i) Briefly review the concept of Lisfranc ligaments and relevant anatomy ii) Outline Lisfranc injuries, including common mechanisms and injury grading iii) Highlight an underappreciated mechanism of sustaining these injuries during surfing

The tarsometatasal joint complex – often referred to by its eponymous name the “Lisfranc joint complex” - is the skeletal and capsuloligamentous structure between the tarsal bones and the five metatarsal bases in the midfoot1, 2. These articulations are interconnected by a series of ligaments divided into dorsal, interosseus and plantar3. Dorsal ligaments are the weakest while the interosseus and plantar ligaments maintain primary stability for the joint. The strongest of these ligaments is termed the Lisfranc ligament, connecting the lateral aspect of the medial...

We present a case series of 4 patients who sustained Lisfranc injuries within the past 5 years while wave surfing. Case 1 Case History 24 year old male who sustained a hyperplantarflexion injury to his right foot while surfing, and also describes a likely simultaneous inversion of the foot. This was accompanied by immediate pain in the midfoot with progressive swelling, however he was able to weight bear immediately post the injury. Imaging Findings Right Foot XR (acute): Displaced fracture of 2nd, 3rd and 4th...

Lisfranc injuries can occur as a result of wave surfing, especially when axial forces are applied to the plantarflexed foot. The clinician and radiologist should be aware of the potential to develop these injuries during surfing, and should include this in their differential diagnosis of midfoot injuries. Including a thorough history of the mechanism of injury may also help the radiologist define the correct pathology. It is especially important to identify Lisfranc injuries in surfers, as they tend to be otherwise fit and athletic. Missing...

Dr. Jeffrey Hocking is the Senior House Officer for Research in the Department of Medical Imaging at the Royal Brisbane and Women's Hospital. He has a strong interest in radiology and teaching. Dr. Craig Buchan is a specialist musculoskeletal radiologist at the Gold Coast Hospital Health Service, and Queensland Diagnostic Imaging. He is also an associate professor of radiology at Bond University, Queensland.

1. Eleftheriou KI, Rosenfeld PF, Calder JD. Lisfranc injuries: an update. Knee Surgery, Sports Traumatology, Arthroscopy. 2013;21(6):1434-46. 2. Jomaah N, Almusa E. Imaging of lisfranc injuries in the athlete. Aspetar Sports Medicine Journal. 2013;1(3):230-5. 3. Diebal AR, Westrick RB, Alitz C, Gerber JP. Lisfranc injury in a west point cadet. Sports Health: A Multidisciplinary Approach. 2013:1941738113477991. 4. Lievers WB, Frimenko RE, Crandall JR, Kent RW, Park JS. Age, sex, causal and injury patterns in tarsometatarsal dislocations: a literature review of over 2000 cases. The Foot....