HISTORY:The patient was a 17-year-old ASG level 10 female gymnast who was performing a power tumbling pass on the floor exercise when she felt a crack in her left foot upon landing. She was unable to weight-bear and had to withdraw from the competition. PHYSICAL EXAMINATION:The patient presented to our office the two days later with mild swelling of the foot, but she could not bear weight without pain. She had no foot deformities with a normal arch. The patient was neurologically intact to light touch and motor strength in both lower extremities. She had a positive squeeze test. She was maximally tender to palpation at the first and second TMT joints. Rotation of the midfoot caused her the most pain, but her tibiotalar and subtalar joints were pain free and mobile without pain. DIFFERENTIAL DIAGNOSIS: 1. Left foot ligament sprain 2. Left midfoot fracture 3. Bone contusion TEST AND RESULTS: XR non-weight-bearing AP and lateral: no definite abnormal finding XR weight-bearing AP and lateral: no definite abnormal finding MRI w/o IV contrast: Lisfranc ligament: surrounding edema with partial tears, suspicion for fracture -midfoot CT w/o IV contrast: minimally displaced avulsion fracture of the plantar base of the second metatarsal FINAL/WORKING DIAGNOSIS: Midfoot Lisfranc joint ligament tears with avulsion fracture at the second metatarsal TREATMENT AND OUTCOMES: 1. Non-weightbearing boot for 4 weeks with crutches 2. Partial weightbearing boot for 4 weeks followed with organized PT for 3 months 3. Due to COVID, physical therapy performed mostly at home 4. Resumed gymnastics 32 weeks post-injury full time with no sequelae; accepted scholarship from the Ohio State University gymnastics team 764