Ultrasound Assessment of Dorsal Lisfranc Ligament Strain Under Clinically Relevant Loads

Background: Pure Lisfranc ligament injuries have a varied clinical presentation, making them difficult to diagnose. This study seeks to understand in vivo strain characteristics of the dorsal Lisfranc ligament under clinically relevant stress loads and foot orientations measured by ultrasound. Methods: Randomized ultrasound imaging trials were performed on 50 asymptomatic feet of 20-to-32-year-old individuals who were free of lower-extremity abnormalities. The dorsal Lisfranc ligament was ultrasound imaged under low, medium, and high stress while at 0 degrees and 15 degrees abducted foot orientations. Load was applied using a seated calf-raise apparatus, and a single examiner performed all of the tests. Two-way repeated-measures analysis of variance was used to determine any significant load or position main effects or load x position interaction. Results: Position main effect for dorsal Lisfranc ligament length demonstrated a significant overall increase in ligament length of 0.21 mm (P < .001), which reflects a 4.03% change in ligament length between the rectus and 15 degrees abducted orientations. Furthermore, low and medium loads demonstrated significant length increase with position effect (P = .03 and P < .001, respectively). No significant load main effect or interaction was determined. Conclusions: Dorsal Lisfranc ligament length undergoes more strain in an abducted foot position at the same load compared with in a rectus foot. We advocate measuring under a medium load if possible and comparing foot positions for the maximum length changes. The participant stress loads and foot positions used are clinically feasible, which makes it possible to perform this ultrasound procedure in the clinical setting.