01Approach to the Critical Patient/attcp35

Immediate priorities

›Neurovascular compromise recognition

›Absent or diminished dorsalis pedis pulse

›Capillary refill delay greater than 2 seconds

›Pallor or cyanosis of toes

›If neurovascular compromise present, emergent orthopedic consultation and reduction

›Compartment syndrome recognition

›Pain out of proportion to apparent injury

›Pain with passive toe extension

›Tense, woody swelling of foot compartments

›Paresthesias in web spaces

›If compartment syndrome suspected, avoid excessive analgesia that masks evolving symptoms

›If compartment syndrome confirmed, emergent fasciotomy

›Open fracture identification

›Skin breach overlying midfoot

›Gross contamination assessment

›If open fracture, IV antibiotics within 1 hour and emergent orthopedic consult

Hemodynamic and monitoring targets

›Vital sign monitoring

›Continuous pulse oximetry for patients in procedural sedation

›Heart rate and blood pressure monitoring during conscious sedation

›Temperature monitoring for open fracture or infection concern

›High-energy polytrauma screen

›Associated calcaneal fracture

›Spinal compression fracture

›Contralateral extremity injury

›If polytrauma, trauma team activation

02History/hx50

Mechanism of injury

›Injury mechanism patterns

›Axial compression through plantarflexed foot

›Twisting force with foot fixed

›Foot caught in stirrup during equestrian activity

›Foot on brake pedal at impact in motor vehicle collision

›Landing from jump with plantarflexed foot

›Stepping off curb or misstep on uneven surface

›Energy level classification

›Low-energy mechanisms

›Tripping, sports pivoting, simple fall

›Easily mistaken for midfoot sprain

›High-energy mechanisms

›Motor vehicle collision, fall from height, crush injury

›Produce obvious fracture-dislocations

Symptom characterization

›Pain features

›Midfoot pain localized to tarsometatarsal region

›Pain worse with weightbearing

›Often complete inability to bear weight after injury

›Pain onset in relation to injury timing

›Swelling and bruising

›Onset and progression of swelling

›Plantar ecchymosis — highly suggestive of Lisfranc injury

›Prior foot injuries for comparison

›Neurological symptoms

›Numbness or tingling in the foot

›Paresthesias in first web space suggesting deep peroneal nerve involvement

03Physical Exam/exam29

Inspection

›Midfoot appearance

›Swelling localized to tarsometatarsal region

›Plantar ecchymosis — pathognomonic when present

›Dorsal foot deformity or bony prominence

›Open wounds or skin breach

›Gross midfoot deformity suggesting fracture-dislocation

›Lisfranc jut sign

›Bony prominence on medial border of first tarsometatarsal joint

›Suggests subluxation in subtle or missed injuries

›Compare with contralateral foot

Palpation

›Tenderness localization

›Tarsometatarsal articulations first through fifth

›Lisfranc ligament zone between first and second metatarsal bases and medial cuneiform

›Navicular and cuboid for associated injuries

›Base of second metatarsal — most sensitive anatomic landmark

›Compartment assessment

›Firmness and tension of dorsal foot compartments

›Intrinsic muscle compartments of foot

›Pain with passive extension of toes

Provocative maneuvers

›Stability testing

›Midfoot squeeze test: Compress forefoot medially and laterally reproducing midfoot pain

›Piano key test: Dorsiflexion and plantarflexion of individual metatarsals producing TMT joint pain

›Passive abduction and pronation stress with hindfoot stabilized

›Neurovascular examination

›Dorsalis pedis pulse quality and symmetry

04Differential Diagnosis/ddx38

Midfoot and forefoot injuries

›Midfoot sprain

›ICD-10: S93.329A — sprain of other ligament of foot

›Most common misdiagnosis for Lisfranc injury

›Distinguished by persistent pain beyond 10 days, inability to bear weight, and positive imaging

