Relevant Anatomy

  • Lisfranc ligament

Lisfranc ligament

  • Connects medial cuneiform to 2nd & 3rd metatarsals

  • Acts as stabilizer of midfoot

  • Injury:

    • Forefoot abduction - plant and twist motion, foot caught in horse stirrup

    • Forced plantar-flexion

  • 3 Types of Radiographic injury:

    • Homolateral - basically all digits move laterally (1st digit may remain in place) (2nd picture)

    • Isolated - Has dorsal metatarsal dislocation

    • Divergent - basically 1st digit moves medially and all other digits move laterally (increase space between 1st and second digits) (3rd picture)

  • Fleck sign - Lisfranc injuries + fracture of base of 2nd metatarsal (most common associated fracture)

  • Nunley-Vertullo further classifies fractures

  • Radiopaedia article

Sever Disease

  • Calcaneal apophysitis

  • Cause of heel pain aggravated with use commonly in kids

Freiberg Infraction

  • Avascular necrosis with delayed growth (osteochondrosis) of metatarsal head, most commonly second metatarsal

  • Caused by repetitive trauma (high heels)

  • Basically recurrent trauma causes destruction of metatarsal head - look for single toe affected when others are normal - systemic disease would not do this

  • Presents as random degenerative changes of the metatarsal head

References:

  • Case courtesy of Andrew Murphy, Radiopaedia.org, rID: 99521 (lisfranc illustration)

  • Case courtesy of Alexandra Stanislavsky, Radiopaedia.org, rID: 10919 (homolateral lisfranc injury)

  • Case courtesy of Ankit Balani, Radiopaedia.org, rID: 34177 (divergent lisfranc injury)

  • Case courtesy of Ashesh Ishwarlal Ranchod, Radiopaedia.org, rID: 168346 (Sever disease)

  • Case courtesy of Hani M. Al Salam, Radiopaedia.org, rID: 9296 (Freiberg disease)