There is midfoot swelling, usually dorsal. There is pain on palpation of the TMT area. A provocative test may show instability. This is painful, so it should be done carefully (under regional or general anesthesia, if possible).
There is often an area of plantar medial ecchymosis.
There is pain seemingly out of proportion to the injury. Unlike a routine ankle sprain, these injuries elicit patients’ comments of a visceral nature like “I almost passed out”, “I almost threw up”.