This 24-year-old male futsal player presents following an injury to his left foot. He describes forcibly plantarflexing his foot as he contested for a ball. He experienced immediate pain and had to be removed from the field. Following the injury, he developed generalised swelling of his foot. When he presented for review five days after his injury, he was able to walk with a limp. He was unable to do a calf raise or hop without pain. There was localised tenderness over the Lisfranc interval (between the bases of the 1st and 2nd metatarsals).
An AP x-ray of the foot is normal. There is high T2 and intermediate T1 signal within the Lisfranc ligament without discontinuity of the ligament. The appearances are most consistent with a moderate sprain. There is no widening of the Lisfranc joint to suggest an unstable injury.
This player was managed with a short period (less than two weeks) of rest in a walking boot with a medial posted orthotic. He was then able to walk without pain in a running shoe. He was able to progressively return to football at about seven weeks following his injury. His foot was taped to support his longitudinal arch while in his football boot.
The Lisfranc joint is a complex structure that provides significant stability to the foot. Unfortunately, football players suffer a much higher rate of midfoot sprains compared to the general population. A spectrum of injury is seen ranging from a mild, stable sprain (like this case) to a severe fracture-dislocation. They can frequently lead to relatively long-term morbidity and can be difficult to manage. X-rays are an important assessment tool – and must be done while weight-bearing as an unstable injury may reduce at rest and be hard to visualise. Findings can be very subtle and comparison views with the other side can be useful. Widening of the first and second metatarsal space is an important finding and implies an unstable injury. In these situations, surgical treatment is generally needed. MRI and CT imaging can also be used to further define this injury. Restoration and maintenance of the anatomic alignment of the Lisfranc joint is the key to the appropriate treatment of this injury.
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.