A 24-year-old female presented with severe pain in her right foot after being blown over by a strong gust of wind while windsurfing. Her foot remained strapped to the board. Examination found tenderness and pain with movement of the midfoot and passive flexion of the right foot, but no bony abnormalities. This is consistent with a possible Lisfranc injury, where the bones in the midfoot are displaced or fractured. Treatment options ranged from immobilization for non-displaced fractures to emergency reduction for displaced, unstable injuries.

2.  24 YOF presents with
severe pain in right foot.
She was windsurfing
when a strong gust blew
her over. Her right foot
remained strapped in
place. She c/o severe pain
across top of her right
foot which is made worse
with all movement.
Denies pain in her ankle,
knee, and thigh of RLE.
 T 97.4 P 112 BP 154/92 O2




97%
Gen: Severe discomfort
2/2 pain.
CV: Sinus tach, no m/r/g
Pulm: CTAB.
MSK: R foot w/o bony
abnormalities. NV intact.
TTP across dorsum. Pain
elicited with torsion of
midfoot and passive
dorsi- and plantar flexion
of R foot.

5. Non-Displaced (<1mm):
 Elevate and Ice Foot
 Analgesics
 Immobilize – Posterior Splint
 Non-weight bearing
 Follow up with Orthopedics in 2 weeks

6. Displaced (unstable injury):
 Elevate and Ice Foot
 Analgesics
 Require emergent reduction
 Emergent ortho consult

7.  Lisfranc joint is found at the base of second metatarsal
and is formed by a 6-bone arch that includes the first,
second, and third cuneiforms and first, second, and
third metatarsals
 Named by a French OBGYN in the Napoleonic wars
 Most commonly misdiagnosed foot fractures
 To facilitate diagnosis, grasp first and second
metatarsals and move them alternately through
plantarflexion and dorsiflexion.

9.  Tintinalli's Emergency Medicine: A Comprehensive Study Guide.
O. John Ma, M.D., Judith E. Tintinalli, J. Stephan Stapczynski,
David M. Cline. McGraw-Hill Professional Publishing: 2010.
 Wheeless Textbook of Orthopedics. Clifford R Wheeless, MD.
 Missing the Lisfranc fracture: a case report and review of the
literature. Rijn J, Dorleijn DM, Boetes B, Wiersma-Tuinstra S,
Moonen S. J Foot Ankle Surg. 2012 Mar-Apr;51(2):270-4.
 Radiology case of the month. Foot pain and swelling. Lisfranc
fracture-dislocation with associated ligamentous tear. Ploch SE,
Le KL, Lindfors DP, Neitzschman HR. J La State Med Soc. 2011
Mar-Apr;163(2):88, 90