There is malalignment of of the tarsometatarsal joints, in particular there is widening between the bases of the first and second metatarsals and the second metatarsal is shifted laterally - these findings are highly concerning for a Lisfranc injury. Small bony fragment at the medial base of the first metatarsal is likely a fracture fragment. There is also a fracture of the base of the fourth metatarsal.