Acute Lisfranc joint disruption in a ballet dancer

Stress Fracture of the Second Metatarsal and Sprain of Lisfranc Joint in a Pre-Professional Ballet Dancer

“…Prompt evaluation for the various potential injuries to the Lisfranc joint complex, ranging from low-impact midfoot sprains to high-impact fracture-dislocations, should be included in the assessment of any foot injury in a dancer. Due to their subtle exam and radiographic presentation, such Lisfranc joint injuries may be easily missed at initial diagnosis 6,7 and, if undetected, can result in residual foot instability for the athlete. [7][8][9][10] The Lisfranc or TMT joint complex is made up of bony and ligamentous elements that provide structural support for the transverse arch of the midfoot.…”

“…Due to their subtle exam and radiographic presentation, such Lisfranc joint injuries may be easily missed at initial diagnosis 6,7 and, if undetected, can result in residual foot instability for the athlete. [7][8][9][10] The Lisfranc or TMT joint complex is made up of bony and ligamentous elements that provide structural support for the transverse arch of the midfoot. It consists of the articulations between the five metatarsals, the three cuneiform bones, and the cuboid.…”

“…Lisfranc ligament injuries have been reported in case studies of ballerinas after falls from full pointe position, missed jump landings (while the foot is in plantar flexion), and during turns or take offs when a foot sticks to the floor. 6,7,15 While in the pointe position, the Lisfranc joint complex is perpendicular to body weight, producing a compressive load rather than shear force on the ligament, which also reduces risk of injury. 3 Others have suggested that this axial load combined with the elongated lever arm, which occurs with the ankle and metatarsophalangeal joints in full extension, actually increases risk for dorsal joint failure.…”

“…All returned to dance, but two were unable to resume the pointe position because of limited plantar flexion. 6,7,15 Regardless of staging or treatment (conservative or surgical), the most important predictive factors in prognosis of Lisfranc joint complex injury are early diagnosis, anatomical reduction, and appropriate treatment. 1 A high index of suspicion is required, as initial symptoms can be ill-defined and early radiographic studies indeterminate.…”