![]() The midfoot bones function as a single unit with minimal motion between the individual bones. ![]() Typically, the forefoot is mobile relative to the stable midfoot. The tarsometatarsal joints attach the forefoot to the midfoot and is a weight-bearing structure with numerous ligaments and tendon attachments. Therefore, a high index of suspicion is needed when diagnosing this injury ( 7). Twenty ( 5, 6) to thirty-five ( 3) percent of these injuries are unrecognized or misdiagnosed. Although they are not that common in the general population, they are the second most common athletic foot injury, occurring in 4% of football players per year ( 4). It is not uncommon for foot and ankle surgeons to see patients with a Lisfranc injury days or sometimes weeks later following a visit to the emergency room with an unrecognized injury. It is the author’s experience that the subtle injuries occur more commonly than reported due to the difficulty of making the appropriate diagnosis. However, in more recent literature, it has been reported as common as 7.9% of all fractures ( 3). ![]() Dislocations at the tarsometatarsal joint are an uncommon injury, comprising only 0.2% of all fractures ( 1, 2). They can cause severe long-term morbidity if not appropriately treated. These injuries encompass a wide spectrum from simple injuries to grossly unstable dislocations. Injuries to the Lisfranc complex can be difficult to diagnose and may be overlooked in patients who have multiple injuries (polytrauma, i.e., motor vehicle accident) or in patients who experience a simple injury such as a sprain. ![]() Fracture dislocations of the tarsal-metatarsal (Lisfranc injuries) can be subtle and may be missed in both initial and later evaluation of midfoot injuries. ![]()
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