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Tarsometatarsal fracture-dislocation
The Lisfranc ligament is critical for stabilization of the midfoot arch and the 2nd MT
Injuries can range from mild (sprains) to severe (gross dislocation)
Injury may be purely ligamentous injuries or a fracture-dislocations
Difficult diagnosis to make
https://www.aafp.org/afp/1998/0701/afp19980701p118-f4.jpg
Mechanisms: MVAs, fall from height or athletic injuries
Common athletic mechanism: Axial load to a hyperplantar flexed forefoot
Injury severity is often underestimated
Severe pain and inability to weight bear
Plantar bruising and bruising throughout midfoot
No specific tests as exam is limited due to pain
Midfoot stress tests
-Often positive but unlikely to be allowed by patient due to pain
https://www.youtube.com/watch?v=v8SGVwz2RHs
Midfoot instability test
Grasp metatarsal heads and apply dorsal force to forefoot.
Other hand palpates the TMT joints and feels for dorsal subluxation