Dynamic Stress MRI of Midfoot Injuries: Measurable Morphology and Laxity of the Sprained Lisfranc Ligament During Mechanical Loading

Abstract

Case: Our 26-year-old patient is a professional ballet dancer who suffered a classic Lisfranc joint injury while performing a dancing maneuver with his foot in full plantar flexion. Initial workup with radiographs revealed borderline Lisfranc interval widening without definitive joint instability. Further evaluation with an innovative dynamic stress magnetic resonance imaging (MRI) revealed mild interosseous Lisfranc ligament laxity and sprain, which allowed the orthopaedic surgeon to pursue conservative management, rather than surgery. After physical therapy, our patient reports a successful return to dancing. Conclusions: Dynamic stress MRI may become a useful technique in evaluating equivocal cases of midfoot injury through the use of new imaging-based criteria.

Lisfranc Sprain with Second Metatarsal Base Adaptive Stress Response in High-Level Athletes: Case Series and Novel Perspective on a Distinct Entity of Chronic Low-Energy Lisfranc Injury

“…We also note that stress fractures reported in ballet dancers characteristically occur at the base of the second metatarsals [ 19 ]. Whilst acknowledging that Lisfranc ligamentous injury is uncommon in ballet dancers given the en pointe position which imparts compressive rather than shearing force across the TMT joints [ 9 , 20 ], there is paucity of literature on MRI correlate of ballet dancers with second metatarsal base fractures and Lisfranc ligaments in this cohort of patients. This would be an important area of research because the imaging of these second metatarsal base fractures described in literature are quite similar to our cases, involving the plantar Lisfranc footprints at metatarsal bases [ 9 ].…”