Nunley and Vertullo classified midfoot sprains involving the Lisfranc ligament complex based on clinical and radiologic features. This can help identify a patient who may require more aggressive management.
Patient selection: midfoot sprain involving the first and second metatarsal bone
Parameters:
(1) pain at the Lisfranc ligament complex
(2) separation of the first and second metastarsal bones (diastasis) on weight bearing in an anteroposterior (AP) X-ray of the foot
(3) height of the foot arch on lateral X-ray
Pain
Metatarsal Separation
Arch Height
Stage
none
none
no loss
0
present
none
no loss
I
present
1 - 5 mm
no loss
II
present
> 5 mm
loss of arch height
III
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