MIDTARSAL INJURIES
Injuries in this area vary from minor sprains, often incorrectly labelled as 'ankle’ sprains, to severe fracture–dislocations that can threaten the survival of the foot. The mechanism differs accordingly, from benign twisting injuries to crushing forces that produce severe soft tissue damage; bleeding into the fascial compartments of the foot may cause a typical compartment syndrome.
Isolated injuries of the navicular, cuneiform or cuboid bones are rare. Fractures in this region should be assumed to be 'combination’ fractures or fracture–subluxations, until proved otherwise.
Remember that small flakes of bone on x-ray often have large ligaments attached to them, and that 'midfoot sprain’ (like 'partial Achilles tendon rupture’) is a dangerous diagnosis to make.
Pathological anatomy
The most useful classification is that of Main and Jowett (1975), which is based on the mechanism of injury.
Medial stress injuries are caused by violent inversion of the foot and vary in severity from sprains of the midtarsal joint to subluxation or fracture–subluxation of the talonavicular or midtarsal joints.
Longitudinal stress injuries are the most common.They are caused by a severe longitudinal force with the foot in plantarflexion. The navicular is compressed between the cuneiforms and the talus, resulting in fracture of the navicular and subluxation of the midtarsal joint.
Lateral stress injuries are usually due to falls in which the foot is forced into valgus. Injuries include fractures and fracture–subluxations of the cuboid and the anterior end of the calcaneum as well as avulsion injuries on the medial side of the foot.
Plantar stress injuries result from falls in which the foot is twisted and trapped under the body; they usually present as dorsal avulsion injuries or fracture–subluxation of the calcaneocuboid joint.
Crush injuries usually cause open comminuted fractures of the midtarsal region.
Clinical features
The foot is bruised and swollen. Tenderness is usually diffuse across the midfoot. A medial midtarsal dislocation looks like an 'acute club-foot’ and a lateral dislocation produces a valgus deformity; with longitudinal stress injuries there is often no obvious deformity. Any attempt at movement is painful. It is important to exclude distal ischaemia or a compartment syndrome.
X-ray
Multiple views are necessary to determine the extent of the injury; be sure that all the tarsal bones are clearly shown. Tarsometatarsal dislocation may be missed if the forefoot falls back into place; fractures of the tarsal bones or bases of the metatarsals should alert the surgeon to this possibility. Abnormality of alignment, or fracture, on any view should lead to CT scanning to better assess the extent of injury.
---from 《Apley’s System of Orthopaedics and Fractures》
扩展：lisfranc损伤：
http://www.360doc.com/content/18/1115/17/48261177_795085260.shtml
http://www.360doc.com/content/18/0516/08/51442402_754315463.shtml
重点词汇整理：
benign twisting injuries轻微的扭伤
/bɪˈnaɪn/adj. 和蔼的，慈祥的；（物）无害的，温和的；（肿瘤）良性的；（疾病）无生命危险的；（条件、环境）良好的，宜人的；认为无关紧要的
sprain=twisting injurie
/spreɪn/v. 扭伤（关节）n. 扭伤
fascial compartments 筋膜室
fascial筋膜的
compartment syndrome筋膜室综合征
navicular /nəˈvɪkjələr/adj. [解剖] 舟状的，船状的n. 舟骨
cuneiform /ˈkjuːnɪfɔːrm/adj. 楔形文字的；楔形的；楔状骨的n. 楔形文字；楔状骨
cuboid bones/ˈkjuːbɔɪd/adj. 立方形的；立方体的n. 长方体；骰骨
Remember that small flakes of bone on x-ray often have large ligaments attached to them记住，x光片上的小骨片通常有很大的韧带附着在上面。
talonavicular or midtarsal joints距舟关节或跗骨中部关节
Longitudinal stress injuries纵向应力损伤
plantarflexion跖曲
/ˈplæntər/adj. [解剖] 跖的；[解剖] 脚底的
The navicular is compressed between the cuneiforms and the talus, resulting in fracture of the navicular and subluxation of the midtarsal joint.舟状骨在楔形骨和距骨之间受到挤压，导致舟状骨骨折和跗骨中关节半脱位。
the medial side of the foot足部内侧
dorsal avulsion injuries背侧撕裂伤
Tenderness is usually diffuse across the midfoot压痛通常扩散至足中部
distal ischaemia远端缺血
ischaemia /is'ki:miə/n. 局部贫血
Tarsometatarsal dislocation 跗跖关节脱位
DeepL翻译（仅供参考，建议自己翻译）：
中足跗骨损伤
这个区域的损伤从轻微的扭伤（经常被错误地称为 "踝关节 "扭伤）到严重的骨折-脱位，都会威胁到脚的生存。其机制也相应地不同，从良性的扭伤到产生严重软组织损伤的挤压力；出血进入足部的筋膜室可能引起典型的筋膜室综合征。
舟状骨、楔状骨或立方体骨的孤立损伤是罕见的。该区域的骨折应被认为是 "组合 "骨折或骨折-半脱位，直到证明不是这样。
请记住，X光片上的小骨片往往有大的韧带附着在上面，"中足扭伤"（如 "部分跟腱断裂"）是一个危险的诊断。
病理解剖学
最有用的分类是Main和Jowett（1975）的分类，它是基于损伤的机制。
内侧应力损伤是由脚的暴力内翻引起的，其严重程度从中跗关节的扭伤到距骨或中跗关节的半脱位或骨折-半脱位。
纵向应力损伤是最常见的。它们是由严重的纵向力引起的，脚处于跖屈状态。舟骨被压在楔形肌和距骨之间，导致舟骨骨折和中跗关节半脱位。
外侧应力损伤通常是由于跌倒时足部被迫外翻造成的。损伤包括立方体和小腿骨前端的骨折和骨折半脱位，以及足部内侧的撕脱性损伤。
足底应力损伤是由于跌倒时足部被扭曲并困于身体之下；它们通常表现为背侧撕脱伤或小腿立方体关节的骨折-半脱位。
挤压伤通常会导致中跗关节区域的开放性粉碎性骨折。
临床特征
足部瘀伤和肿胀。触痛通常弥漫于整个足中部。跖骨中段脱位看起来像 "急性棒状足"，侧向脱位产生外翻畸形；对于纵向应力损伤，通常没有明显的畸形。任何运动的尝试都是痛苦的。排除远端缺血或隔间综合征是很重要的。
X光检查
有必要进行多次透视以确定损伤的程度；要确保所有的跗骨都清楚地显示出来。如果前脚掌落回原位，可能会错过跗骨-跖骨脱位；跗骨或跖骨基部的骨折应提醒外科医生注意这种可能性。任何视角下的对位异常或骨折，都应进行CT扫描，以更好地评估损伤的程度。
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