Imaging Diagnostics of Lisfranc Joint Injuries

Abstract

Background

Lisfranc injuries are traumas to the tarsometatarsal joint, ranging from simple capsular ruptures to complex fracture-dislocations. Overall, these injuries are rare and may be underdiagnosed due to often subtle changes in initial imaging, requiring increased attention.

Method

This review provides an overview of the anatomy, injury mechanisms, classification, and diagnosis of Lisfranc injuries using case examples and relevant literature.

Results

The Lisfranc joint connects the fore- and midfoot and stabilizes the foot’s arch. It is stabilized by multiple ligaments, with the Lisfranc ligament complex between the medial cuneiform and the second metatarsal playing a crucial role. High-energy trauma often causes dislocation fractures, while low-energy sports injuries usually cause subtle ligament lesions that lead to chronic instability, pain and post-traumatic osteoarthritis if left untreated. Radiographs in three planes are used for initial diagnosis; if the findings are unremarkable and there is clinical suspicion, further weight-bearing X-ray, CT or MRI scans are required.

Conclusions

Lisfranc injuries are rare and often difficult to diagnose, but if left untreated, they can lead to long-term functional impairments and osteoarthritis of the Lisfranc joint complex, making targeted diagnostics essential.

Key Points

• Lisfranc injuries include a broad spectrum of tarsometatarsal joint injuries, from simple capsular ruptures to complex dislocation fractures. Subtle injuries require careful diagnosis to avoid long-term consequences such as osteoarthritis.

• Radiographs in three planes are used as standard diagnostics, whereby subtle, mostly ligamentous injuries are often overlooked.

• Weight-bearing X-ray and CT scans can help to detect subtle injuries to the ligamentous apparatus.

• In case of persistent complaints, an MRI scan also enables direct visualization of the ligaments.

Citation Format

• Freppon FN, Lammers OP, Kaul MG et al. Imaging Diagnostics of Lisfranc Joint Injuries. Rofo 2025; DOI 10.1055/a-2648-9756

 

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Keywords

Foot - CT - MR-imaging - radiography - trauma

Introduction

Jacques Lisfranc de Saint-Martin (1787–1835), a French surgeon and gynecologist, first described an amputation at the level of the tarsometatarsal joint (TMT) during the Napoleonic Wars [1]. Since then, this area of the foot has been referred to as the Lisfranc joint. Today, the term Lisfranc injury is used to describe a wide range of injuries to the TMT joint from simple midfoot sprains with discrete rupture of the joint capsule to complex dislocation fractures. Based on the nature of the accident, it is possible to distinguish between high-energy trauma mechanisms, such as those that occur in traffic accidents, crush injuries, or falls from great heights, and low-energy mechanisms, such as those usually found in the context of sports injuries [2] [3] [4] [5] [6] [7]. According to recent studies, the majority of Lisfranc injuries result from low-energy trauma and account for 60–69% of this type of injury [5] [6] [8]. Overall, however, Lisfranc injuries are very rare and, according to a study by Stødle et al. (2020), they affect only 14 out of 100,000 people per year [6]. Nevertheless, it is assumed that the number of unreported cases is higher, because the corresponding injuries are often overlooked, especially in the initial X-ray images [9]; if misdiagnosed or diagnosed at a later time, these injuries can lead to arthritic changes, as well as pain and functional limitations [10] [11] [12]. More attention should therefore be given, in particular, to diagnosing low-energy metatarsal injuries.

 

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Anatomy

The Lisfranc joint, also known as the tarsometatarsal joint (TMT joint; Latin: articulationes tarsometatarsales), represents the amphiarthrotic connection between forefoot and midfoot, and it lies between the cuneiform bones, or cuboid bone, and the five metatarsal bones. It forms the basis of the three-column model of the midfoot ([Fig. 1] a–c) [13]. The medial column begins at the articulation between the medial cuneiform bone (C1) and the base of the first metatarsal bone (M1), and it is enclosed by its own joint capsule [13] [14] [15]. The connection between the intermediate cuneiform bone (C2) and the base of the second metatarsal bone (M2), together with the articulation between the lateral cuneiform bone (C3) and the base of the third metatarsal bone (M3), forms the starting point of the middle metatarsal ray, and it is enclosed by a common joint capsule [13] [14] [15]. The lateral metatarsal ray begins from the articulations of the cuboid bone (Cub) at the bases of metatarsal bones IV and V (M4, M5), and it also has a common joint capsule [13] [14] [15]. It is important to note that the stability of the TMT joint is provided primarily by the medial and middle columns, while the lateral column makes it easier to adapt to uneven terrain through its increased mobility in the sagittal plane and its rotational capacity [16]. In addition, the trapezoidal, plantar tapered configuration of C1, C2, C3 and the bases of M1, M2 and M3 contributes to the formation of the transverse arch of the foot in terms of a Roman arch, which is stabilized by the ligaments of the TMT joint ([Fig. 1]d) [13]. A special feature here is the peg-like embedding of the M2 base between C1 and C3, which further increases stability [17]. Peicha et al. (2001) showed that the depth of the “mortise” is negatively correlated with the risk of a Lisfranc injury in low-energy trauma mechanisms [17].

