The Journal of Bone and Joint Surgery

Image Quiz
A Rare Fracture of the Foot¹
A sixty-eight-year-old farmer, while working in the fields, stepped into a hole and sustained an inversion, plantar flexion injury to the left foot. He was able to bear weight after the accident, and he continued working. That evening, he noticed increasing pain and swelling, and the next day he saw a physician, who diagnosed the injury as an ankle sprain and treated it with ibuprofen and exercise. He continued to work over the ensuing few months but had persistent pain in the lateral aspect of the left foot. Four months after the initial injury, he still had persistent pain.
Physical examination showed a well-perfused foot with palpable dorsalis pedis and posterior tibial pulses. The skin was intact, and only mild swelling was present. An indentation was noted at the lateral aspect of the midfoot. Tenderness was present over the calcaneocuboid joint. Motor and sensory examinations were unremarkable. Ankle motion consisted of 20° of dorsiflexion and 50° of plantar flexion, and subtalar motion consisted of 5° of inversion and 5° of eversion. The patient had an antalgic gait. Plain radiographs and a computed tomographic scan were performed.
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Fig. 1-A	Fig. 1-B

What is the diagnosis?