Gait analysis and functional outcome in patients after Lisfranc injury treatment
Introduction
Lisfranc injuries involve any bony or ligamentous disruption of the tarsometatarsal joint complex. This injury is not very common, with 0.2% of all fractures [1], [2], [3], [4]. The outcome of Lisfranc injury is determined by the extent of soft tissue damage, bone injury and the presence or absence of instability in the tarsometatarsal joint. Other important determinants of good prognosis include early successful identification of instability and treatment [5], [6], [7]. Outcome results after treatment of Lisfranc injuries have mainly been evaluated using patient-reported outcome measures (PROM), physical examination and radiographic findings [8], [9]. Less is known about the biomechanical changes after Lisfranc injury. One study analysed 24 patients, including 6 patients with a Lisfranc fracture, using PROM, pedobarographic analysis and radiographic examinations. They found significantly lower walking speed in patients after Lisfranc injury treatment compared to a group of healthy subjects [3].
Multi-segment foot models (MSFM) are available for analysing kinematic parameters during gait [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29]. The four-segment Oxford foot model (OFM) is described as being a reliable model [15], [18], [27], [30], [31]. Intersegment rang of motion (ROM) during gait was previously found to be related to PROM in patients with foot and ankle trauma [32]. Hence, kinematic gait analysis could provide more insight into kinematic changes in patients after Lisfranc injury and in addition could lead to more information on unsolved issues such as the influence on surgical reduction on functional outcome and the best fixation method [4], [33], [34], [35], [36], [37], [38], [39].
The aim of this study was to investigate kinematic parameters of the foot and ankle in a group of patients after bony Lisfranc injury and to compare these with healthy subjects. The kinematic results were further correlated with PROM and quality of reduction. In addition, a multivariable logistic regression analysis was performed to determine factors explaining patient satisfaction. The hypothesis was that patients who suffer bony Lisfranc injury would show decreased ROM (flexion/extension) in the midfoot compared to healthy subjects and that kinematics during gait would significantly correlate with PROM and the quality of surgical reduction.
Section snippets
Study population
For this prospective observational study (Level II evidence), 19 patients (19 feet) treated for bony Lisfranc injury were recruited. The medical ethics committee of this hospital approved this study, and all study subjects gave written informed consent. All patients underwent computed tomography to determine the extent of the bony Lisfranc injury and were taken to the operating room for fluoroscopic testing of the stability of the Lisfranc joint. If this was stable, patients were treated with
Patient characteristics
Table 1 presents the baseline characteristics for the patients treated for a bony Lisfranc injury, and for the healthy subjects. There were no significant differences between the two groups regarding age, left or right foot being analysed, weight, leg length, knee width or ankle width. In the bony Lisfranc group, there were significantly more women, patients had a lower length and had a higher BMI compared to healthy subjects. Gait analysis was performed at a mean of 17 months (median 11, range
Discussion
The present study reveals a more detailed analysis of kinematic changes in foot and ankle after bony Lisfranc injury by using a MSFM. This study found that patients who had suffered Lisfranc injury had significantly lower walking speed and significantly decreased flexion/extension in the midfoot during the push-off phase. In addition, this ROM was significantly correlated with PROM but not with the radiographic quality of reduction.
A limited number of studies have analysed gait in patients with
Conclusion
This study showed that patients who had suffered bony Lisfranc injury had significantly lower walking speed and significantly lower flexion/extension in the midfoot compared to healthy subjects during the push-off phase. Compensation was found in the ankle joint leading to more exorotation in the foot in patients after Lisfranc injury with lower flexion/extension. The ROM significantly correlated with the patient satisfaction reported in the AOFAS, FADI, SF-36 physical impairment and VAS, but
Ethics approval and consent to participate
This study was approved by the medical ethical board of AZM/UM Maastricht.
NL 34131.068.10/MEC 10-3-072.
Consent of publication
All patients and healthy subject signed informed consent to participate in this study and to publish medical results.
Availability of data and supporting materials section
Please contact author for data requests.
Authors Contribution
S. van Hoeve: gait analysis, writing, submitting.
G. Stollenwerck: writing.
P. Willems: technical procedures/matlab/gait analysis.
A. Witlox: writing.
K. Meijer: data analysis.
M. Poeze: data analysis writing.
Conflict of interest
None of the authors have any financial and personal relationships with other people or organizations to disclose that could inappropriately influence their work.
