Acute Disruption of the Tarsometatarsal (Lisfranc's) Joints in a Ballet Dancer

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. Fluo-roscopic 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.