Acute Disruption of the Tarsometatarsal (Lisfranc's) Joints in a Ballet Dancer
Abstract:A 15-year-old female ballet dancer suffered acute midfoot pain when landing from a jump. Physical examination and imaging studies revealed acute disruption of the tarsometatarsal (Lisfranc's) joints with rupture of Lisfranc's ligament. Fluoroscopic examination under anesthesia confirmed instability of the first, second, and third tarsometatarsal joints. Treatment included operative open reduction and rigid internal fixation to re-establish stable alignment, and postoperative protection (non-weightbearing) in a bivalved cast. The screws were removed 14 weeks after fixation, and weightbearing and physiotherapy were advanced. Follow-up evaluation at 10 months after initial treatment showed maintenance of stable alignment. The patient had no pain at the tarsometatarsal joints, but there was pain at the metatarsal heads after dance activity. She was able to plié, tendu, and work on demi-pointe, and had achieved her age level of dance, but had not resumed pointe work because of limitation in plantar flexion. Acute tarsometatarsal disruption is rare in young dancers and may be difficult to diagnose. Recognition of this type of injury is important because delay in the diagnosis and treatment may be associated with residual instability and poor prognosis.
Document Type: Case Report
Affiliations: 1: Senior Orthopaedic Resident, NYU-Hospital for Joint Diseases, New York, New York 2: Junior Orthopaedic Resident, NYU-Hospital for Joint Diseases, New York, New York 3: Former Paul W. Lapidus Fellow in Foot and Ankle Surgery, NYU-Hospital for Joint Diseases, New York, New York; Consultant Orthopaedic Surgeon, Hull Royal Infirmary, East Yorkshire, England 4: Professor of Radiology, NYU-Hospital for Joint Diseases, New York University, New York, New York 5: Former Chief of the Foot and Ankle Service, NYU-Hospital for Joint Diseases; Senior Orthopaedic Consultant, Harkness Center for Dance Injuries; Associate Professor, New York University, New York, New York; Foot and Ankle Center, Westborough, Massachusetts
Publication date: 2000-12-01