Gait analysis and functional outcome in patients after Lisfranc injury treatment

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 durieng 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 (r(2) = 0.47, p = 0.043) and the SF-36-physical impairment score (r(2) = 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 (beta = 0.707, p = 0.001), stability (beta = 0.423, p = 0.028) and BMI (beta = -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. (c) 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.