Tarsal & Metatarsal Injuries
Midfoot and forefoot injuries are common but often missed. Differentiating between a simple sprain and a major architectural injury like Lisfranc is critical to prevent chronic pain.
1. Lisfranc Injury (Tarsometatarsal)
- Anatomy: Disruption of the ligament between the Medial Cuneiform and 2nd Metatarsal Base (The Keystone).
- Sign: Plantar Ecchymosis (Bruising on the sole of the foot) is pathognomonic. Gap between 1st and 2nd toes.
- Treatment: ORIF (Screws) to stabilize the arch.
2. 5th Metatarsal Fractures
Zone 1 (Pseudo-Jones): Avulsion of the tuberosity (Peroneus Brevis pull). Heals well.
Zone 2 (Jones Fracture): Metaphyseal-Diaphyseal junction. Poor blood supply -> High non-union risk. Requires NWB cast or screw fixation.
Zone 3: Shaft stress fracture.
Zone 2 (Jones Fracture): Metaphyseal-Diaphyseal junction. Poor blood supply -> High non-union risk. Requires NWB cast or screw fixation.
Zone 3: Shaft stress fracture.
3. March Fracture
- Definition: Stress fracture of the 2nd or 3rd Metatarsal neck/shaft.
- Cause: Overuse (e.g., new military recruits marching).
- Treatment: Rest, Stiff-soled shoe.
25 Practice MCQs
Q1. The Lisfranc ligament connects:
Answer: A). Crucial for arch stability.
Q2. A Jones Fracture is located at:
Answer: A). The vascular watershed area.
Q3. Plantar ecchymosis is a highly specific sign for:
Answer: A). Indicates midfoot ligament rupture.
Q4. March Fracture affects:
Answer: A). Stress fracture due to fatigue.
Q5. Pseudo-Jones fracture (Avulsion) is caused by:
Answer: A). Occurs during inversion injury.
Q6. Navicular fractures are high risk for:
Answer: A). Like the scaphoid and talus.
Q7. Treatment for displaced Lisfranc injury is:
Answer: A). Anatomical reduction is essential to prevent arch collapse.
Q8. "Fleck Sign" on X-ray between 1st and 2nd metatarsal indicates:
Answer: A). Subtle sign of major instability.
Q9. In Jones fracture, intramedullary screw fixation is recommended for:
Answer: A). Reduces risk of non-union and return to sport time.
Q10. Chopart Joint is:
Answer: A). Connects hindfoot to midfoot.
Q11. Nutcracker fracture of the Cuboid results from:
Answer: A). Cuboid is crushed between calcaneus and metatarsals.
Q12. Treatment for March fracture is:
Answer: A). Conservative.
Q13. Kohler's Disease is:
Answer: A). Self-limiting osteochondrosis.
Q14. Which metatarsal is the "Keystone" of the transverse arch?
Answer: A). Locked in the mortise between cuneiforms.
Q15. Weight bearing X-rays are essential for:
Answer: A). Stress view.
Q16. Freiberg's Infarction affects:
Answer: A). Flattening of the head in adolescents.
Q17. The "Homolateral" type of Lisfranc dislocation means:
Answer: A). Divergent is 1st medial, others lateral.
Q18. Hard Corn (Clavus) usually forms:
Answer: A). Due to shoe pressure.
Q19. Iselin's Disease is:
Answer: A). Similar to Osgood-Schlatter but in foot.
Q20. Hardware removal in Lisfranc is typically:
Answer: A). Screws break if left too long as the arch is flexible.
Q21. Dancer's Fracture is:
Answer: A). Distal to Jones fracture.
Q22. Navicular stress fracture typically presents with:
Answer: A). "N-spot" tenderness.
Q23. Os Naviculare is:
Answer: A). Tibialis posterior attaches here.
Q24. Compartment syndrome of the foot has:
Answer: A). Medial, Lateral, Superficial, Adductor, 4 Interossei, Calcaneal.
Q25. Primary arthrodesis for Lisfranc is reserved for:
Answer: A). Ligaments heal poorly; fusion is predictable.
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