Atypical Plantar Injury in a Soccer Player: A Lisfranc Mimic Revealing an Uncommon Tear

Case Diagnosis: This was a 20 year old female athlete who presented with plantar bruising consistent with Lisfranc injury who was found to have a partial tear of the plantar fascia.

Case Description or Program Description: The patient was a women's soccer player who reported planting foot and feeling a pop. Her exam was notable for bruising along the plantar aspect of the arch of the foot with tenderness at bruised portion. There was no pain with toe walking, or evidence of arch collapse with walking. X ray was unremarkable. MRI demonstrated partial tear of the medial aspect of the proximal plantar fascia with no acute osseous abnormalities.

Setting: Outpatient sports medicine clinic.

Assessment/Results: MRI results consistent with partial tear of proximal plantar fascia. Patient completed rehab with athletic trainers and was able to play the rest of the season after missing one game.

Discussion (relevance): This case highlights the importance of considering alternative diagnoses in athletes presenting with plantar foot bruising, a common finding in Lisfranc injuries. While the initial presentation raised concern for midfoot instability, the absence of deformity, pain with toe walking, and negative radiographs prompted further imaging, leading to the diagnosis of a proximal plantar fascia tear. This injury is relatively uncommon in young athletes and can mimic more serious pathologies, underscoring the need for careful clinical evaluation. Early recognition allowed for appropriate rehabilitation, enabling a timely return to play.

Conclusions: This case emphasizes the importance of considering plantar fascia tears in athletes with plantar bruising. Thorough physical exam and MRI can help differentiate between Lisfranc injury and soft tissue pathology, guiding appropriate management for a timely return to play.