Edited by Hayley Daniell and Matt Fury - 7/1/2021
Descriptors
Pure ligamentous injury vs bony (proximal MT, tarsal bones)
Exam Pearls
Lower extremity neurovascular exam
Inspect for medial plantar ecchymoses, midfoot swelling, point tenderness over TMT joint
Workup
Radiographs: AP, lateral, oblique of foot and weightbearing AP, lateral,oblique. If unsure if lisfranc injury exists: compare space between base of 1st metatarsal and medial border of middle cuneiform between bilateral weightbearing views of the feet.
Other imaging: CT foot; MRI in outpatient setting for pure ligamentous injury
Labs: None
Other: None
Management
Need for acute intervention: No, immobilization without reduction
Weight-bearing and range of motion: Non-weightbearing lower extremity, no range of motion (splinted)
Type of immobilization: AO short leg splint
Admission or discharge status: Discharge with <1 week follow-up for surgical planning Admit if multiple unstable/displaced metatarsals
Anticoagulation: ASA 325mg daily
Antibiotics: None
Surgical Indications
Absolute: Open fracture, any displacement/instability
Relative: N/A
Not an indication: Nondisplaced injuries that are stable with weightbearing, poor surgical candidates