Lisfranc joint and Chopart joint: location, injuries, diseases, treatment methods

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Home › Joint diseases › Specific joint diseases › Lisfranc joint and Chopart joint: location, injuries, diseases, treatment methods

Many people, even those who know the anatomy of the human skeleton well, do not know such names as Lisfranc joint and Chopard joint. And this is not surprising. These joints are located in the foot area and are low-moving connections of a number of tarsal bones with nearby bones.

Does the arch of your foot hurt in a certain place? Possible damage (pathology) to the Lisfranc or Chopard complexes

The information, drawings, photos and videos in this article will help you get an idea of ​​the anatomical structure of the Lisfranc and Chopard joints, typical injuries and diseases in these areas, as well as standard treatment protocols operated by a traumatologist or orthopedist.

• Anatomy of Chopart and Lisfranc joints
• Traumatology
• Treatment of traumatic injuries
• Orthopedics

Localization and structure

Chopart's joint is located in the tarsal region, closer to the ankle, and combines the talonavicular and calcaneal-cuboid joints. They are held in place by a strong bifurcated ligament that originates from the top of the calcaneus and encircles the scaphoidocuboid bony structures. This connective tissue is called "Chopard's key".

The anatomy of the Lisfranc joint includes the cuneiform and cuboid metatarsal joints, which are located toward the distal end of the foot. The joint formations strengthen the interosseous wedge-metatarsal ligaments, which unite the second wedge-shaped and metatarsal bones. This ligamentous device is called the Lisfranc key.

Bones of the foot. Ankle joint.

Foot, ossa pedis,

has three sections:
tarsus (tarsus), metatarsus (metatarsus) and phalanges of the toes.
Two surfaces: dorsal and plantar (facies dorsalis and plantaris).
The tarsus consists of 7 bones: the talus, calcaneus, cuboid, navicular and three cuneiforms (medial, lateral and intermediate). The talus is a talus with a trochlea and ankle articular surfaces on top. The calcaneus has a tubercle and support from the talus. Between the talus and calcaneus there is a depression - the sinus of the tarsus (tarsi sinus). Metatarsus - 5 short tubular bones, the thickest and shortest is the 1st, the longest is the 2nd. The metatarsal bones have bases, bodies and heads. The thumb is called halux. The ankle joint is an articulatory talocruralis,
formed by the trochlea of ​​the talus, the articular surface of the tibia and the ankles of the tibia and fibula. The joint is complex, block-shaped, uniaxial. Dorsal and plantar flexion of the foot is possible. Joint ligaments. On the lateral side, there are 3 ligaments that begin on the lateral malleolus of the fibula: anterior talofibular, posterior talofibular and calcaneofibular. On the medial side, the capsule is strengthened by the deltoid ligament; it has 4 parts - tibiofavicular, tibiocalcaneal and anterior and posterior tibiotalar.

Why do pathologies of Chopart and Lisfranc joints occur?

Such movable joints of the foot experience a large load, since they support the weight of a person’s body during movement and in a standing position, they are most susceptible to injury and illness.

The Chopart and Lisfranc joints are the most traumatic movable joints of the foot.
The main causes of traumatic injuries and diseases of the musculoskeletal system (MSD) are the following factors:

• twisting the leg;
• jumping from heights;
• direct blow to the foot/feet on a hard object;
• playing sports where the main load falls on the lower limbs;
• professional activities associated with prolonged stay in the zone of vibration and shaking;
• lack of calcium in the body;
• bad habits and unhealthy diet.

Anatomy of the lower leg

The tibia is the part of the leg from the knee to the heel, consisting of two bones: the tibia (located medially), the fibula (located laterally) and the patella. These tubular bones have internal and external processes below. Between them is the interosseous space of the leg. The tibia is the thickest part of the lower leg, its body is triangular in shape with three distinct edges.

The fibula has almost the same length as the tibia, but is much thinner. The body of the bone is triangular, prismatic in shape, curved at the back and twisted along the longitudinal axis.

