Image on left is a coronal PD through the midfoot, and fat saturated PD on the right. What do you see?

There's thickening of the Lisfranc ligament (the ligament connecting the medial cuneiform with the base of the 2nd metatarsal bone). There's no joint widening, and no fracture- and would be radiographically occult.


In civil society, this injury can be sustained during football injuries (or kicking someone's tires). In Napoleon's day, you would have a carriage roll over your foot, causing a fracture. Jacques Lisfranc, after whom the injury is named, is taught to treat this injury with a mid-forefoot amputation.


Ligament injuries can be classified as sprains or tears (in which case, there's discontinuity of the ligament). Clinically, there's localised tenderness and pain when squeezing the midfoot.


The injury is well demonstrated on a PD nonfat sat image- so look carefully.