Clinical Findings

Classically, an athlete presents with a painful midfoot and decreased ability to fully weight bear. Swelling and tenderness about the Lisfranc complex are typically present. With isolated stress applied to individual Lisfranc joints, painful clicking may be elicited. Ecchymosis may develop on the plantar aspect of the midfoot.16 The athlete usually cannot stand on tiptoe secondary to pain. However, classic signs and symptoms may not be present due to the wide continuum of pathology.

Nunley and Vertullo17 emphasize the uniqueness of athletics-related Lisfranc injuries compared to those of high-energy trauma. The radiographic findings are usually subtle. Fractures are rarely present. A sport midfoot injury classification system stratifies these injuries into three subclasses (Table 70-1). Stage I represents a true ligamentous strain; therefore, the ligament is

Table 70-1 Midfoot Sprain Classification

Stage I

No diastasis or loss of arch height

Stage II

Diastasis of the I-II metatarsal bases is present with no

loss of arch height

Stage III

Diastasis of the I-II metatarsal bases is present with loss

of arch height

From Nunley JA, Vertullo CJ: Classification, investigation, and management of midfoot sprain. Lisfranc injuries in the athlete. Am J Sports Med 2002;30:871-878.

From Nunley JA, Vertullo CJ: Classification, investigation, and management of midfoot sprain. Lisfranc injuries in the athlete. Am J Sports Med 2002;30:871-878.

intact and competent with no diastasis between the first and second metatarsal bases. In stage II, dorsolateral subluxation of the second metatarsal is radiographically evident; however, despite the diastasis, no loss of arch height is present. Finally, in stage III, both diastasis and loss of longitudinal arch height is apparent on radiographs.17

Typically, midfoot disruption proceeds in steplike fashion. In these injuries, the second metatarsal base commonly subluxates as the initial event18 (Fig. 70-8). The "clear space" between the first and second metatarsal bases should not exceed 2 mm.

Radiographs must be carefully scrutinized to ensure anatomic alignment of the metatarsal bases to the cuboid and respective cuneiforms in all projections. A small radiopacity (the fleck sign) in the one-two interspace may represent an avulsion fracture of the Lisfranc ligament, belying a midfoot ligamentous injury. Pathologic forces may propagate proximally between the cuneiforms rather than progressing laterally. Therefore, the soft-tissue disruption may be longitudinal rather than transverse. Moreover, metatarsophalangeal joint injuries or metatarsal fractures may also accompany midfoot injury.

Was this article helpful?

0 0
Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

Get My Free Ebook


Post a comment