Traumatic disruption of tarsometatarsal joint. Rare; often initially misdiagnosed
Two types – direct (crushing blow to joint) or indirect injury (forced dislocation, eg forceful forefoot adduction or axial load to plantarflexed foot)
Type A (total) - Disruption of entire joint; most common type
Type B (partial) – Type B1 – Medial displacement of first metatarsal
Type B2 – Lateral displacement of lessor metatarsals
Type C (divergent) Type C1 – Medial displacement of first metatarsal and
lateral displacement of second metatarsal
Type C2 - Medial displacement of first metatarsal and
lateral displacement of lessor metatarsals
Pain on dorsum of foot; pain on palpation with selling over tarsometatarsal joint.
Widening between base of metatarsals on x-ray
Avulsion fracture (‘fleck sign’) often present between base of first and second.
Anatomic reduction under anaesthesia as soon as possible with K-wire fixation or Steinmann pin
Missed injury chronic pain and affects foot function long term
Chronic pain is common, despite adequate and appropriate treatment