A 30-year-old man presented to the emergency department after the sole of his foot impacted a rock in a shallow pool of water. He reported experiencing immediate pain in the mid- and forefoot. He was able to walk, but weight-bearing caused pain. The patient had no previous injuries or surgeries to the foot.

Evaluation revealed swelling and erythema on the plantar midfoot. A faint ecchymosis was developing on the surrounding plantar surface. The dorsal and plantar midfoot regions were tender, but no point tenderness was elicited over the lateral or medial malleoli, base of the fifth metatarsal bone, cuboid bone, navicular bone, calcaneus, or first metatarsophalangeal joint. Non–weight-bearing radiography showed no fractures of the foot or ankle. The patient was discharged with a controlled ankle motion boot and a follow-up appointment with his primary care physician.

After 3 days, he reported that weight-bearing caused severe pain in the midfoot. The midfoot was tender and had extensive ecchymosis on the plantar surface (Figure 1). Weight-bearing radiography showed widening between the intermediate and lateral cuneiform bones, the second and third metatarsal heads, and the first and second metatarsal bases. No fractures or other abnormalities were identified.