Journal of Foot and Ankle Surgery - 2026-04-24 - Journal Article
Beyond the Foot: Proximal Joint Adaptations Following Lisfranc Injury as Suggested by Gait and Pedobarographic Analysis.
Eceviz E, Özyaman O, Yılmaz H, Hekim Ö, Gökmen O, Bilgehan Çevik H
Topics
Key Takeaway
Despite anatomic ORIF for Myerson Type B2 Lisfranc injuries, patients demonstrate persistent deficits in peak plantar flexion, sagittal ankle ROM, and ankle power generation (all p≤0.001) alongside reduced knee absorption power (p=0.031), even with a mean AOFAS midfoot score of 93.63.
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Summary
This study asked whether radiographic anatomic reduction after ORIF for Myerson Type B2 Lisfranc injuries translates to full functional recovery, using 3D gait analysis and pedobarography with contralateral limb as control. Despite a mean AOFAS midfoot score of 93.63 and symmetric clinical ankle ROM, the affected limb showed significantly reduced peak plantar flexion, sagittal plane ROM, and ankle power generation. Knee joint absorption power was also reduced on the affected side, indicating a proximal compensatory adaptation that clinical scoring tools fail to capture.
Key Limitation
The study does not report a standardized postoperative rehabilitation protocol, making it impossible to determine whether the persistent deficits reflect the injury itself, inadequate rehabilitation, or hardware-related restriction.
Original Abstract
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.