Typical mechanisms are:
- Rotational forces with the body rotating around a fixed forefoot
- Axial loading in which the hindfoot is driven into the bases of the metatarsals
- Crush injuries
Physical exam reveals plantar midfoot ecchymosis and swelling, pain along the TMT joint with palpation, motion, or weight-bearing, and midfoot instability. Patients typically cannot bear weight. A careful vascular exam should be performed because there can be damage to a branch of the dorsal pedis artery which crosses the base of the first and second metatarsals.