›No diastasis or malalignment on weightbearing radiographs

›Metatarsal base fracture

›ICD-10: S92.30XA — fracture of metatarsal bone

›Isolated fracture without TMT joint disruption

›Multiple simultaneous metatarsal fractures should raise suspicion for Lisfranc

›Fifth metatarsal fracture variants

›Jones fracture at metaphyseal-diaphyseal junction

›Avulsion fracture of base of fifth metatarsal

›Tenderness more lateral, different radiographic zone

Tarsal and midfoot fractures

›Navicular fracture

›ICD-10: S92.00XA — fracture of calcaneus

›Tenderness more dorsomedial

›Stress fracture variant has insidious onset

›Cuboid fracture

›ICD-10: S92.219A — fracture of cuboid bone

›May coexist with Lisfranc injury

›Isolated lateral column pain

›Cuneiform fracture

›ICD-10: S92.25XA — fracture of cuneiform

›May be part of Lisfranc complex or isolated

›Chopart joint injury

›More proximal midfoot and hindfoot pain

05Laboratory Tests/lt21

Pre-operative assessment

›Surgical planning labs when operative management anticipated

›Complete blood count for baseline hemoglobin and platelet count

›Basic metabolic panel for electrolytes and renal function

›Coagulation studies (PT, INR, aPTT) in anticoagulated patients

›Type and screen if significant blood loss anticipated

›Metabolic optimization

›HbA1c in diabetic patients for wound healing and surgical planning risk

›HbA1c greater than 7.5% mmol/mol associated with increased surgical complications

›Serum glucose in diabetic patients

›Vitamin D level if osteoporosis concern and surgical planning

Infection and open fracture assessment

›Inflammatory markers when infection suspected

›White blood cell count with differential

›C-reactive protein as baseline for open fracture or suspected infection

›Erythrocyte sedimentation rate if chronic osteomyelitis concern

›Wound culture if open fracture present

›Superficial swab has limited utility — deep tissue preferred

›Gram stain to guide initial antibiotic coverage

DVT prophylaxis monitoring

›Anticoagulation monitoring during prolonged non-weightbearing

›Baseline CBC before initiating prophylactic anticoagulation

›Renal function for dosing of low-molecular-weight heparin

›DVT prophylaxis indicated per institutional protocol for non-weightbearing patients

06Diagnostic Tests/dt87

Scoring Systems

›Nunley-Vertullo Classification (athletic and low-energy injuries)

›Stage I: No diastasis on weightbearing radiographs; positive bone scan or MRI

›Intact osseous architecture

›Sprains of Lisfranc ligament without instability

›Managed nonoperatively in most cases

›Stage II: Diastasis 1 to 5 mm on weightbearing films; no arch height loss

›Partial ligamentous disruption

›Surgical fixation generally recommended

›Stage III: Diastasis greater than 5 mm with loss of arch height

›Complete ligamentous disruption

›Operative fixation mandatory

›Stability-based classification

›Increasingly favored over anatomy-based systems for treatment decisions

›Stable: Nondisplaced, intact ligaments confirmed on MRI

›Unstable: Any displacement, diastasis 2 mm or greater, or fleck sign on radiograph

›Intraoperative stress exam under fluoroscopy is gold standard when imaging equivocal

›Ottawa Foot Rules

›Bone tenderness at base of fifth metatarsal

›Bone tenderness at navicular

›Inability to bear weight immediately and in ED

›If any criterion positive, radiographs indicated

›Ottawa rules developed for metatarsal and navicular fractures; not specific to Lisfranc

MRI

›MRI indications and protocol

›Best modality for evaluating Lisfranc ligamentous integrity

›Indicated when radiographs negative or equivocal with persistent clinical suspicion

›Critical for determining operative versus nonoperative management in subtle injuries

›No ionizing radiation — preferred in younger patients and athletes

›MRI findings in Lisfranc injury

›Lisfranc ligament disruption on coronal and axial sequences

›Interosseous Lisfranc ligament between medial cuneiform and base of second metatarsal

›Dorsal Lisfranc ligament complex disruption

›Plantar ligament tears associated with worst instability

›Bone marrow edema at tarsometatarsal joints

›Joint effusions at TMT articulations

›Occult fractures not visible on plain radiograph or CT

›MRI performance

›Sensitivity for Lisfranc ligament tears: 94 to 100%

›Specificity: 75 to 100% depending on ligament assessed

›ACR Appropriateness Criteria: Usually appropriate for suspected ligamentous Lisfranc injury with negative radiographs