Fig. 1 Osseous anatomy of the Lisfranc joint. Three-column model of the forefoot (a): the medial column (light grey) consists of the Os cuneiforme mediale (C1) and Os metatarsale I (M1); the middle column (striped) includes the Os cuneiforme intermedium and laterale (C2 and C3), as well as Os metatarsale II and Os metatarsale III (M2 and M3); the lateral column (dark grey) is composed of the Os cuboideum (Cub) and Os metatarsale IV and Os metatarsale V (M4 and M5). (b) Dorsal view of the foot skeleton, illustrating the mortise-like embedding of the M2 base (*) between C1 and the M3; (c) Plantar view of the foot skeleton; (d) CT in coronal plane showing the transverse arch of the foot (white arc) based on the trapezoidal configuration of the bases of M1 to M3 and C1 to M3.

The ligamentous reinforcement of the TMT joint can basically be divided into dorsal, interosseous, and plantar ligaments ([Fig. 2] a–c), which are named after their path between the bones. The tarsometatarsal ligaments typically run longitudinally between the cuneiform bones or the cuboid bone and the bases of the metatarsal bones, and they can typically be divided dorsally into seven individual ligaments, with an oblique band usually existing between C1–M2 (dorsal Lisfranc ligament) and C3–M2 [18] [19] [20] There are also different ligament variations on the interosseous and plantar side, whereby on the plantar side an additional oblique path can usually be observed between C1 to M2 and M3 (plantar Lisfranc ligament) and between C3–M4 [18] [21]. The transverse intertarsal ligaments are found between the tarsal bones C1, C2, C3 and Cub, and similar to the dorsal ligaments mentioned above they run in an interosseous and plantar direction. The same applies to the transverse metatarsal ligaments between the bases of M2 to M5, although it should be noted that there is no metatarsal ligament between the base of M1 and M2. Instead, the Lisfranc ligament complex is located in this location, which acts as the most important stabilizer in the TMT joint. As mentioned already in the description of the dorsal and plantar tarsometatarsal ligaments, the dorsal portion of the Lisfranc ligament complex runs obliquely between C1 and the base of M2 ([Fig. 2]a), while the plantar portion is V-shaped with a deep portion between C1 and the base of M2 and a superficial portion between C1 and the base of M3 ([Fig. 2]b) [18] [20] [22] [23]. The interosseous portion of the Lisfranc ligament complex, often referred to simply as the Lisfranc ligament, runs from the outer side of C1 to the medial M2 base and, with a length of 8–10 mm and a width of 5–6 mm, it is the strongest ligament in the TMT joint ([Fig. 2]c) [7] [18] [19] [22] [23] [24].

Fig. 2 Ligamentous anatomy of the Lisfranc joint. Schematic illustration of the dorsal (a) and plantar ligaments (b) with the longitudinal course of the tarsometatarsal ligaments (black) and the obliquely oriented dorsal Lisfranc ligament (dark grey) between the medial cuneiform (C1) and the base of the second metatarsal (M2), as well as the obliquely oriented plantar Lisfranc ligament (light grey) between the medial cuneiform (C1) and the bases of the second and third metatarsals (M2 and M3). The transverse course of the intertarsal ligaments (striped) between the cuneiform bones and the cuboid, as well as the metatarsal ligaments (white), with the notable exception that there is no metatarsal ligament between M1 and M2. Schematic depiction of the Lisfranc ligament complex (c) between C1 and M2, including the dorsal (grey), interosseous (black), and plantar (striped) components.

