Lisfranc injury - an approach

Case contributed by Leonardo Lustosa

Presentation

Trauma to the foot.

Diagram

Illustration of common and useful measurement methods to the assessment of a Lisfranc injury.

  • C1-M2 distance: distance between the medial cuneiform (C1) and the 2nd metatarsal (M2)
     
  • C1-C2 distance: distance between the medial cuneiform (C1) and the intermediate cuneiform (C2)
     
  • M1-M2 distance: distance between the 1st metatarsal (M1) and the 2nd metatarsal (M2)
     
  • M1-C1 alignment: alignment between the lateral border of the base of the 1st metatarsal (M1) and the lateral border of the medial cuneiform (C1)
     
  • M2-C2 alignment: alignment between the medial border of the base of the 2nd metatarsal (M2) and the medial border of the intermediate cuneiform (C2)
     
  • M4-Cuboid alignment: alignment between the medial border of the base of the 4th metatarsal (M4) and the cuboid (assessed on the oblique view)

Case Discussion

A Lisfranc injury (or tarsometatarsal injury) is a rare, yet extremely important, possible repercussion of trauma to the foot. Missing a Lisfranc injury may have dire consequences to the patient.

Some findings suggestive of a Lisfranc injury are:

  • malalignment > 1 mm of M1-C1, M2-C2, and/or M4-Cuboid
  • M1-M2 distance > 4 mm (non-weightbearing)
  • M1-M2 distance > 5 mm (weightbearing)
  • M1-M2 distance difference > 1 mm between feet (weightbearing)
  • C1-M2 distance > 3 mm (non-weightbearing)
  • C1-M2 distance > 5 mm (weightbearing)
  • C1-M2 distance difference > 1 mm between feet (weightbearing)
  • fleck sign - an avulsion fracture of the base of the 2nd metatarsal or medial cuneiform which is pathognomonic of a Lisfranc injury

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