In a cadaver study comparing weightbearing to stress radiographs in detecting sectioned Lisfranc ligaments, stress imaging was found to more reliably identify lesions with transverse or longitudinal displacement.
In effect, the Lisfranc ligament rigidly connects the medial and middle columns, allowing the foot to function as a lever arm that propels the foot forward during the gait cycle.
It is believed that while bony injury is common among ballerinas, involvement of the adjacent Lisfranc ligament is rare, despite the significant amount of force experienced at the base of the second metatarsal.
MRI is remarkably useful for depicting soft tissue detail and allowing direct visualization of the Lisfranc ligament, but it is a static test that may not identify the often subtle dynamic instability frequently associated with Lisfranc joint disruption.
There are two classification systems of Lisfranc ligament injuries that are commonly used: the Myerson system (not shown), which focuses on distinguishing displacement patterns, and the Nunley and Vertullo system (Table 2), which applies more subtle radiographic findings of midfoot sprains.
5 Tesla demonstrate indistinctness of the Lisfranc ligament (arrow in A) with surrounding edema.
The midfoot sprain: a review of Lisfranc ligament injuries.