Foot Case #4

24 YOF presents with severe pain in right foot. She was windsurfing when a strong gust blew her over. Her right foot remained strapped in place. She c/o severe pain across top of her right foot which is made worse with all movement. Denies pain in her ankle, knee, and thigh of RLE.

History and PhysicalT 97.4 P 112 BP 154/92

O2 97%Gen: Severe discomfort

2/2 pain.CV: Sinus tach, no m/r/gPulm: CTAB.MSK: R foot w/o bony

abnormalities. NV intact. TTP across dorsum. Pain elicited with torsion of midfoot and passive dorsi- and plantar flexion of R foot.

Image

Lisfranc Fracture

Non-Displaced (<1mm):Elevate and Ice FootAnalgesicsImmobilize – Posterior SplintNon-weight bearingFollow up with Orthopedics in 2 weeks

ED Management

Displaced (unstable injury):Elevate and Ice FootAnalgesicsRequire emergent reduction Emergent ortho consult

ED Management

Lisfranc joint is found at the base of second metatarsal and is formed by a 6-bone arch that includes the first, second, and third cuneiforms and first, second, and third metatarsals

Named by a French OBGYN in the Napoleonic wars

Most commonly misdiagnosed foot fracturesTo facilitate diagnosis, grasp first and second

metatarsals and move them alternately through plantarflexion and dorsiflexion.

Pearls

Additional Images

Tintinalli's Emergency Medicine: A Comprehensive Study Guide. O. John Ma, M.D., Judith E. Tintinalli, J. Stephan Stapczynski, David M. Cline. McGraw-Hill Professional Publishing: 2010.

Wheeless Textbook of Orthopedics. Clifford R Wheeless, MD.

Missing the Lisfranc fracture: a case report and review of the literature. Rijn J, Dorleijn DM, Boetes B, Wiersma-Tuinstra S, Moonen S. J Foot Ankle Surg. 2012 Mar-Apr;51(2):270-4.

Radiology case of the month. Foot pain and swelling. Lisfranc fracture-dislocation with associated ligamentous tear. Ploch SE, Le KL, Lindfors DP, Neitzschman HR. J La State Med Soc. 2011 Mar-Apr;163(2):88, 90

References