This is a rare and difficult to diagnose injury involving the tarsometatarsal joint (also known as the Lisfranc joint). These injuries can arise through both direct and indirect mechanisms.
A classic example of a direct trauma comes from a lateral or medial kick to the middle of the foot, something which often goes unnoticed or underestimated by the recipient. Indirect traumas include falls and awkward placement of the forefoot.
Symptoms are characterised by a localised, intense pain in the midfoot which is then exacerbated along the Lisfranc joint line during compression.
Around 20% of x-rays of Lisfranc dislocations return negative results, however CT scans are very effective at highlighting lesions which point to this kind of injury.
Typically, patients suffering from these kinds of injuries who do not experience any instability are still given a brace for 4-6 weeks, after which remission of symptoms tends to begin. Physiotherapy is used to reduce pain and inflammation and a programme of rehabilitation is planned to help reinforce the intra-rotator ankle muscles and improve the cavus position along the plantar arch.
When dealing with unstable lesions, surgical treatment is most likely required, consisting of percutaneous suspension using wires or screws, followed by immobilisation with a brace or cast. Subsequent rehabilitation techniques after the cast has been removed follow the same principles as when dealing with stable lesions.
