Lisfranc Injury: This is the most likely diagnosis due to the mechanism of injury, which involves a sudden inversion and twisting force to the midfoot, a common cause of Lisfranc injuries. The Lisfranc joint complex is located in the dorsal midfoot, making it susceptible to injury from such a mechanism.

Midfoot Sprain: Given the nature of the injury, a midfoot sprain is a plausible diagnosis. The midfoot region contains multiple small joints and ligaments that can be sprained during an inversion injury.
Chopart's Fracture-Dislocation: Although less common, Chopart's fracture-dislocation, which involves the talonavicular and calcaneocuboid joints, could occur from a similar mechanism, especially if the force was significant.

Compartment Syndrome: Although not the most likely diagnosis, compartment syndrome is a serious condition that can arise from any significant injury to the foot, including a stretching injury to the dorsal midfoot. It is crucial to identify and treat promptly to avoid long-term damage.
Open Fracture or Wound: The possibility of an open fracture or wound, especially if the skin was compromised during the fall from the ladder, must be considered. Infections and other complications can arise if not addressed immediately.

Navicular Stress Fracture: While stress fractures are more common in the metatarsals, a navicular stress fracture could potentially occur, especially in individuals with predisposing factors such as osteoporosis or those who recently increased their physical activity.
Talonavicular or Calcaneocuboid Joint Subluxation: Isolated subluxations of these joints are less common but could occur from a significant twisting force. They might present with similar symptoms to a Lisfranc injury but would require specific diagnostic imaging for confirmation.