Elite Athletes and Subtle LisFranc Injuries: Could a Novel CT Technique Close Diagnostic Gaps?

A recent Foot and Ankle International article highlighted a novel technique to diagnose subtle LisFranc injuries in elite athletes. Delays in diagnosis on conventional imaging can severely impact outcomes, especially in this patient population. The authors present a case study of an 22-year-old elite athlete who eventually went on to require surgical reduction and fixation of such an injury.¹

The case outlines the performance of an augmented stress weight-bearing CT in a standing position with equal weight distribution and feet facing forward. The subject then raised both heels while on the scanner platform in a symmetrical fashion. As a result, the team could obtain more sensitive imaging from the plantarflexion-augmented stress. Subsequent 3D reconstruction renders also allowed comparison between standard weight-bearing images and the augmented stress images.¹

In the case of the patient highlighted in the article, initial weight-bearing X-ray and standard weight-bearing CT did not reveal the injury. Magnetic resonance imaging did, with reinforcement from the clinical examination. However, the augmented stress CT imaging did exhibit the instability. The patient underwent surgical intervention and returned to sport the following season.¹

The authors advocate that this technique could play a role in subtle, unstable LisFranc injuries where imaging is inconclusive, but where the clinical exam still supports a strong clinical suspicion. They suggest more in-depth research and larger sample sizes to further evaluate the sensitivity of this technique.¹

Reference

1. Sugimoto K, Isomoto S, Miura K, et al. Treatment of Symptomatic Os Supranaviculare in Athletes. Foot Ankle Int. 2024;0(0). doi:10.1177/10711007241235674