A 28-Year-Old Woman with Foot Pain After a 10-Foot-Fall

Differential Diagnosis

• Jones fracture
• Lisfranc fracture dislocation
• Navicular fracture
• Proximal 2^nd 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 1^st and 2^nd 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