 

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Trauma mechanism

Regarding the mechanism of Lisfranc injuries, a distinction should be made between high- and low-energy causes.

High-energy traumas result either from direct or indirect forces. Depending on the impact of the force vector on the midfoot, a direct force leads to a dislocation of the metatarsals in dorsal or plantar direction in the TMT joint, and it is often associated with multiple fractures and extensive soft tissue injuries [25]. Crush injuries are a classic example of this type of injury [3]. Indirect high-energy mechanisms, on the other hand, usually result from strong longitudinal forces on the plantar-flexed forefoot, such as those that occur in falls from great heights or traffic accidents, for example, when the brake pedal is pressed down during a rear-end collision, and these forces often result in fractures of the metatarsal bases and ruptures of the joint capsules and ligaments [6]. Fractures of the tarsus also occur frequently [26].

Low-energy Lisfranc injuries are usually based on indirect trauma mechanisms [6] [27]. A less pronounced longitudinal force acting on the plantar-flexed forefoot, for example, when acting on the heel in equinus position, can result primarily in a rupture of the weaker dorsal ligaments in the TMT joint [19]. Alternatively, rotational movements in the fixed, plantar-flexed forefoot can cause a rupture of all ligaments, including the more stable interosseous and plantar ligaments [2] [19]. A typical example of this is when a horse falls and the rider’s foot is caught in the stirrup [2]. Other sports in which midfoot sprains with Lisfranc injuries occur frequently include American football, rugby, basketball, windsurfing, or wakeboarding [2] [3] [4].

 

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Classification of Lisfranc injuries

In 1909, Quénu and Küss first developed a simple way to classify dislocation fractures in the metatarsal region. They distinguished between homolateral, isolated, and divergent dislocations [28]. Based on this classification, further classification systems emerged, including that of Hardcastle et al. (1982) and the classification system created in 1986 by Myerson et al., the latter of which is still in use today. The Myerson classification divides Lisfranc dislocation fractures into three main types (A–C), with all Lisfranc dislocation fractures being considered unstable and requiring surgical treatment [10].

A Type A injury occurs when the entire metatarsal joint exhibits complete incongruity in at least one plane or direction (lateral, medial, dorsal, or plantar) ([Fig. 3]a) [25].

Fig. 3 Lisfranc dislocation fractures according to Myerson (examples). 3D VRT-CT reconstructions: (a) Myerson-A fracture with homolateral, dorsal dislocation in the Lisfranc joint; (b) Myerson-B1 fracture with medial dislocation in the C1–M2 (c) Myerson-B2 fracture with lateral dislocation in the C2–M2 joint; (d) Myerson-C1 fracture with medial dislocation in the C1–M1 joint and lateral dislocation in the C2–M2 to the CubM4 joint.

Type B injuries, on the other hand, describe a partial incongruity. It is important to distinguish here made between a medial dislocation (type B1) and a lateral dislocation (type B2). Type B1 injuries usually affect the first ray, which is dislocated medially in isolation, while the remaining rays are congruent to the midfoot ([Fig. 3]b). Type B2 injuries are characterized by a lateral dislocation of at least one of the four lateral rays with proper alignment between C1 and the base of M1 ([Fig. 3]c) [25].

Type C injuries are characterized by a divergence of the rays. This results in a medial dislocation of the first ray and a partial (type C1) or total (type C2) lateral dislocation of the remaining four rays ([Fig. 3]d) [25].

The classifications by Quénu and Küss, as well as Myerson’s system, do not distinguish explicitly between high- and low-energy trauma, but they are basically more suitable for high-energy injury mechanisms. Subtle injuries, such as those occurring in low-energy midfoot sprains, are poorly represented in the classifications from Quénu and Küss, Hardcastle, and Myerson. As a result, Nunley and Vertullo (2002) introduced their own classification system, divided into the following three stages, based on clinical complaints, weight-bearing radiographs, and skeletal scintigraphy [27]:

Stage I describes a rupture of the joint capsule without elongation of the Lisfranc ligament. Clinically, this stage is indicated by pain in the TMT joint, while stress X-rays show no abnormalities. Increased tracer uptake in skeletal scintigraphy is typical [27]. This is the only category of Lisfranc injuries that can be classified as stable and does not require surgical treatment [10] [27] [29].

