This JAAOS review covers the full spectrum of tarsometatarsal (Lisfranc) joint injuries — from subtle athletic sprains to high-energy fracture-dislocations — addressing how to diagnose them accurately and which treatment strategy to choose, including the emerging role of primary arthrodesis.
When you see midfoot pain after a low-energy athletic injury, don't trust non-weight-bearing films alone — get bilateral weight-bearing AP views and look for >2 mm asymmetric widening or a fleck sign, then counsel the patient for possible exam under anesthesia if still equivocal.
For ligamentous Lisfranc injuries requiring surgery, primary arthrodesis of the medial and middle columns is an evidence-backed alternative to ORIF, but always preserve lateral column mobility.
This JAAOS review covers the full spectrum of tarsometatarsal (Lisfranc) joint injuries — from subtle athletic sprains to high-energy fracture-dislocations — addressing how to diagnose them accurately and which treatment strategy to choose, including the emerging role of primary arthrodesis.
When you see midfoot pain after a low-energy athletic injury, don't trust non-weight-bearing films alone — get bilateral weight-bearing AP views and look for >2 mm asymmetric widening or a fleck sign, then counsel the patient for possible exam under anesthesia if still equivocal.
For ligamentous Lisfranc injuries requiring surgery, primary arthrodesis of the medial and middle columns is an evidence-backed alternative to ORIF, but always preserve lateral column mobility.