The foot is structured and functions as an elastic movable arch, the task of which is to create a certain elevation so that a person rests on individual points, and not on the entire foot. This anatomy of the foot allows you to avoid overstrain in the muscles and joints. Thanks to the vaulted structure, a person can walk upright.

Symptoms: how to recognize the disease?

Traumatic injuries

The most common injuries to the Chopart and Lisfranc joint are bruises, sprains, dislocations or fractures. Signs of various types of injury are given in the table:

Bone diseases

The most commonly diagnosed are arthrosis, arthritis and osteoporosis. How ailments manifest themselves in the Chopart and Lisfranc joints is shown in the table:

Nerves of the foot

Every joint communicates with the central nervous system, including the foot. Communication is maintained by peripheral nerves:

• posterior tibial;
• surface;
• deep fibular;
• gastrocnemius.

The system of nerve fibers is responsible for sensations: feelings of cold, warmth, touch, pain, position in space. They transmit descending impulses from the central nervous system to the periphery. Such stimulation provokes voluntary muscle contractions and a number of reflexes.

According to medical statistics, injuries to the Chopart joint are quite rare. However, statistical data do not always take into account the factor of misdiagnosis. In this regard, the frequency of dislocations in the Chopart joint is above 0.5%.

The cause of a dislocation can be a sudden fall from support onto the foot, or a sharp and strong blow to the protruding middle part. As a rule, injuries are caused by an indirect mechanism of injury under the influence of great force.

Diagnostic methods

If a joint is damaged, you must contact a traumatologist.
Pathologies of the Chopart and Lisfranc joints are diagnosed by an orthopedist or traumatologist. The doctor collects anamnesis, conducts a visual examination and prescribes diagnostic procedures, such as:

• radiography;
• scintigraphy;
• arthroscopy;
• Ultrasound;
• computed tomography or magnetic resonance imaging;
• general and biochemical blood tests.

Metatarsal or metatarsal bones

The metatarsus consists of 5 metatarsal tubular bones, each toe except the big toe (2 phalanges) consists of three phalanges. The bones have some upward curvature, which allows them to participate in the formation of the arch of the foot.

The metatarsophalangeal and interphalangeal joints attach the phalanges of the fingers to the metatarsus. In addition to the thumb, the skeleton of each finger consists of a proximal, intermediate and distal phalanges.

The foot can withstand serious static and dynamic loads due to its anatomical structure and the presence of a large number of elastic elements.

Treatment: which methods are effective?

Drugs

Traumatic injuries are treated with immobilization and the application of a cast, orthosis or splint. To relieve pain and inflammation, the following medications are recommended:

• "Diclofenac";
• "Dolobene";
• "Apizartron";
• "Deep Relief";
• "Longit."

For degenerative-dystrophic diseases, it is necessary to take chondroprotectors:

• "Dona";
• "Arthra";
• "Chondroxide".

The drug restores bone tissue.
If the Shopar and Lisfranc joints are affected by osteoporosis, calcium supplements should be used:

• "Calcium gluconate";
• "Calcemin";
• "Calcium D3 Nycomed";
• "Calcium-Vitrum".

All medications must be taken as prescribed by a doctor; self-medication is unacceptable. To restore foot mobility, you should attend sessions of physiotherapy, massage, manual therapy, water treatments, as well as do strengthening and restorative exercises daily. The degree of load on the foot should be determined by the doctor to avoid relapse of the disease.

Periostitis of the metatarsal bone

Caused by inflammatory processes in the periosteum, developing against the background of excessive stress and injuries. Inflammation occurs in the outer and inner layers of bone, including the Chopart joint. People with flat feet and women who like to wear high heels suffer from the disease more often.

Hypoplasia of the metatarsal bones of the foot is characterized by the presence of a shortened forefoot. The deformity may be congenital or post-traumatic. In addition to the obvious cosmetic defect, there is pain and contracture of adjacent joints with subluxation in the metatarsophalangeal joint.

