Lisfranc Injuries: Difference between revisions
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<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox"> | <div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox"> | ||
'''Original | '''Original Editor '''- [[User:Adam West|Adam West]], [[User:Dieter Schuddinck|Dieter Schuddinck]] | ||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | ||
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== Resources <br> == | == Resources <br> == | ||
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
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== Search Strategy == | |||
== Clinically Relevant Anatomy | |||
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== Definition/Description == | |||
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== Clinically Relevant Anatomy == | |||
The Lisfranc joints are tarsometaral articulations. In the normal Lisfranc joint complex, first 3 metatarsal bases articulate with their respective cuneiforms, and the lateral 2 metatarsals articulate with the cuboid. The second metatarsal base is tightly recessed in a mortise formed by the 3 cuneiform bones. The intertarsal ligaments, dorsal and plantar tarsalmetatarsal (TMT) ligaments, and transverse ligaments provide soft tissue stability.<ref>Wadsworth DJ, Eadie NT. Conservative Management of Subtle Lisfranc Joint Injury: A Case Report. JOSPT 35(3):154-164,2005.</ref> | The Lisfranc joints are tarsometaral articulations. In the normal Lisfranc joint complex, first 3 metatarsal bases articulate with their respective cuneiforms, and the lateral 2 metatarsals articulate with the cuboid. The second metatarsal base is tightly recessed in a mortise formed by the 3 cuneiform bones. The intertarsal ligaments, dorsal and plantar tarsalmetatarsal (TMT) ligaments, and transverse ligaments provide soft tissue stability.<ref>Wadsworth DJ, Eadie NT. Conservative Management of Subtle Lisfranc Joint Injury: A Case Report. JOSPT 35(3):154-164,2005.</ref> | ||
== | == Epidemiology /Etiology == | ||
Injuries to the Lisfranc joint are usually the result of combined external rotation and compression force. Injuries can be caused by either direct or indirect trauma. Injuries to the joint are often missed due to anatomical complexity and rarity.<ref>Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains. Am J Sports Med. 2002;30:871-878.</ref><br> | Injuries to the Lisfranc joint are usually the result of combined external rotation and compression force. Injuries can be caused by either direct or indirect trauma. Injuries to the joint are often missed due to anatomical complexity and rarity.<ref>Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains. Am J Sports Med. 2002;30:871-878.</ref><br> | ||
== Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
Clinically, with the calcaneus held stable, abduction or pronation of the forefoot will produce pain over the midfoot. Typically, there is difficulty weight bearing, minimal swelling over the midfoot, and palpable tenderness along the tarsometatarsal joints.<ref name="Reischl">Reischl SF, Noceti-DeWit LM. Current concepts of orthopaedic physical therapy. 2nd edition: The Foot and Ankle: Physical Therapy Patient Management Utilizing Current Evidence. 2006.</ref> Athletes may have pain with running on the toes and with push-off phase of running. <ref name="Burroughs">Burroughs KE, Reimer CD. Fields KB. Lisfranc injury of the foot: a commonly missed diagnosis. Am Fam Physician. 1998;58:118-124.</ref><br> | Clinically, with the calcaneus held stable, abduction or pronation of the forefoot will produce pain over the midfoot. Typically, there is difficulty weight bearing, minimal swelling over the midfoot, and palpable tenderness along the tarsometatarsal joints.<ref name="Reischl">Reischl SF, Noceti-DeWit LM. Current concepts of orthopaedic physical therapy. 2nd edition: The Foot and Ankle: Physical Therapy Patient Management Utilizing Current Evidence. 2006.</ref> Athletes may have pain with running on the toes and with push-off phase of running. <ref name="Burroughs">Burroughs KE, Reimer CD. Fields KB. Lisfranc injury of the foot: a commonly missed diagnosis. Am Fam Physician. 1998;58:118-124.</ref><br> | ||
== Differential Diagnosis<br> == | |||
