What's the Diagnosis? - Case 9

History 62-year-old man status post fall from a curb.

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Findings Radiographs demonstrate a subtle widening in the first intermetatarsal space with the first case additionally demonstrating offset of the second metatarsal and the intermediate cuneiform.

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Diagnosis: Lisfranc Ligament Disruption Comments: High resolution MRI demonstrates a high grade partial disruption of the Lisfranc ligament in the first case and a complete disruption in the second case. The ligament acts as the keystone in support of the midfoot as it courses from the base of the second metatarsal to the medial cuneiform. Recent literature has helped substantiate that any offset is probably amenable to surgical fixation as malalignment will precipitate pain and early, profound arthrosis.

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Resolution: Second Case The second case was a 22 year old man with pain while playing basketball.

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Resources • Shapiro, Matthew S., Wascher, Daniel C., Finerman, Gerald A. M. Rupture of Lisfranc’s Ligament in Athletes Am J Sports Med 1994 22: 687-691 • Nunley, James A., Vertullo, Christopher J. Classification, Investigation, and Management of Midfoot Sprains: Lisfranc Injuries in the Athlete Am J Sports Med 2002 30: 871-878 • Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF. Magnetic resonance imaging of the Lisfranc ligament of the foot. Foot Ankle Int. 1998 Jul;19(7):438-46.

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