Definition
Injury to the tarsometatarsal joint complex, particularly the stabilising Lisfranc ligament between the medial cuneiform and base of the second metatarsal.
Mechanism
- Direct crush injury
- Indirect twisting or axial load on a plantar-flexed foot
Clinical features
- Midfoot pain and swelling
- Plantar ecchymosis is an important clue
- Pain on forefoot abduction / pronation stress
Imaging
- Weight-bearing AP, oblique and lateral radiographs
- Look for diastasis between first and second metatarsal bases and malalignment
- CT shows subtle fractures and joint incongruity
Management
- Stable non-displaced injuries may be casted
- Displaced or unstable injuries need operative fixation or primary arthrodesis in selected patterns
Complications
- Chronic pain
- Post-traumatic arthritis
- Loss of arch
Diagram
