The left foot x-rays reveal a Lisfranc injury.

The Lisfranc joint, between the base of 1st and 2nd metatarsal base, is widened; there is a lateral shift of the base of the 2nd metatarsal with respect to the medial border of the intermediate cuneiform.

A Lisfranc injury involves the mid-foot at the level of the tarso metatarsal joints. Most commonly, there is a fracture of the base of the 2nd metatarsal with displacements of the 2nd to 5th metatarsals laterally.

Radiological signs that may point to the diagnosis are:

• On the AP view, discontinuity of a line drawn from the medial base of the 2nd metatarsal to the medial side of the intermediate cuneiform.
• Widening of the joint space between the 1st and 2nd metatarsal base. There may be a bony fragment in this space, i.e. fleck sign.
• On the lateral view, dorsal displacement of the base of the 1st/2nd metatarsal.
• On the oblique view, the medial side of the base of the 4th metatarsal does not align with the medial side of the cuboid.

A CT scan is useful for diagnosis and pre-op planning.

Reference:

• Grainger & Allison’s Diagnostic Radiology, 6th Edition.
• www.orthobullets.com