Functional outcomes of traumatic midfoot injuries

Introduction: Midfoot injuries are rare injuries, often the result of high-energy trauma and occurring in the context of multiple trauma. This study aimed to evaluate functional outcomes and health-related quality of life after open reduction and internal fixation for midfoot injuries at a level 1 trauma center treating complex foot injuries. Methods: Retrospective single level 1 center study with follow-up by questionnaire. All adult patients who underwent open reduction and internal fixation (ORIF) for Lisfranc and/or Chopart injuries between 2000 and 2016 were included and invited to complete the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score, the EuroQOL Visual Analog Scale (EQ-VAS), and the EuroQOL five-dimensional questionnaire (EQ-5D-5L). Chart reviews were performed to collect demographic, injury, and treatment characteristics. Results: Forty patients with 45 midfoot injuries were included. Follow-up was available for 29 patients (31 feet), leading to a response rate of 83%. The majority of patients suffered high-energy trauma and nearly all patients had a concomitant injury. Secondary arthrodesis was performed in 7/45 injuries. Median AOFAS score was 64 (IQR 47–78). Higher injury severity score (ISS) was associated with poorer functionality as measured with the AOFAS Midfoot Score (p = 0.046), concomitant injuries were associated with lower quality of life (p = 0.01). EQ-5D scores were significantly lower when compared to the Dutch reference population (p< 0.001). Conclusions: Injuries of the midfoot have negative effects on mid- to long-term quality of life after trauma, with considerable potential for long-term impaired functionality. When counseling patients with these rare injuries after high-energy trauma mechanisms or in the context of multiple trauma, realistic expectations on postoperative recovery should be given.