Chapter

Lisfranc Fracture

March 2018

DOI:10.1007/978-3-319-78387-1_85

In book: Essential Orthopedic Review (pp.189-190)

Authors:

Gregory Waryasz

Massachusetts General Hospital

A Lisfranc injury/fracture is a disruption of the articulation of the medial cuneiform and the base of the second metatarsal. The injury can vary from a mild sprain to a severe dislocation. There are both bony injury and purely ligamentous patterns of the injury. Missed injuries can lead to significant foot deformity, chronic pain, arthritis, and dysfunction due to the disruption of the normal “keystone configuration” of the osseous structure. A provocative test that usually produces pain if the injury is present is pronation and abduction of the forefoot. A common finding is plantar ecchymosis.

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November 1998 · Journal of Pediatric Orthopaedics

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January 1970

Ziad O. Abu-Faraj

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March 1993 · Foot & Ankle

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May 1995 · Foot & Ankle International

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July 2015 · Foot & Ankle International

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The painful foot, Part I: Common forefoot deformities

May 1997 · American Family Physician

T M van Wyngarden

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Klumpfußtherapie nach Ponseti

August 2016 · Operative Orthopädie und Traumatologie

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June 1983 · Journal of Bone and Joint Surgery - British Volume

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Analysis of the plantar pressure distribution in children with foot deformities

January 2010 · Acta of Bioengineering and Biomechanics

This paper describes the method of measuring and assessing the pressure distribution under typical feet and the feet of patients with deformities such as: planovalgus, clubfoot, and pes planus using a pedobarograph. Foot pressure distribution was measured during static and walking at individual normal walking speed. Time-series pressure measurements for all sensors were grouped into five ... [Show full abstract] anatomical areas of human foot. In typical subjects, the heel was the first part of the foot receiving the loading of the body. Then it moved to the toe through the midfoot and the metatarsal area. The highest mean pressure in typical subjects was found under the heel and the metatarsal heads. The lowest pressure distribution was under the cuboid bone. In the planovalgus subjects, a higher pressure distribution was found under cuboid bone compared to typical one. In the pes cavus subjects, the pressure distribution was lower under all parts of foot. In the clubfoot subjects, the pressure distribution, the contact area of each mask, and the time of foot contact area in left and right foot are respectively different.

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Plantarflexion Opening Wedge Medial Cuneiform Osteotomy for Correction of Fixed Forefoot Varus Assoc...

September 2004 · Foot & Ankle International

Flatfoot presents as a wide spectrum of foot deformities that include varying degrees of hindfoot valgus, forefoot abduction, and forefoot varus. Medial displacement calcaneal osteotomy, lateral column lengthening, and subtalar fusion can correct heel valgus, but may not adequately correct the fixed forefoot varus component. The purpose of this study was to determine the effectiveness of ... [Show full abstract] plantarflexion opening wedge medial cuneiform (Cotton) osteotomy in the correction of forefoot varus. Sixteen feet (15 patients) had plantarflexion opening wedge medial cuneiform osteotomies to correct forefoot varus associated with flatfoot deformities from several etiologies, including congenital flatfoot (six feet, average age 37 years), tarsal coalition (five feet, average age 15 years), overcorrected clubfoot deformity (two feet, ages 17 years and 18 years), skewfoot (one foot, age 15 years), chronic posterior tibial tendon insufficiency (one foot, 41 years), and rheumatoid arthritis (one foot, age 56 years). Standing radiographs showed an average improvement in the anterior-posterior talo-first metatarsal angle of 7 degrees (9 degrees preoperative, 2 degrees postoperative). The talonavicular coverage angle improved an average of 15 degrees (20 degrees preoperative, 5 degrees postoperative). The lateral talo-first metatarsal angle improved an average of 14 degrees (-13 degrees preoperative, 1 degree postoperative). Correcting for radiographic magnification, the distance from the mid-medial cuneiform to the floor on the lateral radiograph averaged 40 mm preoperatively and 47 mm postoperatively (average improvement 7 mm). All patients at followup described mild to no pain with ambulation. There were no nonunions or malunions. Opening wedge medial cuneiform osteotomy is an important adjunctive procedure to correct the forefoot varus component of a flatfoot deformity. Advantages of this technique in comparison to first tarsometatarsal arthrodesis include predictable union, preservation of first ray mobility, and the ability to easily vary the amount of correction. Because of the variety of hindfoot procedures done in these patients, the degree of hindfoot correction contributed by the cuneiform osteotomy alone could not be determined. We have had excellent results without major complications using this technique.

