History: trauma. Foot pain
CLICK HERE FOR ANSWER
Answer: Lis-Franc injury (fracture/dislocation). There are homolateral and divergent sub-types, and this would be an example of the homolateral one (technically if the 1st metatarsal and medial cuneiform remain aligned, it is included in the homolateral sub-type - which is more common by the way).
nice reference (especially for the proper alignment): http://www.learningradiology.com/archives06/COW%20217-Lisfranc%20fx/lisfranccorrect.htm
As I have heard from several experts, this is a so called “hot-potato” case. Radiographically they can be EXTREMELY subtle so if they have concern for this type of injury clinically, they need Orthopedic follow-up. The legal ramifications of missing it can be very high so don’t be afraid to punt.