include vehicle accident, falls and some sports, with the presence of a foot fixed within a stirrup/binding being a serious predisposing factor. The Australian Surf Life Saving movement holds the motto of 'No preventable fatalities between the flags' and are the guardians of the Australian beach providing thousands of interventions per years. The IRB (Inflatable Rubber Boat) is an integral part of the approach to team rescue and patrol and requires a driver and crew. The crew use foot-straps for stabilisation of themselves and consequently the boat on negotiation of the break and waves. This predisposes the right (front) foot on wave impact where the body passes over the foot, held within the stirrup, resulting in a forced mid-foot dorsi-flexion and potential Lisfranc injury. Case presentations of this injury, its mechanism and circumstances for IRB crews are presented. Emphasis is placed on early diagnosis, early management and the rehabilitation options. The clinical pathways are presented, as evidenced bydelayed recovery from inappropriate early management due to misdiagnosis and the consequences of early loading versus appropriate management including physiotherapy intervention. The IRB is an essential part of the surf life saving team approach. The dangers of significant injuries that often present as trivial, and are often misdiagnosed,can have permanent and life changing effects of individuals who have volunteered for a community service. This information needs to be disseminated to the associations, its members and the therapists and medical teams who treat them. This will improve early recognition and diagnosis of the injury and assist in ensuring modifications are made to the existing protocol and patrol techniques to minimise the potential for occurrence of Lisfranc injury. Understanding the injury, its mechanism and the severity will enable physiotherapists and other health professionals, including surf life saving club first aid providers as the first contact point, to translate this knowledge to other injury areas and ensure improvement of the early diagnosis and appropriate management of this potentially debilitating injury.