Subtle findings of a Lisfranc (tarsometatarsal) injury

Subtle findings of a Lisfranc injury are found in the plain radiographs above. The image on the left (A) is a non-weightbearing anteroposterior radiograph showing minimal displacement between the first and second metatarsals that can easily be missed. The image on the right (B) is a weightbearing film, which accentuates the diastasis and demonstrates a wide gap between the metatarsals. The weightbearing study also shows loss of alignment of the medial borders of the second metatarsal and second cuneiform.