Midfoot Conditions

Question 1

Detail the Lisfranc Joint

Answer 1

Maintains the transverse arch of the foot

Articulation betwwen the bases of the Metatarsals and the correspnding cuneiforms and cuboid (Tarso-Metatarsal)

Supported by Intermetatarsal Ligament, Lisfranc ligament (medial cunei - seond met) and tarsometatarsal ligament

Question 2

What is the main cause of Lisfranc Injuries?

What are the management options for a Lisfranc Injury?

Answer 2

Direct trauma or external rotation

Management:
Imobalize
Cast or boot for 6-8 weeks.

Orthotics (Support and immobilise midfoot).

Rehab exercises.

Surgery

Question 3

Which of these might you not see in a Lisfranc injury.
a) Forefoot deformity
b) Rearfoot deformity

Would a Lisfranc injury appear more pronated or supinated

Answer 3

Rearfoot deformity

Lisfrancs injuruies are charecterised by Rearfoot maintained instability

Would appear more pronated

Question 4

List the possible differential diagnoses for Lisfranc injury

Answer 4

Metatarsal Fracture
Midfoot sprain
Cuboid fracture
PTTD

Question 5

From the following select what you might see in a lisfranc injury
(select all that apply)

Posterior Heel swelling
Midfoot Bruising
Midfoot Swelling
Heel Spur
Eversion abduction of the Forefoot while locking the Rearfoot
Widening of the midfoot
Aggravated Forefoot Loading

Answer 5

Midfoot Bruising
Midfoot Swelling
Widening of the midfoot
Aggravated Forefoot Loading
Eversion and abduction of the Forefoot while locking the rearfoot

Question 6

From the following select the possible differential diagnosis for a Lisfranc Injury.

Midfoot sprain
Retro Calcaneal Bursitis
Metatarsal fracture
Achillies Tedinopathy
Cuboid fracture
Posterior Tibialis Tendon Dysfunction

Answer 6

Midfoot sprain
Metatarsal fracture
Cuboid fracture
Posterior Tibialis Tendon Dysfunction

Question 7

Which Test is appropriate for Diagnosing Lisfranc Injury
a) Kleigers Test
b) Jacks Test
c) Windlass Test
d) Royal London Hospital Test
e) No Test/ Imaging

Answer 7

There is no current test to diagnose a LIsfranc Injury
X-ray imaging should be used

Question 8

Detail what an Extensor Tendinopathy is

Answer 8

Extensor Tendinopathy refers to pain and dysfunction of the Extensor Muscles due to overuse (Anterior Compartment Muscles)

Tibialis Anterior (Mainly affected)
Extensor Hallucis Longus
Extensor Digitorum Longus

Question 9

Detail the signs and symptomns of Extensor Tendinopathy 5

Answer 9

• Patient report symptomns after increase activity (overuse)
• Or trauma forced plantar flexion or compression of the dorsum
• Eccentric stress on Tib Ant
• Burning pain Medial midfoot worse at night
• Point of tenderness insertion of Tib Ant (Medial Cuneifrom)

Question 10

What diagnostic proccess can be used to asses Extensor Tendinopathy

Answer 10

TAPS TEST:
* Tibialis Anterior Passive Stretch Test = Examiner Plantarflexes the ankle applying a midfoot abduction and pronatory force to passivley Stretch the Tendon
* Posotive test is indicated through reproduction or increase in pain at insertion (Medial Cuneiform)

Gait analysis
* look for toe extensor recruitment and disturbance to swing phase
* Foot drop or slapping gait could indicate Tedinopathy

Question 11

Detail the management fot Extensor tedinopathy

Answer 11

Rest
Activity Modification
Orthotics to improve First Ray + First MTPJ motion
Strengthening programme for ankle Dorsiflexors