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Management of diabetic foot
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Venu Kavarthapu, Raju Ahluwalia
In certain complex deformities, e.g., a previous divergent dissociation of the Lisfranc joint, an additional plate fixation is required to bridge the base of 2nd or 3rd metatarsal to the tarsal bones. Dorsal subluxation pattern deformity and rocker bottom deformities with significant involvement of the lateral column require additional lateral column fixation using a separate lateral approach. This is achieved by using a smaller diameter beam inserted through the 4th metatarsal retrograde or calcaneum in an antegrade direction. Alternatively, a low-profile locking plate spanning the base of 4th metatarsal to the anterior part of calcaneum can be used.
Foot fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Dolfi Herscovici, Julia M. Scaduto
The true incidence is unknown since isolated fractures are uncommon. Injuries are the result of direct trauma and are described as medial, middle or lateral cuneiform fractures. Their most common presentation is either as an avulsion or as a nondisplaced fracture. Most fractures are identified as a component of the TMT (Lisfranc) joint.
Trauma
Published in Harry Griffiths, Musculoskeletal Radiology, 2008
These are named after a French surgeon, Jacques Lisfranc, who lived from 1780 to 1847, and, in 1809, described an amputation through the base of the metatarsals in cavalry officers who sustained fracture dislocations at the midfoot/forefoot level as a result of falling off their horse with their boot firmly caught in the stirrup. Thus, the eponym “Lisfranc joint” has become applied to this joint. Neither the Chopart joint nor the Lisfranc joint lie particularly in any one plane. In the tarsometatarsal joint, the base of the second metatarsal interlocks between the first and third cuneiform as a “keystone” like in an archway. The first cuneiform is usually the largest and oblong in shape, the third cuneiform is somewhat smaller, and the second cuneiform is short and square. The base of the second metatarsal locks this joint into place. Lisfranc fracture dislocations are also sustained as a result of trauma, for instance, a foot caught under a pedal in a car, or being run over, or from a motorcycle accident when the cycle falls over with the driver’s foot still under it, usually wearing a large boot. However, Lisfranc fracture dislocations are also frequently seen in diabetic patients with a neuropathic joint at the tarsometatarsal level.
Pedobarographic, Clinic, and Radiologic Evaluation after Surgically Treated Lisfranc Injury
Published in Journal of Investigative Surgery, 2021
Engin Eceviz, Hüseyin Bilgehan Çevik, Orhan Öztürk, Tuğçe Özen, Tuğba Kuru Çolak, İlker Çolak, Mine Gülden Polat
The Lisfranc joint complex is composed of the articulation between the midfoot and forefoot, and a traumatic disruption of this articulation are called Lisfranc injuries [1]. Lisfranc injuries occur infrequently, with an estimated incidence of 0.2% of all fractures [2–4]. However, these injuries may be under-reported as a range of 19% to 39% are missed on primary radiographs, especially in polytrauma patients [1,5,6]. Misdiagnosed Lisfranc injuries may cause painful malunion/nonunion and negatively influence the function of the foot which makes management more difficult for the orthopedic surgeon. Early diagnosis and management are essential for an optimal outcome [6].
Lisfranc injury: Prevalence and maintaining a high index of suspicion for optimal evaluation
Published in The Physician and Sportsmedicine, 2022
Michael C. Meyers, James C. Sterling
Anterior-posterior (AP), lateral and 30-degree oblique plain radiographs are the typical views that are ordered and may be normal in first or second-degree sprains as these injuries can be subtle. Weight bearing films are highly suggested because of this issue and must be a bilateral comparison of both feet [73–75]. When evaluating radiographs in Lisfranc injuries, three anatomic relations should be evaluated. These include a) the medial border of the middle cuneiform should align with the second metatarsal border medially on the AP film; b) on the oblique view, the medial border of the lateral cuneiform should align with the base of the third metatarsal medial edge as well as the cuboid medial border should line up with the medial edge of the fourth metatarsal; c) on the lateral view, no metatarsal should be offset superiorly or inferiorly with the respective tarsal bone. Any disruption of these relationships indicates a Lisfranc joint injury [76]. A pathognomonic finding in Lisfranc injury is the “fleck sign”, which is reported in 90% of Lisfranc ligament injuries and is defined as an avulsion type fracture at the base of the second metatarsal [59]. Also considered suspicious in tarsal/metatarsal joint injury is the presence of proximal metatarsal fractures. Since radiographs have limited sensitivity and specificity for some tarsometatarsal joint injuries, advanced imaging such as CT scan and MRI should also be obtained. CT scan allows for assessment of fractures and surrounding joint stability [77,78]. MRI allows for evaluation of isolated tears of the Lisfranc ligament as well as other surrounding ligaments [79]. Raikin and colleagues [80] reported that an MRI is accurate for identifying injury to the Lisfranc ligaments as well as adding predictive information for Lisfranc joint complex instability. Diagnostic ultrasound has been used to observe the joint dynamically, and bone scans are used for identification of degenerative changes in chronic fractures/dislocation post injury [81,82].
Contribution of foot joints in the energetics of human running
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Kevin Deschamps, Giovanni Matricali, Helen Peters, Maarten Eerdekens, Sander Wuite, Alberto Leardini, Filip Staes
The IOR-4Segment-model1 was implemented in this study in order to distinguish the mechanical characteristics of the Lisfranc and Chopart joints. The most interesting finding is that the former is mainly a source of power generation with only minor power absorption characteristics during running with heel-strike pattern. These findings are in agreement with those recently published by Deschamps et al. (2017) for walking activities. This negligible amount of negative work most likely originates, on one hand, from the osseous architecture of the joint, and, on the other hand, by ligamentous restraints surrounding the joint. In fact, the architecture features a second metatarsal fitting in the mortise created by medial cuneiform and recessed middle cuneiform, whereas the plantar tarsometatarsal and the Lisfranc ligaments provide the restraint. The positive work occurring at the Lisfranc joint supports the forward propulsion of the body mass. Though it is reasonable to assume that this energetic action is modulated by intrinsic and extrinsic muscle activity, this is beyond the bounds of the scopes and measures of the present study. Further investigation is however recommended in this direction to support this deduction. From a clinical viewpoint, it is believed that these findings may be relevant for pathologies commonly seen in athletes such as dorsal midfoot interosseous compression syndrome and stress fractures of the metatarsals and navicular bone. In fact, one may hypothesize that the etiology of these pathologies is related to an aberrant negative work ratio of this joint as a consequence of mechanical (e.g., ligament rupture) or functional instability (e.g., weakness of intrinsic foot muscles). In addition, it is reasonable to assume that the Lisfranc joint may help in adopting compensation strategies in presence of structural or functional deficits located more proximally in the lower limb kinetic chain. A typical example would be the weakness of the calf muscles where one may typically see a prolonged power absorption at the ankle in association with a decreased power generation during propulsion. In this case, the Lisfranc joint may be a source of power generation (e.g., provided by extrinsic foot muscles) to assist forward propulsion.