title: Lisfranc injury in a west point cadet.
abstract: BACKGROUND
  Lisfranc joint injuries are fairly uncommon; however, few injuries hold such an elevated potential for devastating chronic secondary pain and disability. It is imperative when evaluating an injury to the ankle or foot to have a high clinical index of suspicion for Lisfranc injury, as physical examination findings are often subtle.
  
  
  METHODS
  An 18-year-old military cadet reported to a direct-access sports physical therapy clinic with foot pain. Despite negative radiographic findings, there was a high suspicion for Lisfranc injury based on the injury mechanism and physical examination. A computed tomography scan demonstrated an oblique fracture through the base of the third metatarsal, a small marginal fracture at the plantar base of the second metatarsal, and a subtle diastasis. Two days following his injury, he underwent an open reduction and internal fixation, completed subsequent rehabilitation, and returned to full activity approximately 1 year following injury.
  
  
  CONCLUSIONS
  Early diagnosis of Lisfranc injuries is imperative for proper management and prevention of a poor functional outcome. If a strong clinical suspicion exists, negative radiographic findings are insufficient to rule out a Lisfranc injury, and therefore, advanced imaging is required.
authors.affiliation: US Army-Baylor University Post Professional Sports Medicine-Physical Therapy Doctoral Residency, West Point, New York.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Diebal
authors.affiliation: US Army-Baylor University Post Professional Sports Medicine-Physical Therapy Doctoral Residency, West Point, New York ; Regis University Orthopedic Manual Physical Therapy Fellowship, Denver, Colorado.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Westrick
authors.affiliation: Keller Army Community Hospital, West Point, New York.
authors.forename: Curtis
authors.initials: C
authors.lastname: Alitz
authors.affiliation: US Army-Baylor University Post Professional Sports Medicine-Physical Therapy Doctoral Residency, West Point, New York.
authors.forename: J Parry
authors.initials: JP
authors.lastname: Gerber
keywords: Lisfranc; foot sprain; tarsometatarsal joint injury