Surgical procedures, providing anatomical alignment and fixation, should be performed starting at stage II, which represents a greater elongation or rupture of the Lisfranc ligament with intact plantar structures; in a weight-bearing X-ray, this stage indicated by a diastasis of 2–5 mm between the bases of M1 and M2, without loss of height in the arch of the foot in lateral view [7] [27].

In stage III, in addition to the diastasis between the bases of M1 and M2, there is a height loss in the arch of the foot in lateral view. This is measured by comparing the plantar border of C1 and the plantar base of M5. This stage reflects a rupture of the dorsal capsule, the Lisfranc ligament, and the plantar capsuloligamentous structures and, similar to stage II, it is classified as an unstable Lisfranc injury [27].

 

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Diagnostics

Severe metatarsal trauma is usually diagnosed quickly due to swelling and deformity. Early detection of a possible compartment syndrome as a serious complication is particularly important [7] [19].

In low-energy trauma, the clinical signs are often more unspecific. Plantar ecchymosis is considered almost pathognomonic [30]. Instability during weight bearing, swelling, pain during piano key testing, or during passive abduction and pronation of the forefoot may indicate a TMT joint injury [2] [31]. To confirm the diagnosis, further imaging diagnostics are necessary.

 

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Imaging

X-ray

If a Lisfranc injury is suspected, a non-weight-bearing radiograph of the affected foot should initially be taken in three planes (dorsoplantar, in a 30° oblique view and in a strictly lateral projection) [7]. While major fractures and dislocations can be easily diagnosed, it is possible to overlook subtle injuries, for example, in the event of spontaneous repositioning and low-energy trauma. In case of unclear findings in the initial X-ray, or if there is a high clinical suspicion of a Lisfranc injury, additional weight-bearing X-rays should be taken in dorsoplantar and lateral projections, as these can better demonstrate smaller fractures and minimal diastases [32]. Regarding the dorsoplantar images, it should be noted that the patient stands with both feet above or on the detector while the tube is tilted 15° in a posterior direction [33]. In addition, in order to be able to distinguish minor asymmetries in the tarsometatarsal joint, the healthy foot should also be scanned for purposes of comparison [7].

When evaluating both the initial radiographs and the stress radiographs, specific anatomical alignments and distances should be evaluated. In the dorsoplantar view, a harmonious alignment of the lateral borders of M1 and C1, as well as the medial borders of M2 and M3 to C2 and C3, respectively, is very important ([Fig. 4]a). Similar criteria apply to the oblique view, where the alignment of the lateral borders of M2 and M3 to C2 and C3, respectively, as well as the medial border of M4 to the Cub should be taken into account ([Fig. 4]b). In lateral stress radiographs, a harmonious alignment of the dorsal borders of the TMT joint and the tarsometatarsal angle is particularly crucial ([Fig. 4]c). The latter is measured between the long axes of the talus and M2 and should be less than 10°. In addition, the arch of the foot should be assessed, with the plantar border of C1 projecting dorsal to the plantar border of M5 [7].

Fig. 4 Normal non-weight-bearing radiographs in three planes. Dorsoplantar radiograph (a) showing normal lateral alignment of C1–M1 (continuous line) and normal medial alignment of C2–M2 (dotted line) and C3–M3 (dashed line). Oblique radiograph (b) demonstrating proper lateral alignment of C2–M2 (continuous line) and C3–M3 (dotted line) as well as medial alignment of C4–M4 (dashed line). Lateral radiograph (c) illustrating the tarsometatarsal angle and the correct projection of the plantar base of C1 dorsal to the base of M5 (dashed lines).

According to a large meta-study by Sripanich et al. (2019), the following are indicative of Lisfranc injuries: (1) an increased distance between the M1 and M2 bases in the dorsoplantar radiograph of >4 mm in the non-weight-bearing radiograph or >5 mm in the weight-bearing radiograph or an increased distance in the side-by-side comparison of >1 mm. (2) An increased distance between C1 and the M2 base >3 mm without weight bearing or >5 mm with weight bearing or an increase of >1 mm in a side-by-side comparison [34]. (3) In addition, attention must also be paid to a lateral or medial offset of the bony alignment in the tarsometatarsal joint [7].

An almost pathognomonic sign in the dorsoplantar radiograph is the fleck sign ([Fig. 5]a). This is a small bone fragment that projects into the joint space between the base of M1 or C1 and the base of M2, and it corresponds to a bony avulsion of the interosseous Lisfranc ligament, usually at the medial base of M2 [7] [25]. It should not be confused with the marginally sclerotic accessory os intermetatarseum, which occurs in 1.2–10% of the population ([Fig. 5]b) [35] [36].

