Watson et al. review the diagnosis and management of Lisfranc tarsometatarsal joint injuries, covering anatomy, mechanism, classification systems, imaging workup, and surgical versus nonsurgical decision-making for a spectrum of injury severities from subtle athletic sprains to high-energy fracture-dislocations.
5 mm diastasis + arch collapse) — nonsurgical for Stage I, surgical for II/III yielded 93% excellent results
When you see midfoot pain after low-energy trauma — especially plantar ecchymosis, inability to toe-rise, or a fleck sign on radiograph. Treat it as a Lisfranc injury until proven otherwise and obtain bilateral weight-bearing films; ≥2 mm asymmetric diastasis is your surgical threshold.
Attempt closed reduction with percutaneous screw fixation first, but convert to open reduction without hesitation if alignment is in question, and consider primary arthrodesis for purely ligamentous injuries given evidence of lower reoperation rates.
Watson et al. review the diagnosis and management of Lisfranc tarsometatarsal joint injuries, covering anatomy, mechanism, classification systems, imaging workup, and surgical versus nonsurgical decision-making for a spectrum of injury severities from subtle athletic sprains to high-energy fracture-dislocations.
5 mm diastasis + arch collapse) — nonsurgical for Stage I, surgical for II/III yielded 93% excellent results
When you see midfoot pain after low-energy trauma — especially plantar ecchymosis, inability to toe-rise, or a fleck sign on radiograph. Treat it as a Lisfranc injury until proven otherwise and obtain bilateral weight-bearing films; ≥2 mm asymmetric diastasis is your surgical threshold.
Attempt closed reduction with percutaneous screw fixation first, but convert to open reduction without hesitation if alignment is in question, and consider primary arthrodesis for purely ligamentous injuries given evidence of lower reoperation rates.