Lisfranc Injury MRI has been advocated as a sensitive diagnostic test in evaluation of Lisfranc ligamentous complex (especially if the patient is not able to bear weight), and 3-D volumetric acquisitions have proven superiority over orthogonal proton density fat-suppressed imaging [33,38,41-45]. There is a high correlation between MRI and intraoperative findings for an unstable Lisfranc injury [44]. In the patient with a suspected Lisfranc injury and normal radiographs, the literature supports further advanced imaging by MRI and CT [21,33,43,46]. Acute Tendinous Rupture MRI tends to be used as a screening tool when one is not certain of the specific tendon injury or if concomitant osseous injury is suspected. Both MRI and US have been shown to be sensitive for the diagnosis of acute tendon rupture or dislocation in the foot [39]. In a surgically confirmed study, MRI was shown to have 83% sensitivity for diagnosing tendon and ligament traumatic injuries about the foot and ankle [37]. US Foot The importance of focused US examinations is emphasized in the literature [57,58]. Protocol-based US evaluation identified 97.4% of symptomatic abnormalities in the distal extremities (including the foot), with additional accuracy obtained with focused examination [57]. Lisfranc Injury Although the literature evidence is limited, US may hold promise as an alternative method to accurately evaluate for a significant Lisfranc injury providing direct and indirect assessment of the Lisfranc ligamentous complex as well as dynamic evaluation with weightbearing as demonstrated in a series of 10 patients [59]. Dorsal component of Lisfranc ligament is amenable to direct US evaluation [59,60], although this structure may not be critical for stability for the Lisfranc joint [20,32]. The physiologic deformation of the dorsal Lisfranc ligament resulting from functional loading emphasized the need for normative US data as well as proper positioning when bilateral evaluation is performed [61,62].
Acute Trauma to the Foot. Lisfranc Injury MRI has been advocated as a sensitive diagnostic test in evaluation of Lisfranc ligamentous complex (especially if the patient is not able to bear weight), and 3-D volumetric acquisitions have proven superiority over orthogonal proton density fat-suppressed imaging [33,38,41-45]. There is a high correlation between MRI and intraoperative findings for an unstable Lisfranc injury [44]. In the patient with a suspected Lisfranc injury and normal radiographs, the literature supports further advanced imaging by MRI and CT [21,33,43,46]. Acute Tendinous Rupture MRI tends to be used as a screening tool when one is not certain of the specific tendon injury or if concomitant osseous injury is suspected. Both MRI and US have been shown to be sensitive for the diagnosis of acute tendon rupture or dislocation in the foot [39]. In a surgically confirmed study, MRI was shown to have 83% sensitivity for diagnosing tendon and ligament traumatic injuries about the foot and ankle [37]. US Foot The importance of focused US examinations is emphasized in the literature [57,58]. Protocol-based US evaluation identified 97.4% of symptomatic abnormalities in the distal extremities (including the foot), with additional accuracy obtained with focused examination [57]. Lisfranc Injury Although the literature evidence is limited, US may hold promise as an alternative method to accurately evaluate for a significant Lisfranc injury providing direct and indirect assessment of the Lisfranc ligamentous complex as well as dynamic evaluation with weightbearing as demonstrated in a series of 10 patients [59]. Dorsal component of Lisfranc ligament is amenable to direct US evaluation [59,60], although this structure may not be critical for stability for the Lisfranc joint [20,32]. The physiologic deformation of the dorsal Lisfranc ligament resulting from functional loading emphasized the need for normative US data as well as proper positioning when bilateral evaluation is performed [61,62].