Gait analysis and functional outcome in patients after Lisfranc injury treatment

S van Hoeve; G Stollenwerck; P Willems; M A Witlox; K Meijer; M Poeze

doi:10.1016/j.fas.2017.07.003

Gait analysis and functional outcome in patients after Lisfranc injury treatment

Foot Ankle Surg. 2018 Dec;24(6):535-541. doi: 10.1016/j.fas.2017.07.003. Epub 2017 Jul 18.

Authors

S van Hoeve¹, G Stollenwerck², P Willems³, M A Witlox⁴, K Meijer³, M Poeze⁵

Affiliations

¹ Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: s.vanhoeve@student.maastrichtuniversity.nl.
² Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
³ Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 616, 6200 MD Maastricht, The Netherlands; NUTRIM, School for Nutrition, Toxicology and Metabolism, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
⁴ Department of Orthopaedics, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
⁵ Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; NUTRIM, School for Nutrition, Toxicology and Metabolism, P.O. Box 616, 6200 MD Maastricht, The Netherlands.

PMID: 29409269
DOI: 10.1016/j.fas.2017.07.003

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.

Keywords: Biomechanics; Follow-up; Gait; Lisfranc injury; Range of motion.

MeSH terms

Arthrodesis
Biomechanical Phenomena
Conservative Treatment
Foot Injuries / diagnostic imaging
Foot Injuries / physiopathology
Foot Injuries / surgery
Foot Injuries / therapy*
Foot Joints / diagnostic imaging
Foot Joints / injuries*
Foot Joints / surgery
Fracture Fixation, Internal
Fractures, Bone / diagnostic imaging
Fractures, Bone / physiopathology
Fractures, Bone / surgery*
Fractures, Bone / therapy
Gait Analysis*
Humans
Ligaments, Articular / diagnostic imaging
Ligaments, Articular / injuries*
Ligaments, Articular / physiopathology
Ligaments, Articular / surgery
Patient Reported Outcome Measures
Patient Satisfaction
Range of Motion, Articular
Treatment Outcome
Walking Speed