Individuals with midfoot injuries may present to physical therapists in a variety of clinical settings. The ability of the physical therapy practitioner to optimally manage the care of such an individual may be dependent on understanding the diagnostic imaging that is indicated or has been been completed. Among the potentially most debilitating midfoot injuries are Lisfranc fracture-dislocations. This case outlines the use of conventional radiology, standard computerized tomography (CT), and three-dimensional CT for differential diagnosis of Lisfranc and associated midfoot injury in a 26 year-old female recreational athlete. Her subsequent surgical and post-surgical management is briefly discussed.

Physical therapists evaluating patients with suspected midfoot injuries should be cognizant of the tendency for Lisfranc injuries to escape initial detection, possibly precipitating misdiagnosis or delay to diagnosis. Nonweight-bearing radiography may be insensitive to demonstrating the anatomical disruption of significant midfoot injuries. Weight-bearing radiographic views along with selective use of MRI and CT aid in proper identification of injury to the tarsometatarsal joints and optimal management of patients with these injuries.