History and physical exam
These injuries may arise in athletics and be very subtle, or they may be the result of higher-energy injury and be more obvious. Their mechanism is similar to a Lisfranc midfoot injury or a similar twist, and they may indeed be part of a Lisfranc fracture dislocation.
The high-energy injury is often part of a polytrauma and is often associated with other injuries, in the foot and other parts of the body.
In the multiply-injured patient, intertarsal injuries and fractures may be picked up on the secondary survey. In the case of unconscious patients, care should be taken to check for unusual swelling, crepitus and/or deformity. If suspected, foot x-rays are indicated.