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Mascot Case Illustrates Presentation
- The hosts use a humorous case of a 20-year-old run over by his girlfriend in a Red Sox mascot costume to introduce Lisfranc injury recognition.
- The patient initially ambulated but later refused weight-bearing with a widened C1–M2 joint space on x-ray.
Order CT For Suspected Lisfranc Instability
- If AP x-ray shows >2 mm gap between C1 and M2, order a CT of the foot for definitive mapping and preoperative planning.
- Treat most unstable Lisfranc injuries with operative fixation (ORIF) after CT guidance.
Key Anatomy And Radiographic Threshold
- The Lisfranc ligament runs from the first cuneiform (C1) to the base of the second metatarsal (M2) and stabilizes the midfoot arch.
- A C1–M2 gap >2 mm on AP or instability on weight-bearing films indicates a Lisfranc injury.