Is Pes Cavus Alignment Associated With Lisfranc Injuries of the Foot? (original) (raw)
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Prediction of Midfoot Instability in the Subtle Lisfranc Injury
The Journal of Bone and Joint Surgery-American Volume, 2009
Background: The objective of the present study was to assess the utility of magnetic resonance imaging for the diagnosis of an injury to the Lisfranc and adjacent ligaments and to determine whether conventional magnetic resonance imaging is a reliable diagnostic tool, with manual stress radiographic evaluation with the patient under anesthesia and surgical findings being used as a reference standard. Methods: Magnetic resonance images of twenty-one feet in twenty patients (ten women and ten men with a mean age of 33.6 years [range, twenty to fifty-six years]) were evaluated with regard to the integrity of the dorsal and plantar bundles of the Lisfranc ligament, the plantar tarsal-metatarsal ligaments, and the medial-middle cuneiform ligament. Furthermore, the presence of fluid along the first metatarsal base and the presence of fractures also were evaluated. Radiographic observations were compared with intraoperative findings with respect to the stability of the Lisfranc joint, and logistic regression was used to find the best predictors of Lisfranc joint instability. Results: Intraoperatively, seventeen unstable and four stable Lisfranc joints were identified. The strongest predictor of instability was disruption of the plantar ligament between the first cuneiform and the bases of the second and third metatarsals (the pC1-M2M3 ligament), with a sensitivity, specificity, and positive predictive value of 94%, 75%, and 94%, respectively. Nineteen (90%) of the twenty-one Lisfranc joint complexes were correctly classified on magnetic resonance imaging; in one case an intraoperatively stable Lisfranc joint complex was interpreted as unstable on magnetic resonance imaging, and in another case an intraoperatively unstable Lisfranc joint complex was interpreted as stable on magnetic resonance imaging. The majority (eighteen) of the twenty-one feet demonstrated disruption of the second plantar tarsalmetatarsal ligament, which had little clinical correlation with instability. Conclusions: Magnetic resonance imaging is accurate for detecting traumatic injury of the Lisfranc ligament and for predicting Lisfranc joint complex instability when the plantar Lisfranc ligament bundle is used as a predictor. Rupture or grade-2 sprain of the plantar ligament between the first cuneiform and the bases of the second and third metatarsals is highly suggestive of an unstable midfoot, for which surgical stabilization has been recommended. The appearance of a normal ligament is suggestive of a stable midfoot, and documentation of its integrity may obviate the need for a manual stress radiographic evaluation under anesthesia for a patient with equivocal clinical and radiographic examinations. Level of Evidence: Diagnostic Level II. See Instructions to Authors for a complete description of levels of evidence. I nadequate treatment of low-energy injuries of the Lisfranc articulation can result in substantial disability, deformity, and dysfunction 1. These injuries often occur in young active individuals who are involved in sports activities, and they are frequently missed at the time of the initial presentation 1-3. The mechanism of injury usually involves an axial load that is applied to the heel of a plantar flexed ankle (with the toes extended), resulting in a tensile force to the convexity of the tarsometatarsal articulations 4. This forces the metatarsal bases dorsally and can disrupt the supporting ligaments, resulting in Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Diagnosis and management of lisfranc injuries and metatarsal fractures
Rhode Island medical journal (2013), 2013
Forefoot and midfoot injuries are relatively common and can lead to chronic disability, especially if they are not promptly diagnosed and appropriately treated. A focused history and physical examination must be coupled with a thorough review of imaging studies to identify the correct diagnosis. Subtle radiographic changes can represent significant ligamentous Lisfranc injury. Midfoot swelling in the presence of plantar ecchymosis should be considered to be a Lisfranc injury until proven otherwise. While most metatarsal fractures can be treated with some form of immobilization and protected weight-bearing, this article will distinguish these more common injuries from those requiring surgical intervention. We will review relevant anatomy and biomechanics, mechanisms of injury, clinical presentation, imaging studies, and diagnostic techniques and treatment.
Archives of Orthopaedic and Trauma Surgery
Background Injury of the tarsometatarsal (TMT) joint complex, known as Lisfranc injury, covers a wide range of injuries from subtle ligamentous injuries to severely displaced crush injuries. Although it is known that these injuries are commonly missed, the literature on the accuracy of the diagnostics is limited. The diagnostic accuracy of non-weight-bearing radiography (inter- or intraobserver reliability), however, has not previously been assessed among patients with Lisfranc injury. Methods One hundred sets of foot radiographs acquired due to acute foot injury were collected and anonymised. The diagnosis of these patients was confirmed with a CT scan. In one-third of the radiographs, there was no Lisfranc injury; in one-third, a nondisplaced (
Pedobarographic, Clinic, and Radiologic Evaluation after Surgically Treated Lisfranc Injury
Journal of Investigative Surgery, 2020
Introduction: Lisfranc injuries are rare, often missed, and may cause permanent structural deterioration of tarsometatarsal joint, despite optimal management. Consequently, a Lisfranc injury may lead to disruption of the biomechanics of the normal foot during walking and may alter the plantar pressure distribution, which is essential for proper gait mechanics. Therefore, the main purpose of the study was to specify the dynamic plantar pressure, radiographic and clinical features, after surgically managed Lisfranc injuries. Methods: This study was carried out over a period of 10 years and included 62 patients who were surgically treated for Lisfranc injury, with mean 57-month follow-up. Radiological (intermetatarsal, Kite's, first metatarsophalangeal, Meary's, Hibbs' and calcaneal pitch angles, and medial cuneiform-fifth metatarsal distance), pedobarographical, and clinical results with the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score assessments for both feet were assessed. Results: In the radiological assessment, the mean first intermetatarsal (p ¼ 0.006) and Meary's angle (p ¼ 0.000) were decreased on the injured feet compared to the uninjured feet on the anteroposterior and lateral radiographs. In the pedobarographic assessment, the injured feet midfoot contact time increased (p ¼ 0.03), and maximum force (p ¼ 0.001), total peak pressure (p ¼ 0.008), and contact area (p ¼ 0.017) decreased, compared to the uninjured feet. The mean AOFAS score was 75/100 at the final follow-up visit. There was seen to be reduced both contact surface area and time of the midfoot. Conclusion: Despite surgical management of Lisfranc injuries, the injured foot does not regain functional, radiological, or pedobarographical levels as compared to the uninjured foot for ! 57 months.
