Acute midfoot injuries and their management

​Low energy injury to the foot

“…Lisfranc injuries are generally associated with high energy mechanisms, for example, fall from a height or motor vehicle accident 1 2. However, they may also occur from relatively lower energy trauma, such as a ground-level fall depending on the positon of the foot.…”

“…However, they may also occur from relatively lower energy trauma, such as a ground-level fall depending on the positon of the foot. The most common injury is axial loading or a twisting injury to a plantar flexed foot 2. C and D are incorrect as, respectively, one develops from increased pressure on the interdigital nerve between the great and second toe and the other is a congenital abnormality.…”

“…Twenty per cent of unstable Lisfranc injuries are misdiagnosed on plain radiographs 2. Signs of Lisfranc instability on X-ray include a widening between the first and second metatarsal bases >2 mm.…”

“…3 Weight-bearing views can improve the reliability of plain radiographs but may be difficult to obtain initially due to pain, and in these cases a week’s delay can be useful (figure 2). 2 In low energy Lisfranc injuries these abnormalities may be harder to detect since they are more obvious in high impact settings where multiple joints are dislocated.…”

“…Treatment of Lisfranc injuries depends on the stability of the injury. Poor outcomes, such as collapse of the cuneiform-metatarsal arch and/or intractable midfoot arthritis are common where injuries have been missed 1 2…”