Elsevier

Foot and Ankle Surgery

Volume 24, Issue 6, December 2018, Pages 535-541
Foot and Ankle Surgery

Gait analysis and functional outcome in patients after Lisfranc injury treatment

https://doi.org/10.1016/j.fas.2017.07.003Get rights and content

Highlights

  • First describing biomechanics after Lisfranc injury.

  • Lower speed, and lower flexion/extension in patients after Lisfranc injury.

  • Motion significantly correlated with patient reported outcome measures.

  • Stability, BMI and gait were factors most influencing outcome.

Abstract

Introduction

Lisfranc injuries involve any bony or ligamentous disruption of the tarsometatarsal joint. Outcome results after treatment are mainly evaluated using patient-reported outcome measures (PROM), physical examination and radiographic findings. Less is known about the kinematics during gait.

Methods

Nineteen patients (19 feet) treated for Lisfranc injury were recruited. Patients with conservative treatment and surgical treatment consisting of open reduction and internal fixation (ORIF) or primary arthrodesis were included. PROM, radiographic findings and gait analysis using the Oxford Foot Model (OFM) were analysed. Results were compared with twenty-one healthy subjects (31 feet). Multivariable logistic regression was used to determine factors influencing outcome.

Results

Patients treated for Lisfranc injury had a significantly lower walking speed than healthy subjects (P < 0.001). There was a significant difference between the two groups regarding the range of motion (ROM) in the sagittal plane (flexion-extension) in the midfoot during the push-off phase (p < 0.001). The ROM in the sagittal plane was significantly correlated with the AOFAS midfoot score (r2 = 0.56, p = 0.012), FADI (r2 = 0.47, p = 0.043) and the SF-36-physical impairment score (r2 = 0.60, p = 0.007) but not with radiographic parameters for quality of reduction. In a multivariable analysis, the best explanatory factors were ROM in the sagittal plane during the push-off phase (β = 0.707, p = 0.001), stability (β = 0.423, p = 0.028) and BMI (β = −0.727 p = <0.001). This prediction model explained 87% of patient satisfaction.

Conclusions

This study showed that patients treated for Lisfranc injury had significantly lower walking speed and significantly lower flexion/extension in the midfoot than healthy subjects. The ROM in these patients was significantly correlated with PROM, but not with radiographic quality of reduction. Most important satisfaction predictors were BMI, ROM in the sagittal plane during the push-off phase and fracture stability.

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.

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