Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute midfoot pain and swelling following a high-energy trauma/torsional injury to the foot. Reports inability to bear weight. Physical exam reveals significant plantar ecchymosis (pathognomonic), midfoot tenderness, and pain on passive abduction/pronation of the forefoot.
Clinical Examination Findings
Inspection: Significant midfoot edema and plantar ecchymosis noted. Palpation: Focal tenderness over the tarsometatarsal (TMT) joint complex. Neurovascular: Distal pulses (DP/PT) intact; capillary refill < 2 seconds. Sensation intact in the first dorsal web space (deep peroneal nerve). Stability: Positive stress test for midfoot instability; pain elicited with forefoot abduction/pronation.
Treatment Protocol
Immediate non-weight bearing (NWB) status initiated. Immobilization via posterior splint. Radiographic evaluation (weight-bearing views if stable, or CT scan) to assess displacement. Surgical consultation for Open Reduction Internal Fixation (ORIF) or primary arthrodesis indicated due to high risk of post-traumatic arthritis and chronic instability.