Differential Diagnosis to Lisfranc injury includes: midfoot sprain, metatarsal fracture, cuboid fracture, posterior tibialis tendon dysfunction, and compression injuries to the navicular.<ref>Reischl SF, Noceti-DeWit LM. Current concepts of orthopaedic physical therapy. 2nd edition: The Foot and Ankle: Physical Therapy Patient Management Utilizing Current Evidence. 2006.</ref><br> | |||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
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Currently, there are no specific clinical tests to confirm the extent of an injury. Therefore, diagnosis of ligmentous injuries may be based on a high level of suspicion. In suspected Lisfranc injuries, use of imaging modalities is warrented. Recommended radiographs include anteroposterior, lateral, and 30 degree internal oblique projections in weightbearing. <ref name="Wadsworth">Wadsworth DJ, Eadie NT. Conservative Management of Subtle Lisfranc Joint Injury: A Case Report. JOSPT 35(3):154-164,2005.</ref><br> | Currently, there are no specific clinical tests to confirm the extent of an injury. Therefore, diagnosis of ligmentous injuries may be based on a high level of suspicion. In suspected Lisfranc injuries, use of imaging modalities is warrented. Recommended radiographs include anteroposterior, lateral, and 30 degree internal oblique projections in weightbearing. <ref name="Wadsworth">Wadsworth DJ, Eadie NT. Conservative Management of Subtle Lisfranc Joint Injury: A Case Report. JOSPT 35(3):154-164,2005.</ref><br> | ||
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== Outcome Measures == | == Outcome Measures == | ||
== Management | add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]]) | ||
== Examination == | |||
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== Medical Management <br> == | |||
Treatment to Lisfranc injuries may be operative or non-operative depending on severity. In mild to moderate sprains, the lower extremity may be immobilized for approximately six weeks. More severe injuries may be treated with open reduction and internal fixation. Following ORIF, the foot is usually immpbilized for 8-12 weeks.<ref name="Burroughs">Burroughs KE, Reimer CD. Fields KB. Lisfranc injury of the foot: a commonly missed diagnosis. Am Fam Physician. 1998;58:118-124.</ref><br> | Treatment to Lisfranc injuries may be operative or non-operative depending on severity. In mild to moderate sprains, the lower extremity may be immobilized for approximately six weeks. More severe injuries may be treated with open reduction and internal fixation. Following ORIF, the foot is usually immpbilized for 8-12 weeks.<ref name="Burroughs">Burroughs KE, Reimer CD. Fields KB. Lisfranc injury of the foot: a commonly missed diagnosis. Am Fam Physician. 1998;58:118-124.</ref><br> | ||
== Physical Therapy Management <br> == | |||
Physical therapy intervention begins shortly following immobilization in both operatvie and conservative treatment. Interventions include: edema reduction, strengthing to address post immobilization atrophy, flexibility exercises, gait training, and manufacturing of foot orthoses to help support the tarsometatarsal articulations.<ref>Reischl SF, Noceti-DeWit LM. Current concepts of orthopaedic physical therapy. 2nd edition: The Foot and Ankle: Physical Therapy Patient Management Utilizing Current Evidence. 2006.</ref> | Physical therapy intervention begins shortly following immobilization in both operatvie and conservative treatment. Interventions include: edema reduction, strengthing to address post immobilization atrophy, flexibility exercises, gait training, and manufacturing of foot orthoses to help support the tarsometatarsal articulations.<ref>Reischl SF, Noceti-DeWit LM. Current concepts of orthopaedic physical therapy. 2nd edition: The Foot and Ankle: Physical Therapy Patient Management Utilizing Current Evidence. 2006.</ref> | ||
== | == Key Research == | ||
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== Resources <br> == | == Resources <br> == | ||
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== | == Clinical Bottom Line == | ||
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
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[[Category:Articles]] [[Category:Condition]] [[Category:EIM_Student_Project_2]] [[Category:Foot]] [[Category:Musculoskeletal/Orthopaedics]] | [[Category:Vrije_Universiteit_Brussel_Project|Template:VUB]] [[Category:Articles]] [[Category:Condition]] [[Category:EIM_Student_Project_2]] [[Category:Foot]] [[Category:Musculoskeletal/Orthopaedics]] | ||
Revision as of 11:53, 9 November 2010
Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
Original Editor - Adam West, Dieter Schuddinck
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
add text here
Epidemiology /Etiology[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Resources
[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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Search Strategy[edit | edit source]
add text here related to databases searched, keywords, and search timeline
Definition/Description[edit | edit source]
add text here
Clinically Relevant Anatomy[edit | edit source]
The Lisfranc joints are tarsometaral articulations. In the normal Lisfranc joint complex, first 3 metatarsal bases articulate with their respective cuneiforms, and the lateral 2 metatarsals articulate with the cuboid. The second metatarsal base is tightly recessed in a mortise formed by the 3 cuneiform bones. The intertarsal ligaments, dorsal and plantar tarsalmetatarsal (TMT) ligaments, and transverse ligaments provide soft tissue stability.[1]
Epidemiology /Etiology[edit | edit source]
Injuries to the Lisfranc joint are usually the result of combined external rotation and compression force. Injuries can be caused by either direct or indirect trauma. Injuries to the joint are often missed due to anatomical complexity and rarity.[2]
Characteristics/Clinical Presentation[edit | edit source]
Clinically, with the calcaneus held stable, abduction or pronation of the forefoot will produce pain over the midfoot. Typically, there is difficulty weight bearing, minimal swelling over the midfoot, and palpable tenderness along the tarsometatarsal joints.[3] Athletes may have pain with running on the toes and with push-off phase of running. [4]
Differential Diagnosis
[edit | edit source]
Differential Diagnosis to Lisfranc injury includes: midfoot sprain, metatarsal fracture, cuboid fracture, posterior tibialis tendon dysfunction, and compression injuries to the navicular.[5]
Diagnostic Procedures[edit | edit source]
add text here related to medical diagnostic procedures
Currently, there are no specific clinical tests to confirm the extent of an injury. Therefore, diagnosis of ligmentous injuries may be based on a high level of suspicion. In suspected Lisfranc injuries, use of imaging modalities is warrented. Recommended radiographs include anteroposterior, lateral, and 30 degree internal oblique projections in weightbearing. [6]
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
[edit | edit source]
Treatment to Lisfranc injuries may be operative or non-operative depending on severity. In mild to moderate sprains, the lower extremity may be immobilized for approximately six weeks. More severe injuries may be treated with open reduction and internal fixation. Following ORIF, the foot is usually immpbilized for 8-12 weeks.[4]
Physical Therapy Management
[edit | edit source]
Physical therapy intervention begins shortly following immobilization in both operatvie and conservative treatment. Interventions include: edema reduction, strengthing to address post immobilization atrophy, flexibility exercises, gait training, and manufacturing of foot orthoses to help support the tarsometatarsal articulations.[7]
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1riwIKvlTlJmFqFCjX2lZw2RHIvMr_O47uH2dl0pOThQjiqoz0|charset=UTF-8|short|max=10: Error parsing XML for RSS
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Wadsworth DJ, Eadie NT. Conservative Management of Subtle Lisfranc Joint Injury: A Case Report. JOSPT 35(3):154-164,2005.
- ↑ Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains. Am J Sports Med. 2002;30:871-878.
- ↑ Reischl SF, Noceti-DeWit LM. Current concepts of orthopaedic physical therapy. 2nd edition: The Foot and Ankle: Physical Therapy Patient Management Utilizing Current Evidence. 2006.
- ↑ 4.0 4.1 Burroughs KE, Reimer CD. Fields KB. Lisfranc injury of the foot: a commonly missed diagnosis. Am Fam Physician. 1998;58:118-124.
- ↑ Reischl SF, Noceti-DeWit LM. Current concepts of orthopaedic physical therapy. 2nd edition: The Foot and Ankle: Physical Therapy Patient Management Utilizing Current Evidence. 2006.
- ↑ Wadsworth DJ, Eadie NT. Conservative Management of Subtle Lisfranc Joint Injury: A Case Report. JOSPT 35(3):154-164,2005.
- ↑ Reischl SF, Noceti-DeWit LM. Current concepts of orthopaedic physical therapy. 2nd edition: The Foot and Ankle: Physical Therapy Patient Management Utilizing Current Evidence. 2006.
