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Recurrent Lisfranc Instability in a Division I Collegiate Diver: A Case Report

Stacy Lynn Germany, Daniele Albert, Lori Greenwood

Abstract


The objective of this case report was to present a case of recurrent Lisfranc instability in a division I collegiate diver.  A 19 year old female diver presented to the athletic trainer with severe right midfoot pain following a twister dive at a meet.  The patient had a history of Lisfranc instability.  She had been diagnosed with a midfoot sprain, extensor hallicus longus tendon strain, Lisfranc sprain, and fractures of the navicular, 1st cuneiform, 2nd cuneiform, 1st metatarsal, and 2nd metatarsal.  Initially the patient underwent conservative treatment with rest and a weight-bearing walking boot.  The patient continued to have incidence of instability.  Despite the lack of diastasis on weight-bearing radiographs the patient opted to undergo open reduction internal fixation.  The patient was immobilized and non-weight bearing for eight weeks, partial weight-bearing in a walking boot for four weeks, full weight-bearing in a walking boot for two weeks, and finally full weight-bearing with custom orthotics. The normal healing process of the body to develop scar tissue masked the degree of instability in the Lisfranc joint. The current classification and imaging techniques in diagnosing Lisfranc injuries need to be improved in order to provide patients with optimal treatment.  The nature of competitive diving places extraordinary stress on the Lisfranc joint while barefoot, therefore more research should be conducted to determine if conservative treatment is a viable option for divers. Despite the set-backs of conservative treatment before surgery, the patient made a full return to competitive diving. Keywords: Lisfranc Injury, Lisfranc instability, Midfoot Sprain

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