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Can a gap between metatarsal and cuneiform be normal in X-ray? Injured foot, painful, minimal swelling

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Practicing since : 2005
Answered : 34 Questions
On weight bearing x-rays, can a 2mm gap between the 1st and 2nd metatarsals and 1st and 2nd cuneiforms be normal? I injured my foot sliding into a base playing softball 6 weeks ago. There was immediate pain on the top of my foot, but minimal swelling and no bruising. It hurt to walk on it, but I figured I just sprained it a little and that it would get better over time. After 5 weeks when I still was experiencing pain, I went to my GP. Regular X-rays were normal. My GP doesn't seem interested in pursuing further testing ( I work at a veterinary hospital and took my own weight bearing x-rays) and just gave me a prescription for an anti-inflammatory. I still can't run on it and it bothers me if I stand or walk on it for prolonged periods of time. I'm afraid to try to play softball again if it may cause further harm. Could this be a mild Lisfranc (Grade I) sprain? Any advice would be greatly appreciated. Thank you.
Posted Sat, 22 Sep 2012 in X-ray, Lab tests and Scans
Answered by Dr. Ranjeet Jagdale 15 hours later

Thank you for posting your query on XXXXXXX

The Lisfranc injuries are graded I, II and III. In a Grade I, gap will be normal i.e. less than 2mm
Grade II and III injuries it will be more than 2mm.

Without an opportunity to look at X-rays, I am unable to confirm the type of injuries you have.

Please look for
- Loss of alignment of the medial margin of the second metatarsal base and the medial edge of the middle (second) cuneiform;
- Look for loss of in-line arrangement of the lateral margin of the first metatarsal base with the lateral edge of the medial (first) cuneiform.
- You can also compare distance between the base of the first and second metatarsals or the medial and middle cuneiforms with the unaffected side.

Since you have swelling, tarsometatarsal joint tenderness and the inability to bear weight, it can still be Grade I injury and this would require 6weeks of non weight bearing cast.

Further imaging with nuclear study can surely help you. And so is MRI scanning.

Hope this information suffices. Let me know if you have any doubts/concerns.

Above answer was peer-reviewed by
Follow-up: Can a gap between metatarsal and cuneiform be normal in X-ray? Injured foot, painful, minimal swelling 11 hours later
Dr. Jagdale

I have uploaded two images, the first is a non-weight bearing and the second is weight bearing. I do not have images of my unaffected foot.

Thank you.
Answered by Dr. Ranjeet Jagdale 49 minutes later
Hello ,
These radiographs look fine to me. May be you can try the anti-inflammatory treatment for some time along with rest and if your symptoms persist even after that, you can get it investigated further.
So at this stage its better to wait for few days and see if you feel better with treatment and rest.
Hope you get well soon!!
Above answer was peer-reviewed by
Follow-up: Can a gap between metatarsal and cuneiform be normal in X-ray? Injured foot, painful, minimal swelling 10 minutes later
Thank you
Answered by Dr. Ranjeet Jagdale 9 hours later
You are welcome, in future if you need any help, feel free to ask.
Take care
Above answer was peer-reviewed by
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