Article

The use of dynamic pedobarography (DPB) in the post-operative evaluation of pes cavovarus

September 1999 · Gait & Posture

Purpose of the study Pes cavovarus is a complex deformity of the forefoot, the midfoot and the hindfoot, frequently of neuropathologic etiology. The goals of surgical interventions consist of anatomical and functional correction of the foot deformity by soft tissue and bony procedures. Preoperative planning and postoperative assessment are based on clinical and radiographic examination. The ... [Show full abstract] present study was undertaken to find out if pedobarographic outcomes correlate with those postoperative results and if the dynamic pedobarography provides useful information in the functional evaluation of cavovarus feet. Material and methods Sixteen patients with cavovarus foot deformity (mean age 32.8 years, range 17-56) with a total of 21 feet were examined before and after surgery. The average follow-up time was 24 months (range 6-50). The study protocol included physical examination, angle measurements on weightbearing radiographs and dynamic pedobarography. The patients performed five trials at self-selected speed for each foot. The amount of correlation was established between: plantar peak pressure pattern and patient's subjective functional result, the evidence of callosities and increased peak pressures in forefoot and midfoot regions of interest, the change of calcaneal pitch or Hibbs' angle (first metatarsal - calcaneal axis) and the midfoot contact area. Results The patient's functional opinion and pedobarographic improvement of peak pressures correlated in 7 feet, the patients estimated the result better in 13 feet and worse in 1 foot. In 4 regions of interest callosities and increased peak pressures occured together in 69% of the cases, in 15.5% callosities were observed without augmented peak pressures and in 15.5% increased peak pressures were measured without evidence of callosities. No correlation was found between radiographic and pedobarographic parameters which describe a reduction of the cavus deformity: calcaneal pitch angle and midfoot contact area (Pearson correlation coefficient r = -0.36), Hibbs' angle and midfoot contact area (r = 0.55), altough all parameters changed significantly (p = 0.001). Discussion and conclusion Pre- and postoperative assessment of the cavovarus foot is mainly based on static methods such as clinical and radiographic evaluation. The results of this study demonstrate that the dynamic measurement of plantar peak pressures and contact area offers limited information about functional and anatomical improvement after surgery. Patients with severe deformities and muscular discoordination have difficulties walking consistently on the platform at each trial and severe decrease of plantar contact area makes the exact positioning of the masks difficult, which leads to problems with standardised measurements. In this context, the dynamic pedobarography cannot be used as a profitable diagnostic tool which provides an objective measurement that can add a dynamic component to a clinical or radiographic examination.

Article

Foot deformity in hereditary onycho-osteodysplasia

January 1988 · Canadian Association of Radiologists Journal

A 30-year-old woman with hereditary onycho-osteodysplasia was examined. In addition to the classic tetrad of fingernail and toenail dysplasia, patellar aplasia, iliac horns, and radial head hypoplasia and dislocation, she also had scoliosis, proteinuria, and distinctive bilateral foot anomalies. The foot deformity consisted of a ball-and-socket ankle joint, valgus ankle, forefoot supination, and ... [Show full abstract] lateral subluxation at the tarsal-metatarsal joints. The literature showed that the radiographic findings of foot deformity in this dysplasia have never been reported in detail before. Evidence suggests that this distinctive pattern of deformity may be more common than previously appreciated.