Lisfranc Injuries: Difference between revisions
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'''Original Editor '''- [[User:Adam West |Adam West]] | '''Original Editor '''- [[User:Adam West|Adam West]] | ||
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== Clinically Relevant Anatomy<br> == | == Clinically Relevant Anatomy<br> == | ||
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> | ||
== Mechanism of Injury / Pathological Process<br> == | == Mechanism of Injury / Pathological Process<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> | 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 == | == 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> | ||
== Diagnostic Procedures == | == 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. <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> | ||
== Outcome Measures == | == Outcome Measures == | ||
== Management / Interventions<br> == | == Management / Interventions<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 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> | ||
== Differential Diagnosis<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> | 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> | ||
== Key Evidence == | == Key Evidence == | ||
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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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== References == | == References == | ||
Revision as of 15:02, 3 December 2009
Original Editor - Adam West
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
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]
Mechanism of Injury / Pathological Process
[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]
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]
Diagnostic Procedures[edit | edit source]
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. [5]
Outcome Measures[edit | edit source]
Management / Interventions
[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 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.[6]
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.[7]
Key Evidence[edit | edit source]
Resources
[edit | edit source]
add appropriate resources here
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Recent Related Research (from Pubmed)[edit | edit source]
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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.
- ↑ 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.
- ↑ 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.
