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MCL sprain — MRCEM SBA MCQ

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HardKnee InjuriesMCL sprainMRCEM SBA

A footballer has midfoot swelling and plantar ecchymosis after an axial load to a plantar-flexed foot. Non-weight-bearing radiographs show no fracture or diastasis, but tarsometatarsal tenderness is marked. What is the best next investigation strategy?

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Correct answer: B — Obtain weight-bearing foot radiographs if tolerated and CT when suspicion remains

The best answer is “Obtain weight-bearing foot radiographs if tolerated and CT when suspicion remains”. A Lisfranc injury can be occult on non-weight-bearing films; plantar ecchymosis and focal tarsometatarsal pain should maintain suspicion. Weight-bearing comparison views may reveal instability when tolerated, while CT defines subtle fractures and joint incongruity. The patient should be immobilised and kept non-weight-bearing pending orthopaedic assessment. A normal initial film does not justify mobilisation, ultrasound does not evaluate the joint complex, and delaying definitive imaging risks chronic pain, deformity and post-traumatic arthritis.

Reference: British Orthopaedic Association BOAST assessment of foot injuries: https://www.boa.ac.uk/resource/boast-12-pdf.html