Differential Diagnosis

  • Jones fracture
  • Lisfranc fracture dislocation
  • Navicular fracture
  • Proximal 2nd MT fracture

Diagnosis

The x-ray reveals widening of M1-M2, C1-M2 distance, and longitudinal fracture of the cuboid. This patient suffered a Lisfranc fracture dislocation.

Learnings/What to Look for

  • May occur from sports-related injuries, motor vehicle accidents, or falling from a height
  • Appearance typically shows widening at the base of the 1st and 2nd metatarsals (or the more lateral proximal metatarsals) >2.5mm
  • Look for ecchymosis, instability, and pain at tarsal-metatarsal joints

Pearls for Urgent Care Management and Considerations for Transfer

  • Early diagnosis is essential for maintenance of function
  • Initial management in the urgent care setting includes immobilization and instructions for the patient to avoid weightbearing
  • Patients with a diagnosis of Lisfranc injury should be sent for immediate referral to the ED or orthopedist
A 28-Year-Old Woman with Foot Pain After a 10-Foot-Fall
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