The x-ray shows a less obvious tarso-metatarsal dislocation. The relationship between the base of the 2nd MT and the intermediate cuneiform appears normal, but there is a step between the base of the 4th MT and the cuboid.
Click on the x-ray to enlarge.
How should these injuries be managed?
These injuries need orthopaedic referral. Most will be investigated with a CT and most will be internally fixed.
Not all injuries at this joint are obvious on initial x-rays (click on the x-ray to enlarge). If it is suspected clinically but x-rays are normal, the patient should be kept under review and consideration given for a CT.