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Possible Lisfrancs Joint Injury?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by footsoldier, Sep 25, 2008.

  1. footsoldier

    footsoldier Member

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    Hi all,
    I need some advice. I saw a patient today who was referred to me by a physio. The patient is a 25 year old female who participates at a high level in the 100m high hurdles. Approx 1 year ago she injured her right foot whist competing. She informs me that she heard a snapping sound as she landed from jumping the hurdle. Her foot swelled immediately and she was taken to A&E. X rays were taken but all nothing was detected. She had some treated via a physio for about 3 months but although swelling and bruising went down, she still was unable to run or train. She then saw a sports doctor who diagnosed a rutured palntar fascia, although no MRI was given. She was referred to an orthopod who then told her to retire from running, get shoe supports and if they didn't help he would "fuse her foot". Obviously she was horrifed and didn't go back to him. Anyway she eventually came to my clinic on the advice of a friend who I had treated.
    O/e she c/o of pain along the dorsum of her right foot along Lisfrancs Joint. She was tender along the navicualr insertion of tib post. She c/o of numbness around the dorsum of her foot at night time. She was also tender along medial band of palntar fascia.Complained of post static dyskinesia Her muscle power and strenght was very poor especially on abductioon and adduction of her mid tarsal under resistence. Single limb support testing was accomplised but very slowly and painfully.
    She had a positive tinels sign. Her foot adopted a very pronated attitude in static stance. Gait confired excessive pronation throughout her cycle.
    Now my opinion is
    1. She has a tarsal tunnel syndrome
    2. Lisfrancs joint injury
    3. Tib Post Dysfunction
    4. Planatar fascial Strain
    I gave some stretches for gastro soleus complexes. Proprioception exercises and applied some Low Dye Strapping. Advised more stable shoes and sent a letter to her GP requsting an MRI. I will cast her for orthoses in the near future.
    My query is, are there any other clinical teats I should carry out to confirm a Lisfrancs joint injury? Should I apply some diagnostic LA to confirm Tarsal Tunnel syndrome. Is an MRI maybe a bit to much to ask for?
    She is willing to pay all privately. However I would prefer to give a better diagnosis myself rather than her out the expense.
    Sorry for the long winded story.
    I hope you can help.
    Incidently, she txt me earlier to say that the Low Dye strapping had eased her symptoms dramatically.
  2. Ella Hurrell

    Ella Hurrell Active Member

    Hi Footsoldier

    I think I'm right in saying that a bone scan would pick up a old lisfranc injury?

  3. drsarbes

    drsarbes Well-Known Member

    Hi Foot...
    IF she has an acquired flat foot post injury with resultant weakness, I would take an educated guess that she tore the post tibial tendon. Her Tarsal Tunnel is most likely secondary. She may have also injured the fascia.

    At this point in time it would be in her best interest to obtain an MRI (around 80% Dx in PTib tears).
    She may not be too far post injury to correct this with a primary repair of the post tibial and absorbable STJ arthroreisis.

  4. efuller

    efuller MVP

    With the info given, I would agree with Dr. Sarbes. A ruptered PT could cause plantar fascial strain and tarsal tunnel as secondary effects.

    Additional info that would be helpful: Was she landing normally when the pop occured? It's hard to imagine a normal foot landing causing a lisfranc's insury.

    The other confusing item is the weakness with abduction. Is the weakness because of pain and if it where is the pain when that occurs? A sore PT tendon can hurt with range of motion, but should hurt medially.

    Is she still trying to compete? what is her current activity level? I can't think of any tests that would be specific for a year old lisfranc's injury.

    Subluxed cuneiform?


    Eric Fuller
  5. NewsBot

    NewsBot The Admin that posts the news.

    Sonographic evaluation of Lisfranc ligament injuries.
    Woodward S, Jacobson JA, Femino JE, Morag Y, Fessell DP, Dong Q.
    J Ultrasound Med. 2009 Mar;28(3):351-7
  6. Griff

    Griff Moderator


    Saw this as Newsbot bumped it up to the top again - what was the outcome/what did the MRI show?


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