Definition

The human foot consists of metatarsus, tarsus and toes.
In turn, the tarsus consists of the sphenoid bones, as well as the cuboid, navicular, calcaneus and talus. Metatarsus ( midfoot in vertebrates, located between the tarsus and toes

) consists of 5 tube-shaped bones, and the fingers are made of phalanges, as on the hands. The Lisfranc joint runs across and connects the metatarsus and tarsus to each other; it is also called the tarsometatarsal joints.

The following joints form the Lisfranc joint:

• 3 wedge-metatarsal;
• 1 cuboid-metatarsal.

These joints are narrow and immobile; their stabilization is provided by the Lisfunk ligaments, which consist of 3 bundles. They connect the second metatarsal bone and the medial one, while supporting the entire arch of the foot and preventing it from turning extremely massively and also from moving to the side.

Lisfranc joint ( Lisfranc de Saint-Martin (French Jacques Lisfranc de St. Martin; April 2, 1790, Saint-Paul-en-Jaret, - May 13, 1847) - French surgeon and gynecologist

) is injured quite often, fracture-dislocations and tarsometatarsal dislocations usually occur (
violation of the congruence of the articular surfaces of bones, both with and without violation of the integrity of the articular capsule, under the influence of mechanical forces (trauma) or destructive processes in
), but the disease is diagnosed from time to time time, in less than 0.5% of cases, since the pathology is usually associated with a fracture of the metatarsal bones. In addition, the disease is more common in young men under the age of 35.

If the movement is not good, a sprain of the ligament may occur, then the stability of the joint is disrupted. In this case, dislocation occurs with displacement of the bones to the plantar or dorsal side, or to the medial and lateral side. Dorsal and lateral dislocations are most often observed.

According to the nature of the injury to the Lisfranc joint ( Lisfranc de Saint-Martin (French Jacques Lisfranc de St. Martin; April 2, 1790, Saint-Paul-en-Jaret, - May 13, 1847) - French surgeon and gynecologist

) the following types of pathologies are distinguished:

• Fracture-dislocations. They can be complete or incomplete, as well as open and closed.
• Dislocation of the Lisfunk joint, it can be complete or incomplete.
• Multiple foot injuries are also likely ( the distal (far) section of the limb of plantigrade quadrupeds is an arch that is in direct contact with the surface of the earth and serves as a support when standing and moving
  ), in which fracture-dislocation of the Lisfunk joint occurs.

Depending on the direction of bone displacement, dislocations and fracture-dislocations are internal, external, external-dorsal, divergent and combined. In the latter case, the bones shift in a couple of directions; this is typical for severe injuries.

Diagnostic features

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After an injury, the patient should contact a surgeon or traumatologist at a clinic or a trauma center as quickly as possible. When examining the victim, the doctor collects complaints and medical history (fact of injury), and carefully examines the pathological symptoms. But in order to definitively establish the type of injury to the foot and, in particular, the Lisfranc joint, it is necessary to conduct additional research.

The most common and accessible is x-ray examination, which is carried out in 3 projections: direct, lateral and oblique, that is, at an angle of 30 degrees. If the displacement of bone structures is sufficiently pronounced, then the X-ray photographs clearly show the lines of fracture and separation of bone fragments, the expansion of interosseous spaces, and signs of inconsistency of bone surfaces with each other.

In these cases, diagnosis occurs quickly and reliably, but sometimes it can be difficult. In particular, diagnostic inaccuracies may be due to the overlapping shadows of the tarsal bones on each other, which can visually create a fracture line. To exclude these issues, it is necessary, for example, to also take an x-ray of the healthy foot and compare the data obtained.

X-ray examination remains the most important method for diagnosing injuries

Unfortunately, it is not possible to determine the type of ligament and tendon damage using X-rays, so computed tomography often becomes the next diagnostic step. This method allows you to “see” the smallest details of the injury that affected the bone, cartilage or soft tissue structures of the Lisfranc joint, as well as diagnose hidden injuries to the foot.

If seeking medical help was late, if the injury is multiple and severe, if all therapeutic resources have not been used, then serious complications are very likely to develop after injuries to the Lisfranc joint. These include persistent foot deformity, arthrosis of a post-traumatic nature, and chronic pain syndrome.