The purpose of this article was to review current literature on tarsometatarsal injuries and to describe clinical assessment, imaging and management.
Injury to the tarsometatarsal joint, commonly referred as the Lisfranc joint, is a relatively rare occurrence that can lead to debilitating consequences if left undiagnosed.
The technical definition of a Lisfranc injury involves the displacement of one or more of the metatarsals from the tarsus, and injuries can range from subtle subluxations to obvious fracture dislocations.
Lisfranc injuries can arise from a variety of situations and mechanisms, with both direct and indirect injuries possible.
Direct injuries are the most common cause of Lisfranc injuries, with motor vehicle accidents, crush injuries and falls from a height being prominent mechanisms.
The main mechanism of indirect injury is axial force through the foot or twisting on a plantar flexed foot.
Plantar ecchymosis is considered pathognomonic for a Lisfranc injury.
Other clinical signs that should trigger clinicians’ suspicions include swelling in the mid-foot and pain during attempted weight-bearing, especially mid-foot pain when walking down stairs.
On examination, pain may be elicited by palpation of the dorsal aspect of the involved tarsometatarsal joints.
First-line investigations for a suspected Lisfranc injury include bilateral weightbearing anteroposterior radiographic imaging with 30 degree oblique, and lateral views of the involved foot and ankle.
Correct diagnosis is imperative given the high risk of post-traumatic degenerative changes.
Physiotherapy input would be a valuable addition at all stages of conservative management.
Once the patient is pain-free under abducted stress, they can swap to a stiff-soled shoe with rigid orthotic support for six months.
Any evidence of instability or diastasis of the joint requires an orthopaedic referral for surgical fixation.
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