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Intercuneiform instability and the "gap" sign.
1Holy Spirit Hospital, Brisbane, Australia.
Foot & Ankle International
|October 6, 1999
Summary
Low-energy midfoot injuries can rupture Lisfranc's ligament without causing tarsometatarsal damage. Surgical findings revealed associated intercuneiform instability in these cases.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Foot and Ankle Trauma
Background:
- Lisfranc ligament injuries are typically associated with high-energy trauma.
- Diagnosis can be challenging due to subtle physical signs.
- Tarsometatarsal joint integrity is often presumed in low-energy midfoot injuries.
Observation:
- Three cases of low-energy midfoot injuries were analyzed.
- Physical examination revealed significant findings only upon weightbearing.
- Surgical exploration identified intercuneiform instability in all cases.
Findings:
- Rupture of the Lisfranc ligament occurred without associated tarsometatarsal injury.
- Intercuneiform instability was a consistent finding alongside Lisfranc ligament rupture.
- Weightbearing examination is crucial for detecting subtle midfoot injuries.
Implications:
- This challenges the traditional understanding of Lisfranc ligament injury mechanisms.
- Highlights the importance of thorough clinical examination, including weightbearing assessment, for midfoot injuries.
- Suggests intercuneiform instability may be an associated finding or precursor in certain Lisfranc ligament ruptures.