Title: Lisfranc injury<br/>Author: Brian Corwell<br/><a href='http://umem.org/profiles/faculty/294/'>[Click to email author]</a><hr/><p>
<strong>Tarsometatarsal fracture-dislocation</strong></p>
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The Lisfranc ligament is critical for stabilization of the midfoot arch and the 2<sup>nd</sup> MT</p>
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Injuries can range from mild (sprains) to severe (gross dislocation)</p>
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Injury may be purely ligamentous injuries or a fracture-dislocations</p>
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Difficult diagnosis to make</p>
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<a href="https://www.aafp.org/afp/1998/0701/afp19980701p118-f4.jpg">https://www.aafp.org/afp/1998/0701/afp19980701p118-f4.jpg</a></p>
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</p>
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Mechanisms: MVAs, fall from height or athletic injuries</p>
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Common athletic mechanism: Axial load to a hyperplantar flexed forefoot</p>
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<a href="https://thumbs.dreamstime.com/z/vector-illustration-healthy-human-foot-foot-lisfranc-injury-weight-bearing-mechanism-injury-100392176.jpg">https://thumbs.dreamstime.com/z/vector-illustration-healthy-human-foot-foot-lisfranc-injury-weight-bearing-mechanism-injury-100392176.jpg</a></p>
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Injury severity is often underestimated</p>
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Severe pain and inability to weight bear</p>
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Plantar bruising and bruising throughout midfoot</p>
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<a href="https://footeducation.com/wp-content/uploads/2019/02/Figure-3-Bruising-from-Lisfranc-Injury-600x781.png">https://footeducation.com/wp-content/uploads/2019/02/Figure-3-Bruising-from-Lisfranc-Injury-600x781.png</a></p>
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No specific tests as exam is limited due to pain</p>
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<strong>Midfoot stress tests </strong></p>
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-Often positive but unlikely to be allowed by patient due to pain</p>
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<a href="https://www.youtube.com/watch?v=v8SGVwz2RHs">https://www.youtube.com/watch?v=v8SGVwz2RHs</a></p>
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<strong>Midfoot instability test</strong></p>
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Grasp metatarsal heads and apply dorsal force to forefoot.</p>
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Other hand palpates the TMT joints and feels for dorsal subluxation</p>
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