Diagnosis

Intraarticular base fractures of the first metatarsal shaft

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 Mechanism of injury
 Imaging
 Clinical signs
Mechanism of injury

A low energy avulsion type fracture (A) or a higher energy Lisfranc fracture dislocation pattern (B).


Imaging

Conventional radiographs of the foot (AP and lateral oblique views) are sufficient for diagnosis and treatment.

Weight bearing or stress views may be helpful in assessing for adjacent TMT instability. 

CT scans may be useful for preoperative planning. An MRI may be utilized to assess the Lisfranc dorsal and plantar ligaments.


Clinical signs

The clinical picture includes swelling, ecchymosis and pain over the midfoot. Plantar ecchymosis is nearly always present in a Lisfranc injury.

Tenderness of adjacent TMTs should also be assessed, if Lisfranc is suspected.