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WEIGHT BEARING X-RAY FOR LISFRANC INSTABILITY
Why weight-bearing views matter for Lisfranc joint injury
- Early diagnosis of Lisfranc instability is crucial to prevent premature osteoarthritis in the mid foot.
- Subtle instability patterns can be very difficult to identify on x-rays.
- Plain radiographs may not effectively identify instability at the Lisfranc joint, especially on non-weight-bearing views.
- Weight-bearing x-rays are important as they reveal subtle differences between the injured and uninjured sides.
- However, weight bearing may not be possible in the acute phase due to pain.
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Look for lateral displacement of the second metatarsal in relation to the intermediate cuneiform on weight-bearing radiographs. A step-off of more than 3mm is abnormal.
Measure the distance between the medial cuneiform and the base of the second metatarsal on weight-bearing radiographs. A distance of more than 2.1mm is abnormal.
- Comparison views of the contralateral foot are also very useful.
- Do both non-weight-bearing and weight-bearing comparison views.
- Subtle instability and widening can be easier to recognize when there is a direct comparison with the normal side.
- Weight-bearing radiographs provide greater reliability in diagnosing Lisfranc instability compared to non-weight-bearing views, revealing subtle differences between the injured and uninjured sides.
- A C2–M2 step-off of more than 3mm between the second metatarsal and the intermediate cuneiform suggests instability.
- A C1–M2 distance of more than 2.1mm between the medial cuneiform and the base of the second metatarsal suggests instability.
- Comparison views of the contralateral foot, both weight-bearing and non-weight-bearing, help identify subtle instability.
- Early diagnosis is important to prevent premature osteoarthritis developing in the mid foot.
Plain radiographs may not effectively identify instability at the Lisfranc joint on non-weight-bearing views. Weight-bearing x-rays reveal subtle differences between the injured and uninjured sides that non-weight-bearing views can miss.
A step-off of more than 3mm between the second metatarsal and the intermediate cuneiform on weight-bearing radiographs.
A distance of more than 2.1mm between the medial cuneiform and the base of the second metatarsal on weight-bearing radiographs.
Subtle instability and widening can be easier to recognize when there is a direct comparison with the normal, uninjured side, ideally with both weight-bearing and non-weight-bearing views.
Early diagnosis is crucial to prevent premature osteoarthritis developing in the mid foot.
VIEW VIDEO: WEIGHT BEARING X-RAY LISFRANC INSTABILITY
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