The tarso-metatarsal (Lisfranc) injury is frequently diagnosed in a later stage, which undermines the initial treatment.
Sports injuries, axial compression of the foot or fall of a heavy object on the dorsal side of the foot, should bring suspicion of this disabling injury.
Plantar ecchymosis plantar (left) must be evaluated and if present, CT or MR scans should be ordered, otherwise this injury may be undiagnosed, as shown in the normal radiography on the right.
This case illustrates a Lisfranc injury that was misdiagnosed and treated as an ankle sprain for 7 months.
The inability to perform prolonged walking, foot oedema and pain, togheter with joint tenderness were suficient to suspect of this lesion, that was later confirmed through a CT scan.
Due to the amount of time that had passed from the initial injury, an intercuneiform, 2nd and 3rd tarsal-metatarsal arthrodesis was performed.
This approach allowed full recovery, while preserving foot mobility.
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