OK- messing up the images with colour overlays. 


There is a thickened and oedematous Lisfranc ligament (1st intermetarsal space) consistent with Lisfranc ligament sprain/partial tear. 


Note mild widening of the Lisfranc joint. 

The Lisfranc joint injury spans a spectrum from strain to frank dislocation. We've talked about it here before. 


The Lisfranc ligament is also called the first intermetatarsal ligament and bridges the medial cuneiform with the base of the 2nd metatarsal. The other metatarsals are connected by intermetatarsal ligaments which are transverse in orientation. The 1st intermetarsal joint has no transverse ligament. This effectively jams the base of the 2nd metatarsal into the cuneiform on weight-bearing (a keystone effect).


Lisfranc injuries manifest as a step off at the base of the 2nd metatarsal relative to the cuneiforms. Patients also cannot tip-toe due to pain.