6. Clinical Presentation
Variable
Pain, especially with weight bearing activity
Plantar ecchymosis
Dorsal tenderness, edema
Mild discomfort
Deformity/instability
High index of suspicion based on
mechanism!
7. Diagnosis
Physical exam
view X-Ray (AP, lateral, medial oblique)-weight-
bearing films helpful.
20% of films are negative initially. Repeat films
at 7-14 days, consider CT/MRI.
Often mistaken as a sprain-when in doubt, splint
and refer to ortho.
10. Fracture/dislocation findings
The medial cuneiform-second MT space
should be evaluated for the "fleck sign"
indicating avulsion of the Lisfranc
ligament.
12. Classification
Homolateral
All of the metatarsals are dislocated to the same side
Usually involves the 2nd through 5th dislocated
laterally
Divergent
May be associated with a fracture of the 1st cuneiform
Usually involves medial displacement of the 1st
metatarsal and lateral displacement of 2nd-5th
metatarsals
14. Classification
Homolateral
All of the metatarsals are dislocated to the same side
Usually involves the 2nd through 5th dislocated
laterally
Divergent
May be associated with a fracture of the 1st cuneiform
Usually involves medial displacement of the 1st
metatarsal and lateral displacement of 2nd-5th
metatarsals
17. Treatment
Depends on severity
RICE
If no dislocation--immobilize and no weight
bearing for 4-8 weeks
If significant dislocation--closed reduction or
ORIF