Beyond the foot: Proximal joint adaptations following lisfranc injury as suggested by gait and pedobarographic analysis.

BACKGROUND

Anatomic reduction is the gold standard for Lisfranc injuries; however, its relationship with functional recovery remains controversial.

PURPOSE: To evaluate gait and functional parameters in patients with Lisfranc injuries treated with open reduction and internal fixation (ORIF), and determine whether radiographic anatomic alignment ensures full functional recovery.

STUDY

DESIGN

Retrospective cohort study.

METHODS

Thirty patients who underwent ORIF with anatomic reduction for Myerson Type B2 Lisfranc injuries between 2020 and 2024 were retrospectively evaluated. Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score and ankle range of motion (ROM). Three-dimensional gait analysis and pedobarographic measurements were compared between the affected and unaffected sides.

RESULTS

The mean AOFAS midfoot score was 93.63, and ankle ROM did not differ between sides (p ≥ 0.05). However, peak plantar flexion (p = 0.001), sagittal plane ROM (p ≤ 0.001), and ankle power generation (p ≤ 0.001) were reduced on the affected. Knee joint absorption power also decreased on the affected side, suggesting a compensatory mechanism (p = 0.031). Spatiotemporal analysis indicated trends toward reduced step length and shorter stance phase on the affected side (p ≤ 0.05). However, these differences were not statistically significant following Holm-Bonferroni correction.

CONCLUSIONS

Despite achieving anatomic reduction, full functional recovery after Lisfranc injury may not always be achieved. Objective gait analysis revealed persistent functional deficits despite high clinical scores and radiographic alignment. Reduced ROM and power, along with altered knee mechanics, suggest that Lisfranc injuries may affect not only the foot but also the ankle and knee.