The LISFRANC JUT: A physical finding of subtle LISFRANC injuries.

Abstract

Low-energy Lisfranc injuries are uncommon and are often misdiagnosed as sprains. This results in a delay for the definitive treatment. The aim of this study is to discuss the physical finding of a midfoot "jut," that can be used to help diagnose subtle Lisfranc injuries, in patients who present with persistent midfoot pain after low-energy trauma. Between January 2015 through December 2019, patients previously diagnosed with a sprain, who were at least six weeks after their original injury, and presented with midfoot pain, were identified. All had a bony prominence on the medial border of the first tarsometatarsal joint, defined as a "jut", which produced pain. Standing radiographs demonstrated subluxation of the tarsometatarsal joint(s). Seven patients (5 females/2 males) presented as isolated injuries, with a mean age of 40.4 years. Mechanisms of injury were five falls, one from a sporting event, and one twisting injury. Time to diagnosis, from their date of injury, averaged 9.9 weeks. All underwent fixation. Follow-up averaged 13.7 months. At final follow-up none of the patients developed surgical site infections, wound dehiscence, loosening of implants, loss of reductions or a recurrence of the "jut". None of the patients demonstrated arthrosis and only one patient had a broken screw and declined further surgical intervention. Patients presenting with a history of low-energy trauma, a diagnosis of sprain, continued complaint of foot pain, and a "jut" on the medial border of the midfoot, should be evaluated for a subtle Lisfranc injury.