CT

›CT indications

›Radiographs negative or equivocal with high clinical suspicion

›Surgical planning to define fracture fragments and comminution

›Detection of subtle subluxation missed on plain radiograph

›Non-contrast CT of the foot without IV contrast required

›CT findings

›Diastasis between metatarsal bases and cuneiforms

›Occult fractures at metatarsal bases and cuneiform margins

›Fleck sign avulsion fragment between first and second metatarsal bases

›Subluxation at individual TMT articulations

›3D CT diagnostic signs

›Mercedes sign: Three-way separation of metatarsal bases

›Sensitivity 92 to 97%, specificity 92 to 93%

›Peeking metatarsal sign: Metatarsal base visible beyond cuneiform margin

›Sensitivity 92%, specificity 93%

›Peeking cuneiform sign: Cuneiform edge protruding beyond metatarsal

›Bilateral CT comparison improves surgical decision-making for subtle injuries

›CT limitations

›Non-weightbearing CT may underestimate instability compared to weightbearing radiographs

›Cannot assess ligament integrity directly (MRI required)

Ultrasound

›Ultrasound role in Lisfranc injury

›Limited primary role compared to radiograph and CT

›May identify Lisfranc ligament disruption as hyperechoic gap or irregularity

›Useful for guiding aspiration of hematoma or joint effusion

›Dynamic assessment of TMT joint instability with stress maneuvers possible

›Point-of-care ultrasound applications

›Rule out vascular injury to dorsalis pedis artery with Doppler

›Guide procedural nerve blocks (deep peroneal, tibial nerve) for pain management

›Identify periarticular fluid collections

›Ultrasound limitations

›Operator-dependent

›Not routinely recommended as primary imaging for Lisfranc diagnosis

›ACR Appropriateness Criteria: Usually not appropriate as primary diagnostic modality

Plain Radiography

›First-line imaging

›Weightbearing AP, lateral, and oblique views of the foot bilaterally for comparison

›Non-weightbearing radiographs unreliable for detecting subtle injuries

›Both feet should be imaged for comparison

›Key radiographic signs

›AP view findings

›M1-M2 diastasis 2 mm or greater between first and second metatarsal bases

›Loss of alignment of second metatarsal medial cortex with medial cuneiform

›Fleck sign: Small bony avulsion fragment between first and second metatarsal bases

›Indicates avulsion of Lisfranc ligament — implies instability

›Oblique view findings

›Loss of alignment of fourth metatarsal medial cortex with cuboid

›Lateral view findings

›Loss of dorsal metatarsal-cuneiform alignment

›Plantar step-off at TMT joint

07Disposition/dispo26

Discharge criteria

›Safe discharge requirements

›Stable injury confirmed on weightbearing radiographs or imaging

›Adequate pain control with oral analgesics

›Non-weightbearing status maintained with crutches or knee scooter

›No signs or symptoms of compartment syndrome

›Reliable orthopedic follow-up confirmed within 5 to 7 days

›Patient understands return precautions explicitly

Admission and urgent consultation criteria

›Indications for admission

›Gross fracture-dislocation requiring urgent reduction

›Compartment syndrome confirmed or evolving

›Open fracture requiring irrigation and debridement

›Neurovascular compromise

›Polytrauma with associated injuries

›Inability to maintain non-weightbearing (social or functional barriers)

›Orthopedic consultation triggers

›All confirmed Lisfranc injuries require orthopedic discussion

›Urgent consultation for displaced or unstable injuries

›Emergent consultation for open fractures, neurovascular compromise, and compartment syndrome

Follow-up planning

›Outpatient follow-up

›Orthopedic follow-up within 5 to 7 days for all ED-diagnosed Lisfranc injuries

›Repeat weightbearing radiographs at 10 to 14 days if initial films negative but suspicion high

›Close follow-up to ensure no interval displacement on serial imaging

›Transfer considerations

›Transfer to facility with orthopedic surgery if emergent operative capability unavailable

›Stabilize neurovascular status before transfer

08Treatment/t68

Initial ED management

›Immediate stabilization

›Non-weightbearing status enforced immediately

›Posterior short-leg splint application

›Neutral ankle position (90 degrees)

›Adequate padding over bony prominences

›Post-application neurovascular check

›Limb elevation above heart level

›Ice application for first 48 hours

Analgesia

›Pain management

›Topical NSAIDs for mild to moderate pain

›Diclofenac gel 1% applied to midfoot three to four times daily

›Oral NSAIDs

›Ibuprofen 400 to 600 mg orally every 6 to 8 hours with food

›Naproxen 500 mg orally every 12 hours

›ACP and AAFP Level B recommendation for musculoskeletal injury pain

›Acetaminophen

›650 to 1000 mg orally every 6 to 8 hours

›Maximum 3000 mg per 24 hours (2000 mg in hepatic disease or alcohol use)

