There is a discrepancy in relation to the frequency of isolated midtarsal sprain suggesting that this clinical entity is often underdiagnosed ^1-3.

In addition imaging findings are often overlooked because they are subtle and lacking knowledge about injury patterns and Chopart joint anatomy on the radiological side ^1,2.

Furthermore, midtarsal sprains also occur in conjunction with lateral ankle sprains, which are much more common and enjoy a higher degree of familiarity. Similar to the latter, midtarsal sprains are usually treated conservatively. The accurate diagnosis is however important, since inappropriate management or premature weight-bearing may cause instability as a cause of chronic foot pain ¹.

In the visible radiograph, the tiny shell-like fragment above the navicular bone (the distal insertion site for the dorsal talonavicular ligament) points towards the diagnosis and should prompt the search for further avulsion fractures

In MRI the bone marrow edema pattern in the plantar talar head and sustentaculum tali are further immediately visible signs.

The dorsal calcaneocuboid ligament avulsion fracture at the anterior process of the calcaneus and the dorsal talonavicular ligament avulsion injury suggest inversion accompanied by plantar flexion as a mechanism. This can happen with high-heeled shoes ².