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Lower Extremity Anatomy II > Lecture 8 > Flashcards

Lecture 8 Flashcards

1
Q

Lisfranc injury

A
  • Fracture dislocation of the tarsometatarsal joint

- Commonly refers to medial aspect of the joint (1st and 2nd mets, medial and intermediate cuneiform

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2
Q

Primary mechanism of Lisfranc injury

A
  • Direct: crush injury (motor vehicle accidents, industrial accidents, falls)
  • Indirect (more common): rotational force and axial force through the foot while it positioned in plantarflexion
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3
Q

Lisfranc injuries have different degrees of severity ranging from mild sprains (partial ligament tears) and stability to joint diastasis and instability

A
  • Purely ligamentous vs. ligamentous and bony
  • 2nd met base fits into mortise created by cuneiforms
  • Ligaments between the medial cuneiform and 2nd met base
  • Interosseous (Lisfranc’s) and the plantar ligaments are especially important
  • Dorsal ligaments are weak making dorsal dislocation common
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4
Q

Lisfranc injury may also be classified based on

A
  • How much of the tarsometatarsal joint is involved

- Direction of dislocation

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5
Q

Lisfranc injury is most common in

A
  • 3rd decade of life
  • More common in athletes
  • M > F
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6
Q

Lisfranc injury presentation

A
  • May be delayed (initial impression is a minor injury is present)
  • Midfoot pain and pain with weightbearing (especially with forefoot weightbearing/push-off)
  • Swelling in the midfoot
  • Ecchymosis can be present on the medial plantar foot
  • Tenderness over midfoot, especially the tarsometatarsal joint
  • Pain with forefoot abduction and eversion or just twisting the forefoot
  • Pain or subluxation with passive dorsiflexion and plantarflexion at the tarsometatarsal joint (piano key test)
  • Have to check dorsalis pedis
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7
Q

Lisfranc injury requires weightbearing x-rays that may reveal

A
  • Misalignment of lateral margin of medial cuneiform and 1st met base
  • Misalignment of the medial margin of 2nd metatarsal base and intermediate cuneiform
  • Widening between 1st and 2nd metatatarsals
  • Misalignment between dorsal cortex of 1st or 2nd metatarsal and medial cuneiform on lateral x-ray (step off)
  • Small avulsion fragments of the bones (“fleck sign”)
  • Avulsion of Lisfranc ligament
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8
Q

Chronic ankle instability results from

A
  • Recurring bouts of the ankle giving way
  • Develops after previous ankle sprain(s)
  • Inadequate healing or rehab of the ligaments and muscles
  • Each ankle sprain leads to further weakening of the ligaments, greater instability and increased chance of future ankle sprains
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9
Q

Previous studies associate chronic ankle instability with

A
  • Delayed reaction time
  • Ankle weakness
  • Dynamic balance
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10
Q

Purpose of ankle instability study

A
  • Determine what factors contribute to CAI
  • Compare the potential contributors of ankle instability in those with CAI vs. normal controls
  • Contributors to decreased function
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11
Q

Contributors to decreased function in CAI

A
  • Peroneal RT
  • Dynamic balance
  • Strength
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12
Q

Cumberland ankle instability tool

A
  • Questionnaire that assesses severity of instability (lower score: decreased ankle function)
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13
Q

CAI group participants

A
  • Age 22.6yrs
  • Height: 172 cm
  • Body mass: 69.1kg
  • CAIT: 19.5
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14
Q

Control group participants

A
  • Age: 20.9
  • Height: 172cm
  • Body mass: 66.5kg
  • CAIT: 28.7
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15
Q

CAI conclusion

A
  • Dominant ankle (kicking leg) had the following:
  • At least 1 significant ankle sprain > 3 months prior to study
  • 2 or more episodes of ankle giving way in last 6 months
  • CAIT score 24 or less
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16
Q

Exclusion criteria for both groups

A
  • Previous lower extremity surgeries
  • History of frx requiring realignment
  • Acute injury previous 3 months that affected joint function (interrupted at least 1 day of activity)
17
Q

Peroneal reaction time test

A
  • Device produced 30ᵒ of inversion
  • Average of 3 trials
  • ~ 60-90s rest between trial
18
Q

Balance test on Biodex stability system

A
  • Ant/Post (APSI) and Med/Lat stability (MLSI)
  • Stability in the sagittal and coronal plane)
  • Overall stability index (OSI)
  • 3 practice trials
  • Average of 3-20sec test with 10sec rest
  • Higher values = poorer stability
19
Q

Star excursion balance test

A
  • 8 directions tested, 45ᵒ from each other
  • 4 practice trials
  • Average of 3 test
  • Reach distance measured for each direction (normalized to leg length)
20
Q

Isokinetic strength test in eversion

A
  • 3 different velocities: 60,180, and 300ᵒ per sec
  • Eccentric and concentric contractions in eversion
  • 10 min warmup and 3 submax reps
  • 5 reps for each test velocity
  • Peak torque normalized for body mass
  • E/C ratios
21
Q

Results of study

A
  • CAI group had prolonged RT in peroneus brevis and longus
  • Poor performance in overall stability index, medial/lateral stability index, anterior/posterior stability index
  • Decreased reach distance in all 8 directions of the star excursion balance test
  • No difference in inversion/eversion peak torques
  • CAI had higher E/C ratio at 180ᵒ/sec
22
Q

Moderate correlation between CAIT score and

RT of PL and PB

A
  • Negative correlation

- Lower CAIT score longer reaction time and vice versa

23
Q

Moderate correlation between CAIT score and all directions of SEBT except for AL

A
  • Positive correlation

- Lower CAIT score lower reach distance and vice versa

24
Q

Small correlation between CAIT and OSI and MLSI of BSS

A
  • Negative correlation
25
Q

Small correlation between CAIT and AL direction of SEBT

A
  • Positive correlation
26
Q

CAI study limitations

A
  • Other factors that can alter balance might not have been excluded from the study
  • Previous rehab programs not taken into account
  • Inversion testing is different than real life
  • Testing order was not randomized

Lower Extremity Anatomy II (9 decks)

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