The foot's mid-portion functions primarily as a simple block transmitting forces to and from the hindfoot and forefoot. Its composite range of motion is very limited. Midfoot injuries commonly affect the complex osseoligamentocapsular structures of the Lisfranc joint complex.
Injury pathomechanics result from either forefoot hyperdor-siflexion or hyperplantarflexion. Such injuries may be either ligamentous, bony, or mixed. Pure ligamentous injuries are commonly underdiagnosed or delayed in diagnosis due to minimal radiographic changes. Furthermore, the midfoot's inherent bony stability may mask the ligamentous disruption, unless weight-bearing radiographs are obtained or stress radiography is performed. Therefore, a high index of suspicion and specialized testing is often necessary to detect occult injuries.2
As previously discussed, the joint complex has unusual bony stability represented by the unique dovetail configuration of the second metatarsal base interlocking into the three cuneiforms. Extensive plantar ligaments connect the metatarsal bases to the cuneiforms and the cuboid. Intermetatarsal ligaments span each of the metatarsal bases except the first and second, where the obliquely oriented Lisfranc ligament is found. This ligament spans the second metatarsal base to the medial cuneiform, providing second metatarsal security.
In low-energy athletic injuries, the injury is primarily liga-mentous and instability affects only the second metatarsal. However, more extensive injury may occur; the amount and direction of applied energy determine the extent and direction of the Lisfranc disruption. Football-related injuries are not uncommon, especially in linemen. Snowboarding- and windsurfing-related injuries may result as one falls away from the forefoot, which is secured by a foot sling.
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