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SET T0016 -
Emergency Department

CASE 1

HISTORY	HISTORY Fell over. Midfoot and forefoot somewhat swollen and tender. Walking has been painful for the last week or two, and is now rather worse following the fall.
QUESTION	QUESTION Normal or abnormal?
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW Evidence of a stress fracture of the 3rd metatarsal. Otherwise - normal appearances. Specifically - the 2nd and 3rd Lisfranc joints are anatomically in correct alignment. a). Unsure about the normal appearance of the Lisfranc joints? b). Are you aware of a pitfall in relation to overlooking a Lisfranc injury on the radiographs - specifically when your clinical suspicion in relation to the tarso-metatarsal joints is particularly high? *See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 295-297 and 306*

CASE 2

HISTORY	HISTORY Fell down a long flight of stairs. Really painful foot; cannot bear weight.
QUESTION	QUESTION Normal or abnormal?
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW Detached fracture fragment at the 2nd Lisfranc joint; also, lateral subluxation at this joint.

CASE 3

HISTORY	HISTORY Horse rider. Foot caught in a stirrup when dismounting. Painful midfoot and forefoot.
QUESTION	QUESTION Normal or abnormal?
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW The oblique view : the 3rd Lisfranc joint is anatomically aligned. The straight AP view : subluxation at the 2nd Lisfranc joint. The normal and abnormal appearances at the 2nd and 3rd Lisfranc joints are elegantly and helpfully illustrated by Philip Wilson, the medical artist . . . *See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 295-297*

CASE 4

HISTORY	HISTORY Painful foot for some time. Today the foot is swollen after a trip over some furniture. Midfoot and forefoot really painful and swollen.
QUESTION	QUESTION Normal or abnormal?
RADIOGRAPHS	RADIOGRAPHS
ANSWER	ANSWER VIEW The normal 2nd and 3rd Lisfranc joint alignments are well shown on these oblique and straight AP radiographs. The exuberant callus around the neck of the 3rd metatarsal represents a stress fracture. This explains the long standing forefoot pain in this patient (an enthusiastic jogger).

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