![]() ![]() Examination findings of the Lisfranc injury are pain and tenderness at the metatarsal bases and medial/middle cuneiform, pain with rotational stress of forefoot, and ecchymosis on the plantar aspect of the midfoot. The typical mechanism of injury is hyper–plantar flexion of the Lisfranc joint. Because a Lisfranc injury can often compromise important anatomic structures in its vicinity, long-term effects of a missed diagnosis can end an athlete’s career. The Lisfranc injury is often misdiagnosed or completely missed because of its subtle symptoms and its usual involvement with polytrauma. Lisfranc fractures account for 0.2% of all fractures, with an incidence of about 1 in 55,000 people yearly. The Lisfranc ligament measures 1 cm in height and 0.5 cm in width, making it the largest and strongest interosseous ligament. The Lisfranc ligament spans from the lateral aspect of the medial cuneiform, attaching to the base of the medial aspect of the second metatarsal. The second metatarsal is stabilized by its osseous surroundings and the Lisfranc ligament. The first metatarsal is stabilized by the plantar attachment of the peroneus longus and the dorsal attachment of the tibialis anterior. The interosseous ligaments are the strongest, yet there is no interosseous ligament between the first and second metatarsals. The dorsal ligaments are weaker than the plantar ligaments and this weakness is thought to be a reason for the dorsal dislocation at this joint. There are dorsal and plantar interosseous ligaments for the metatarsals, cuneiforms, and cuboid. The transverse fibers interconnect the bases of the metatarsals. The longitudinal and oblique fibers connect the tarsals to the base of the metatarsals. The dorsal and plantar ligaments have 3 components: longitudinal, transverse, and oblique.
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