Fig. 5 Fleck sign and Os intermetatarseum. Dorsoplantar radiograph of a Myerson B2 injury (a) showing disrupted medial alignment of C2M2, increased M1–M2 and C1–M2 distances and the pathognomonic fleck sign (arrow). However, the fleck sign should not be mistaken for an accessory, margin-sclerosed Os intermetatarseum (arrowhead), as shown in the transverse CT MPR (b).

In the lateral scan, the following are suggestive of a Lisfranc injury: a reduced arch, represented by a reduced distance between the plantar border of C1 and the base of M5, a dorsal subluxation of the TMT joint, evident by disturbed alignment, and an increase in the talometatarsal angle over 10° [7] [25].

 

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Computed tomography

X-rays are summation images, which means overlays and suboptimal angles can compromise their quality and increase the probability of overlooking subtle fractures [37] [38]. By contrast, computed tomography (CT) allows a visualization of the foot skeleton in several planes and thus provides significantly better diagnostic accuracy [39]. Preidler et al. (1999) were able to show that 60% more metatarsal and almost twice as many tarsal fractures in midfoot sprains could be diagnosed using CT compared to conventional X-rays [38]. In addition, stress radiographs are often not sufficiently feasible due to pain, so that, especially in cases of high clinical probability of a Lisfranc injury and unremarkable X-ray findings, an additional CT should be indicated [8] [40].

In addition, 3D reconstructions of the foot skeleton can be created from the CT data sets using volume rendering technology. These reconstructions show a higher sensitivity to joint incongruities and subluxations compared to 2D CT slices [40], and they can also be used for surgical planning ([Fig. 6] a–c).

Fig. 6 Lisfranc injury in radiography and computed tomography. Myerson B2 injury in dorsoplantar radiograph (a), coronal CT MPR (b), and 3D VRT reconstruction (c) showing increased C1–M2 and M1–M2 distances, fleck sign (arrowhead), and a fracture of the M3 base (arrow).

Another advance is the use of special cone-beam CT scanners to perform stress CT studies, which allow both feet to be compared under physiological load. This approach evaluates, in particular, the distance between M1–M2 and C1–M2, which in the case of a Lisfranc injury has a greater distance compared to the healthy side [41] [42].

 

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Magnetic resonance imaging

Magnetic resonance imaging (MRI) is the preferred imaging modality for visualizing ligamentous injuries in subtle metatarsal dislocations thanks to its high soft tissue contrast compared to X-ray and computed tomography, and it should be used when there is a high clinical suspicion of a Lisfranc injury and X-ray or CT diagnostics are unremarkable [34] [43]. MRI allows direct visualization of the ligaments in the tarsometatarsal joint, particularly the Lisfranc ligament complex between C1 and the M2 base ([Fig. 7]) [7] [34]. To get the best possible diagnosis, sagittal, coronal (short axis), and transverse (long axis) proton-weighted sequences or fat-saturated T2-weighted sequences and a coronal T1-weighted sequence are recommended ([Table 1]) [14] [15] [44] [45]. In addition, specific foot coils, or alternatively flex or knee coils should be used [15] [44]. In supine position, pay special attention to maintaining stability; as an alternative, a prone position is also recommended, as it reduces movement artifacts, as well as potential magic angle effects [15] [44].

Fig. 7 MRI scans of the Lisfranc ligament complex. Fat-saturated coronal T2-weighted imaging (a) depicting the interosseous Lisfranc ligament (closed arrow) and the plantar Lisfranc ligament (arrowhead) between C1 and M2 (deep portion) as well as M3 (superficial portion). Non-fat-saturated coronal T2-weighted imaging (b) showing the dorsal superficial Lisfranc ligament (open arrow) and the interosseous Lisfranc ligament (closed arrow). 3D PD-weighted imaging with MPR in transverse orientation (c and d) highlighting the interosseous Lisfranc ligament between C1 and M2 (c; closed arrow) and the plantar Lisfranc ligament between C1 and M3 (d; arrowhead).

Table 1 Recommended MRI sequences for the diagnosis of Lisfranc injuries. Modified based on the protocol recommendations of the German Radiological Society’s working group on imaging techniques for the musculoskeletal system [44] and Siddiqui et al. (2014) [45].

