Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute midfoot pain following a twisting injury/axial load to the foot. Reports inability to bear weight, localized swelling over the dorsal midfoot, and ecchymosis along the plantar arch. Pain is exacerbated by ambulation and palpation of the tarsometatarsal joints.
Clinical Examination Findings
Inspection reveals significant dorsal midfoot edema and plantar ecchymosis. Palpation demonstrates point tenderness at the base of the first and second metatarsals and the cuneiforms. Positive "piano key" test noted with pain upon manipulation of the metatarsal heads. Neurovascular status intact with palpable dorsalis pedis pulse and normal capillary refill.
Treatment Protocol
Immediate non-weight bearing status initiated. Immobilization via posterior splint or cast. Referral to orthopedic surgery for evaluation of potential ORIF (Open Reduction Internal Fixation) vs. closed reduction. Analgesia provided with NSAIDs and elevation of the extremity above heart level to reduce edema.