Midtarsal Sprain Misdiagnosed as Ankle Sprain: Role of Ultrasonography in Diagnosis.
A 26 yr old woman presented with left foot pain for 2 mos after she fell on her knee and dorsum of left foot. After negative plain radiographs in the emergency department, she was treated for an ankle sprain with an aircast brace for 2 wks. The patient, however, experienced persistent pain and swelling at the dorsal aspect of the foot. Upon her visit to the clinic at 2 mos after the injury, the patient described her pain as being 9 of 10 in intensity on numerical rating scale with intermittent clicking sensation on the dorsum of the left foot. Her symptoms were exacerbated by standing and walking. Physical examination revealed maximum tenderness on the dorsum of the foot corresponding to the talonavicular and calcaneocuboid joints. Passive plantarflexion of the foot while fixing the calcaneus precipitated her pain. Ultrasonography examination of the left ankle and foot was performed using a 12 MHz linear transducer and a LOGIQ E scanner (General Electric Healthcare, Milwaukee, WI) Hypoechoic thickening of ligaments and joint capsules of both talonavicular and calcaneocuboid joints were shown on the dorsum of the midfoot (Figs. 1 and 2) The rest of the ultrasonography examination showed normal tibiotalar and naviculocuneiform joints and intact anterior talofibular and anterior distal tibiofibular ligaments. The patient was therefore diagnosed with a midtarsal sprain and was instructed to wear footwear with a stiff sole and supportive mediolateral counters.
American journal of physical medicine rehabilitation