›Multimodal analgesia combining NSAID and acetaminophen reduces opioid requirement

›Opioids

›Reserve for severe pain from fracture-dislocations only

›Short course only (3 to 5 days maximum in ED discharge prescriptions)

›Tramadol not recommended — no better than placebo for acute musculoskeletal pain

›Avoid excessive regional analgesia in patients at risk for compartment syndrome

Reduction of gross dislocation

›Emergency reduction indications

›Neurovascular compromise requiring emergent reduction

›Gross fracture-dislocation with tenting of skin

›Unable to delay for definitive operative fixation

›Procedural sedation

›Procedural sedation required for closed reduction

›Adequate relaxation essential for successful reduction

›Reassess neurovascular status immediately post-reduction

›Fluoroscopy confirms alignment when available

Nonoperative management

›Stable nondisplaced injuries

›Short-leg non-weightbearing cast or boot for 4 to 6 weeks

›Strict non-weightbearing for entire immobilization period

›Progress to weightbearing cast or boot for 2 to 4 additional weeks

›Repeat weightbearing radiographs to confirm no interval displacement

›Athletes with stable nondisplaced injuries and intact ligaments on MRI

›Return to sport possible in 6 to 10 weeks

›Physiotherapy directed at proprioception and arch support

›Custom orthotics and arch support at long-term follow-up

Operative management

›Surgical fixation indications

›Displacement 2 mm or greater at any TMT articulation

›Fleck sign indicating ligamentous instability

›Failure of nonoperative management with persistent instability

›Most Lisfranc injuries qualify as unstable and require operative fixation

›ORIF with bridge plating or screw fixation

›Most common operative approach

›Bridge plating consensus trending preferred over transarticular screws

›Suture button fixation for ligamentous injuries

›Emerging technique with promising early results

›Lower reoperation rates in purely ligamentous injuries

›Postoperative non-weightbearing 8 to 12 weeks

›Return to full weightbearing at 3 to 4 months

›Return to sport 4 to 6 months postoperatively

›Primary arthrodesis

›Considered for comminuted injuries or non-salvageable joint surfaces

›Lower post-traumatic arthritis rates: 2.8% vs 17.3% compared to ORIF

›Lower unplanned reoperation rates: 14.7% vs 38.3% compared to ORIF

›Appropriate for medial column (first through third TMT joints)

›Lateral column (fourth and fifth TMT joints) generally not fused due to mobility requirements

DVT prophylaxis

›Anticoagulation during immobilization

›DVT prophylaxis considered for prolonged non-weightbearing immobilization

›Low-molecular-weight heparin preferred

›Enoxaparin 40 mg subcutaneously once daily (standard dose)

›Adjust for renal impairment (CrCl less than 30 mL/min: 20 mg daily)

›Duration: Continue throughout non-weightbearing period per institutional protocol

09Special Populations/sp51

Pregnancy

›Physiologic considerations in pregnancy

›Musculoskeletal changes predisposing to injury

›Relaxin-mediated ligamentous laxity increases midfoot instability risk

›Weight gain increases axial load through tarsometatarsal joints

›Altered gait and center of gravity increase fall risk

›Imaging in pregnancy

›Radiographic evaluation acceptable with abdominal shielding for suspected Lisfranc

›Radiation dose to foot radiographs minimal, well below teratogenic threshold

›MRI preferred over CT for further evaluation to avoid radiation exposure

›CT acceptable if MRI unavailable and clinical decision is urgent

›Treatment modifications

›NSAIDs contraindicated in third trimester due to premature ductus arteriosus closure

›Acetaminophen preferred analgesic in pregnancy — all trimesters

›Opioids with caution, particularly near delivery; neonatal abstinence risk

›Low-molecular-weight heparin safe for DVT prophylaxis in pregnancy

›Operative timing coordination with obstetric team for second and third trimester patients

Geriatric

›Age-related considerations

›Osteoporosis increases fracture severity at lower energy mechanisms

›Peripheral neuropathy and vascular disease common comorbidities affecting presentation

›Falls as primary mechanism of injury in elderly patients

›Polypharmacy assessment for anticoagulants, steroids, and medications impairing bone healing

›Diagnostic considerations

›Low threshold for CT when plain radiographs appear negative with high clinical suspicion

