Patient History

21-year-old man who injured his left foot while playing football 3 days prior

Findings

SKELETAL/BONES:

Mild osteoedema consistent with contusion or microtrabecular injury with multiple chip fractures involving the 2nd metatarsal base, anterior lateral cuneiform, anterior navicular and cuboid. No macrotrabecular fracture. No stress fracture.

ARTICULATIONS:

Tibiotalar joint/talar dome: No osteochondral defect of the talar dome or tibial plafond. Mild capsulitis with a small effusion.

Ankle mortise/syndesmosis: The ankle mortise is in anatomic alignment. No syndesmosis widening.

Chopart joint: Unremarkable.

Midfoot/hindfoot: No fracture or injury of the anterior calcaneal process. No prominent midfoot or hindfoot arthrosis.

Lisfranc joint: Complete full-thickness tear of the interosseous Lisfranc ligament (torn interosseous C1 M2). Complete full-thickness tear of the dorsal Lisfranc ligament (torn dorsal C1 M2). Full-thickness tearing of the plantar Lisfranc ligament (torn plantar C1 M2 and C1 M3). Moderate soft tissue edema/contusion surrounding the Lisfranc articulation. Partial divergent pattern of subluxation, with the base of the 2nd metatarsal laterally translated by approximately 2 mm relative to the intermediate cuneiform. Relationship of the 3rd, 4th and 5th metatarsals with respect to the articulating portions of the lateral cuneiform and cuboid are preserved. Tarsal arch preserved (no collapse of the tarsal arch).

LIGAMENTS:

High ankle: Grossly intact.

Low ankle: Intact.

Subtalar/Chopart: Intact. 

Lisfranc ligament complex:  See articulation section above.

TENDONS:

Intact.

GENERAL:

Sinus tarsi: Unremarkable.

Muscles: No traumatic muscle injury. No volumetric muscle atrophy.

Soft tissue: Diffuse edema throughout Kager’s fat pad. Diffuse edema/contusion surrounding the Lisfranc articulation. Nominal reactive retrocalcaneal bursal thickening with associated trace effusion. Extensive subcutaneous soft tissue edema overlying the dorsal aspect of the midfoot and mediolateral aspect of the hindfoot.

Plantar fascia: Intact.

Neurovascular complex/tarsal tunnel: Unremarkable. No evidence of entrapment neuropathy.

Intra-articular/loose bodies: None.

Impressions

Lisfranc injury with Lisfranc ligament rupture:

  1. Completely torn dorsal interosseous and plantar components of the Lisfranc ligament as described above.
  2. Associated mild divergent subluxation pattern (2 mm lateral translation of the 2nd metatarsal).
  3. Contusions/microtrabecular injury at the base of the 2nd metatarsal, lateral cuneiform, anterior navicular, and cuboid bones. No macrotrabecular fracture.