Archives of Orthopaedic and Trauma Surgery
Background Current knowledge of the role of the nonoperative treatment of Lisfranc injuries is based on a few retrospective case series. Hence, consensus on which patients can be treated nonoperatively does not exist. The aim of this study was to investigate outcomes after nonoperative treatment of Lisfranc injuries. Methods In this study, patients were collected by recruiting all computer tomography-confirmed Lisfranc injuries treated during a 5-year period at a major trauma hospital. Between 2 and 6 years after suffering the injury, patients completed the visual analogue scale foot and ankle questionnaire. Results In total, 55 patients returned adequately completed questionnaires and were included in the study. Of those, 22 patients had avulsion fractures and 33 had simple non-displaced intra-articular fractures. Of these patients, 30 (55%) scored over 90 points in both the pain and function subscales of the VAS-FA, and 35 (64%) scored over 90 points overall. In addition, three (5...
Imaging Sports Medicine Injuries of the Foot and Toes
T he Lisfranc joint, aka the tarsal-metatarsal (TMT) joint, marks the transition between the more rigid midfoot and the relatively flexible forefoot. It provides critical stability in maintenance of both the transverse and longitudinal arch of the foot. That stability is derived from both its osseous geometry and complex capsuloligamentous architecture.
Lisfranc fracture dislocation: a review of a commonly missed injury of the midfoot
Emergency Medicine Journal, 2016
Musculoskeletal trauma to the foot is a common presentation to EDs. A Lisfranc fracture dislocation involves injury to the bony and soft tissue structures of the tarsometatarsal joint. While it is most commonly seen post high velocity trauma, it can also present post minor trauma. It is also misdiagnosed in approximately 20% of cases. These Lisfranc injuries typically present to EDs with pain particularly with weight bearing, swelling and post a characteristic mechanism of injury. Diagnosis is via clinical examination and radiological investigation-typically plain radiographs and CTs. Once diagnosed, Lisfranc injuries can be classified as stable or unstable. Stable injuries can be immobilised in EDs and discharged home. Unstable injuries require an orthopaedic referral for consideration of surgical fixation.
Clinical management of Lisfranc joint injuries
Jacques Lisfranc (1790-1847), a field surgeon in Napoleon's army, described an amputation involving the tarsometatarsal (TMT) joint due to a severe gangrene that developed when a soldier fell from a horse with his foot caught in a stirrup. 1-3 Although this is one type of TMT joint injury, it must be understood that the so-called Lisfranc injury does not delineate any one specific fracture or dislocation, but instead a spectrum of processes involving the TMT joint complex.
Incidence and Characteristics of Midfoot Injuries
Foot & Ankle International, 2018
Lisfranc injury was originally described as a partial or complete dislocation of the tarsometatarsal (TMT) joints by Quenu and Kuss in 1909. 18 Nunley and Vertullo 16 described that the injury can also be subtle when there is no detectable dislocation in nonweightbearing radiographs. Recently, however, Chiodo and Myerson 2 introduced a new approach to these injuries where they suggested to divide the injuries in medial (TMT 1), central (TMT 2-3), and lateral (TMT 4-5) columns. Lau et al 10 completed the columnar approach with a classification where the prognosis of injury is related to number of affected columns and displacement (less or more than 2 mm) instead of the diastasis between I and II TMT joints. Main and Jowett 13 developed a classification for Chopart injuries, where they stated that these injuries vary from small avulsion fragments to severe subluxation of the whole joint. Diagnostics have become more precise as a result of the more common use of computed tomography (CT). It is unclear whether there is such a type of injury as "purely ligamentous injury," or whether is it detectable from bony avulsion fragments. 7,8,17 The definitions and classifications of these injuries has changed, and still, 100 799741F AIXXX10.
Practical Management of Lisfranc Injuries in Athletes
Clinical Journal of Sport Medicine, 2007
Foot injuries are common in athletes. Injuries to the midfoot and particularly the Lisfranc joint are less common but have a high risk of ending the athletes' season or even career.