Sequence	Planning
Sagittal PD/T2 fs	Align with long axis of M2
Coronal (short axis) PD/T2 fs	Plan sagittal sequence and align with first and second TMT joints
Transverse (long axis) PD/T2 fs	Plan coronal sequence and align with metatarsal bases
Coronal (short axis) T1	Plan sagittal sequence and align with first and second TMT joints

Healthy ligaments appear hypointense on T1-weighted images [38] and show low to intermediate signal behavior in the PD weighting [23] [46]. Injured ligaments, on the other hand, exhibit periligamentous fluid accumulations in the acute phase, a wavy or irregular course, and in the case of total ruptures, a complete interruption ([Fig. 8]) [7] [15]. Indirectly, isolated bone marrow edema, fractures, especially in the second cuneometatarsal ray, displacement of the tibialis anterior tendon into an enlarged space of the first interosseous muscle, and soft tissue edema in the interosseous muscles may indicate a ligament injury of the Lisfranc ligament complex [15] [47], which requires a careful assessment of the individual ligaments within the ligament complex. Small avulsion fractures can occasionally be misinterpreted as bone marrow edema, so these should be excluded by an additional CT, if necessary [7] [34]. For better ligament assessment, isotropic 3D MRI sequences with multiplanar reformations along the ligament can also be used [46].

Fig. 8 MRI scans of a ruptured Lisfranc ligament complex. Dorsoplantar non-weight-bearing radiograph (a) showing increased M1–M2 and C1–M2 distances, dislocation in the C2–M2 joint, and a fleck sign (black arrow). MRI of the same patient in transverse (b) and coronal (c) fat-saturated PD-weighted sequences depicting the ruptured dorsal (open white arrow), interosseous (closed white arrow), and plantar (white arrowhead) Lisfranc ligament between C1 and the base of M2.

In the chronic phase, demarcation of ruptured ligaments is often more difficult due to fibrotic remodeling and the loss of intraligamentous adipose tissue. Indications of a rupture include an irregular course of thickened ligaments and the presence of concomitant TMT joint arthrosis [15] [46].

 

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Dynamic stress examination using image intensifier

If clinical suspicion of a Lisfranc injury persists despite unremarkable imaging findings, a dynamic stress test using an image intensifier can ultimately be performed [2] [29]. In the case of instability, the forced abduction of the forefoot with a fixed hindfoot leads to malalignment in the Lisfranc joint row, which indicates surgical treatment [48] [49].

 

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Imaging summary and diagnostic plan

The meta-analysis by Sripanich et al. (2019) reveals that sensitivity and specificity vary greatly depending on the imaging modality and the respective study. As a result, no single modality can be identified as the best for diagnosing Lisfranc injuries. Instead, it is necessary to differentiate between modalities on a case-by-case basis [34]. In particular, subtle Lisfranc injuries, which are often caused by low-energy trauma mechanisms, are often overlooked or underestimated, and they therefore require special attention. For these cases, Sripanich et al. (2019) recommend the following approach ([Fig. 9]):

1. Initial imaging: As a first step, non-weight-bearing radiographs of the affected foot should be carried out in three planes. The aim is to identify or rule out bone pathologies.

2. Stress X-rays: If the initial radiographs are unremarkable, weight-bearing radiographs should be taken as soon as the patient is able to do so to visualize possible malalignment in the Lisfranc joint row.

3. Computed tomography: If stress radiographs are unremarkable or if stress cannot be performed due to pain, but there is high clinical suspicion, CT imaging is the next diagnostic step, and it is particularly well suited to detecting subtle subluxations and bony avulsions in the TMT joint.

4. MRI: If symptoms persist despite unremarkable CT findings or if they last longer than six weeks after the initial trauma, MRI is the method of choice. MRI allows for a detailed assessment of the ligamentous structures.

5. Final diagnosis: If all diagnostic modalities are consistently negative, a midfoot sprain can be assumed. In case of a positive finding, dynamic stress tests should be considered to assess instability and plan surgery.

Fig. 9 Diagnostic algorithm for Lisfranc injuries. Flowchart adapted from Sripanich et al. (2019) outlining the radiological diagnostics for Lisfranc injuries.

 

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Conflict of Interest

The authors declare that they have no conflict of interest.

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Publication History

Received: 13 April 2025

Accepted after revision: 25 June 2025

Article published online:
11 August 2025