›Bone density assessment may be relevant for surgical planning

›Cognitive impairment may limit reliable symptom reporting

›Treatment modifications

10Background/b61

Epidemiology

›Incidence and demographics

›Lisfranc injuries occur in approximately 1 per 55,000 persons per year

›Misdiagnosed in approximately 20% of cases on initial evaluation

›Slight male predominance: 54% of cases

›Mean age at injury: 43 years in men, 49 years in women

›Swedish Fracture Register study: 2084 Lisfranc injuries analyzed (2025)

›Mechanism distribution

›Low-energy mechanisms (simple falls, sports, stepping off curb) predominate

›High-energy mechanisms (motor vehicle collisions, crush injuries) produce more severe patterns

›Athletic injuries increasingly recognized in elite and recreational athletes

›Medicolegal significance

›Among most common causes of litigation against emergency physicians and radiologists

›20% misdiagnosis rate contributes to delayed care and poor outcomes

›Delayed diagnosis associated with worse functional outcomes and post-traumatic arthritis

Pathophysiology

›Anatomy of the tarsometatarsal joint complex

›Lisfranc joint: Tarsometatarsal articulations between all five metatarsal bases and tarsal bones

›Medial cuneiform articulates with first and second metatarsal bases

›Middle cuneiform articulates with second metatarsal

›Lateral cuneiform articulates with third metatarsal

›Cuboid articulates with fourth and fifth metatarsal bases

›Lisfranc ligament complex

›Interosseous Lisfranc ligament: Between medial cuneiform and base of second metatarsal

›Strongest ligament in the complex

›Primary stabilizer of the medial column

›Dorsal Lisfranc ligament: Weaker, often injured first

›Plantar Lisfranc ligament: Strongest component; disruption indicates severe instability

›No intermetatarsal ligament between first and second metatarsal — Lisfranc ligament only connection

›Injury mechanism

›Axial compression through plantarflexed foot transmits force along metatarsal shafts to bases

›Twisting forces create rotational stress across TMT joint complex

›Spectrum of injury: Ligamentous sprain to complete fracture-dislocation

›Fleck sign represents avulsion of Lisfranc ligament at second metatarsal base

›Complications

›Post-traumatic arthritis: Most common long-term sequela

›Chronic midfoot pain and instability

›Arch collapse and flatfoot deformity

›Compartment syndrome: Tight fascial compartments of the foot susceptible after injury

›Neurovascular injury to dorsalis pedis artery and deep peroneal nerve

Therapeutic Considerations

›Nonoperative versus operative management evidence

›Purely ligamentous Lisfranc injuries have worse outcomes with nonoperative management if unstable

›Stable, nondisplaced injuries (confirmed on MRI): Nonoperative treatment with good outcomes

›Any diastasis 2 mm or greater is indication for operative fixation

›Operative technique considerations

›Bridge plating trending preferred over transarticular screws to avoid iatrogenic cartilage damage

›Suture button fixation advantages

›Preserves native joint motion

›Lower reoperation rates for ligamentous injuries

›Emerging evidence supports equivalence or superiority to screw fixation

›Primary arthrodesis vs ORIF debate

›Primary arthrodesis: Post-traumatic arthritis rate 2.8% vs 17.3% with ORIF

›Primary arthrodesis: Reoperation rate 14.7% vs 38.3% with ORIF

›Primary arthrodesis most appropriate for medial column injuries

›Return to sport evidence

›Over 90% of athletes return to sport after appropriate treatment

›Stable injuries: Return to sport 6 to 10 weeks

›Operative cases: Return to full activity 4 to 6 months

›2024 International Foot and Ankle Sports Consensus provides athlete-specific guidance

›Post-traumatic arthritis prevention

›Anatomic reduction reduces risk of post-traumatic arthritis

›Even with optimal treatment some degree of arthritis common after high-energy injuries

›Patient counseling about long-term prognosis and potential arthritis essential

11Patient Discharge Instructions/pdi32

copy discharge instructions

›Diagnosis and injury overview

›You have been diagnosed with a Lisfranc injury (midfoot injury involving the tarsometatarsal joints)

›This injury can range from a ligament sprain to a fracture-dislocation of the midfoot

›Your injury was evaluated and determined to be stable at this time

›Activity restrictions

›Do not bear any weight on your injured foot

›Use crutches or a knee scooter for all movement

›Keep your foot elevated above the level of your heart as much as possible

›Apply ice wrapped in a cloth for 20 minutes several times daily for the first 48 hours