Role of the funding source
There was no funding source for this study.
References (48)
- et al.
Kinematic assessment of paediatric forefoot varus
Gait Posture
(2009) - et al.
Repeatability of a multi-segment foot protocol in adult subjects
Gait Posture
(2011) - et al.
Kinematic analysis of amulti-segment foot model for research and clinical applications: a repeatability analysis
J Biomech
(2001) - et al.
Intra-rater repeatability of the Oxford foot model in healthy children in different stages of the foot roll over process during gait
Gait Posture
(2009) - et al.
Subtalar neutral position as an offset for a kinematic model of the foot during walking
Gait Posture
(2008) - et al.
An anatomically based protocol for the description of foot segment kinematics during gait
Clin Biomech
(1999) - et al.
Rear-foot, mid-foot and fore-foot motion during the stance phase of gait
Gait Posture
(2007) - et al.
Foot kinematics and kinetics during adolescent gait
Gait Posture
(2003) - et al.
Three dimensional kinematics of the forefoot, rearfoot, and leg without the function of tibialis posterior in comparison with normal during stance phase of walking
Clin Biomech
(1999) - et al.
The Heidelberg foot measurement method: development, description and assessment
Gait Posture
(2006)
Repeatability of a model for measuring multi-segment foot kinematics in children
Gait Posture
Repeatability of the modified Oxford Foot model during gait in healthy adults
Gait Posture
Gait parameters and muscle activation patterns at 3, 6 and 12 months after total hip arthroplasty
J Arthroplasty
Gait patterns after total hip arthroplasty and surface replacement arthroplasty
Arch Phys Med Rehabil
Differences in foot kinematics between young and older adults during walking
Gait Posture
ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion — part I: ankle, hip, and spine
J Biomech
Dislocation of the tarsometatarsal joint
J Bone Joint Surg
Diagnosis and management of lisfranc injuries and metatarsal fractures
Orthop Rehabil
Comparing the outcomes between Chopart, Lisfranc and multiple metatarsal shaft fractures
Arch Orthop Trauma Surg
Outcome after open reduction internal fixation of Lisfranc joint injuries
J Bone and Joint Surg
Tarsometatarsal joint injuries in the athlete
J Sports Med
The midfoot sprain: a review of Lisfranc ligament injuries
Phys Sportsmed
Tarsometatarsal (Lisfranc's) fracture-dislocation
Am J Orthop (Belle Mead NJ)
Lisfranc midfoot dislocations: correlations between surgical treatment and functional outcomes
Rev Med Chir Soc Med Nat Iasi
Cited by (16)
A systematic review and meta-analysis of the treatment of acute lisfranc injuries: Open reduction and internal fixation versus primary arthrodesis
2020, Foot and Ankle SurgeryCitation Excerpt :The patients sustaining these injuries are also heterogeneous in terms of the pre-morbid activity and functional level. If neglected or missed these injuries can lead to significant deformity and disability [2–4] There are 2 broad groups of surgical interventions available for the treatment of these injuries; either open reduction and internal fixation (ORIF) or primary arthrodesis (PA).
The relationship between gait and functional outcomes in patients treated with circular external fixation for malunited tibial fractures
2019, Gait and PostureCitation Excerpt :Van Hoeve et al. used gait analysis to investigate changes during push off and demonstrated a significant positive correlation between hindfoot range of motion, the Foot and Ankle Disability Index (FADI), the Short Form SF-36 physical component score, and range of motion between the hindfoot and tibia in the push-off phase calculated on gait analysis [4]. The same research group identified similar relationships with respect to midfoot motion [5]. In a group of 106 patients treated surgically with anterior cruciate ligament reconstruction, the GAITRite temporal and spatial gait-analysis system (measuring walking speed, cadence, and stride length, and relating this to Patient Reported Outcomes), revealed a strong correlation between gait and patient reported outcome measures (PROMS) [12,13].
Gait and strength assessment following surgical repair by intramedullary nailing of isolated tibial shaft fracture
2024, Journal of Orthopaedic ResearchOpen Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis
2024, Foot and Ankle OrthopaedicsSurgical controversies and current concepts in Lisfranc injuries
2022, British Medical BulletinKinematic Analysis of Sequential Partial-Midfoot Arthrodesis in Simulated Gait Cadaver Model
2022, Foot and Ankle International