Abduction Stress and AP Weightbearing Radiography of Purely Ligamentous Injury in the Tarsometatarsal Joint

Abstract

Twenty volunteers (40 feet) with no prior foot injury underwent standardized abduction stress and standing AP radiographs. Subsequently, the Lisfranc and dorsal tarsometatarsal ligaments in nine feet from cadavers were sectioned in a varying sequential manner, and interval standardized radiographs of abduction stress and AP simulated weightbearing were obtained. On abduction stress radiographs in 39 of 40 feet of volunteers and nine of nine feet of cadavers before sectioning, a line tangential to the medial aspect of the navicular and medial cuneiform (medial column line) intersected the base of the first metatarsal. Combining the sectioning of the Lisfranc and dorsal tarsometatarsal ligaments produced a disruption of the medial column line in all feet from cadavers. Disruption of this medial column line may be a simple and valuable diagnostic tool for determining significant ligamentous injury to the tarsometatarsal interval.

Lisfranc Injuries

“…Traditionally, pronation and abduction stress at the midfoot has been used to reveal instability, 23 but a squeeze test between the medial and middle columns has also been advocated as a supplemental stress examination to identify unstable injuries. 24 The utility of stress radiographs has been called into question because of the variable forces applied by the examiner and lack of standardization to declare a positive test. 22 Other investigators have reported more reliable use of stress radiographs with patients placed under sedation or anesthesia as patients may not be able to comply with these radiographs in the clinic setting.…”

Ligament reconstruction with single bone tunnel technique for chronic symptomatic subtle injury of the Lisfranc joint in athletes

“…Some reports have defined the key diagnostic feature as diastasis or instability between the first and second metatarsals on radiological investigation [4][5][6]. Most surgeons recommend screw or plate fixation for a fresh unstable subtle injury [1,2,[7][8][9], and novel techniques using Endobutton [10] or Tightrope [11] have been recently reported.…”

Screw and Wire Fixation for Lisfranc Fracture Dislocations

“…Surgery was indicated in patients with instability, which was defined as ≥1 mm of malalignment of the medial column on stress radiographs 14 or disturbed normal alignment of the cuboid and fourth metatarsal on oblique radiographs, or loss of normal alignment of the second metatarsal and middle cuneiform on anteroposterior radiographs. …”