›Splint and cast care

›Keep your splint or boot dry at all times

›Do not remove or adjust the splint

›If the splint feels too tight, return immediately to the emergency department — do not wait

›Medications

›Take ibuprofen or naproxen with food as directed for pain

›Take acetaminophen as directed if NSAIDs are not sufficient or not tolerated

›Do not take more than the prescribed dose of any medication

›Follow-up appointment

›You must see an orthopedic surgeon within 5 to 7 days — this appointment is mandatory

›Repeat weightbearing X-rays may be taken at your follow-up to confirm the injury has not shifted

›Return to the emergency department immediately if you experience any of these warning signs

›Severe or increasing pain that is not controlled by medications or elevation

›Numbness, tingling, or inability to move your toes

›Toes turning pale, blue, or cold

›Worsening swelling that does not improve with elevation

›Splint or boot feels increasingly tight

›Any open wound, drainage, or signs of infection (redness, warmth, foul odor)

12References/r24

Guidelines and key sources

›McDermott A, Repanshek Z, Koyfman A, Long B. High Risk and Low Incidence Diseases: Lisfranc Injury. American Journal of Emergency Medicine. 2024. PMID 39276688

›Comprehensive emergency medicine review; primary grounding source for ED management and disposition

›Lau S, Bozin M, Thillainadesan T. Lisfranc Fracture Dislocation: A Review of a Commonly Missed Injury of the Midfoot. Emergency Medicine Journal. 2017. PMID 27013521

›Clinical review of mechanism, exam findings, imaging, and treatment

›Siddiqui NA, Galizia MS, Almusa E, Omar IM. Evaluation of the Tarsometatarsal Joint Using Conventional Radiography, CT, and MR Imaging. Radiographics. 2014. PMID 24617695

›Detailed imaging review including fleck sign, diastasis criteria, and multimodal imaging

›Juto H, Mukka S, Wolf O, Moller M. Epidemiology, Classification, and Treatment of 2084 Lisfranc Injuries. Injury. 2025. PMID 39626601

›Large Swedish Fracture Register epidemiological study

›Semelsberger SD, Boggiano VJ, Webber K, et al. Diagnostic Evaluation and Nonoperative Management of Lisfranc Injuries in Athletes. Knee Surgery Sports Traumatology Arthroscopy. 2025. PMID 41451696

›Athletic population management and return to sport evidence

›Poutoglidou F, van Groningen B, McMenemy L, Elliot R, Marsland D. Acute Lisfranc Injury Management. Bone and Joint Journal. 2024. PMID 39615511

›Current management guidelines including ORIF vs arthrodesis evidence

›O'Connor KP, Tackett LB, Riehl JT. Primary Arthrodesis Versus ORIF for Acute Lisfranc Injuries: Systematic Review and Meta-Analysis. Archives of Orthopaedic and Trauma Surgery. 2024. PMID 39680239

›Post-traumatic arthritis 2.8% vs 17.3% and reoperation 14.7% vs 38.3% data

Imaging and classification sources

›Expert Panel on Musculoskeletal Imaging, Gorbachova T, Chang EY, et al. ACR Appropriateness Criteria: Acute Trauma to the Foot. Journal of the American College of Radiology. 2020

›ACR guidance on appropriate imaging modality selection

›Tamir E, Essa A, Levi A, et al. Lisfranc Injury Diagnosis: Diagnostic Reliability of New Radiographic Signs Using 3D CT. Clinical Orthopaedics and Related Research. 2023. PMID 37078895

›Mercedes sign, peeking metatarsal sign, peeking cuneiform sign sensitivity 92 to 97%

›Nunley JA, Vertullo CJ. Classification, Investigation, and Management of Midfoot Sprains: Lisfranc Injuries in the Athlete. American Journal of Sports Medicine. 2002. PMID 12435655

›Nunley-Vertullo Classification Stage I to III original publication

›Herscovici D, Scaduto JM. The Lisfranc Jut: A Physical Finding of Subtle Lisfranc Injuries. Injury. 2021. PMID 33413925

›Description of Lisfranc jut sign for subtle injury detection

›Balboni JM, Levine AR, Boggiano VJ, et al. Operative Treatment of Lisfranc Injuries in Elite Athletes: 2024 International Foot and Ankle Sports Consensus. Knee Surgery Sports Traumatology Arthroscopy. 2026. PMID 41649218

›International consensus on operative management in athletes

Evidence & Review

Evidence & Review