Subtle Lisfranc Injury

Subtle Lisfranc injuries are seen less often than high energy displaced Lisfranc injuries. They typically occur during athletic activity resulting from low-energy mechanisms. These injuries pose diagnostic and treatment challenges to the clinician. Therefore, one must have a high index of suspicion for an unstable Lisfranc injury when the diagnosis of a mid-foot sprain is made. Appropriate diagnostic work up with weight-bearing radiographs and other studies, if needed, must follow. Treatment of an unstable subtle Lisfranc injury requires open reduction and stable fixation for the best long-term results. When the diagnosis is missed, leading to inappropriate treatment, outcomes are poor. This article will focus on diagnosis and management of subtle Lisfranc injuries, proximal variants, and the use of bridge plating as an option for surgical stabilization.