Foot & Ankle International - July 2018 - 803

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Mora et al
to weight bear in a boot and from 12 weeks weight bearing
in a running shoe with an over-the-counter arch support.
Removal of hardware was scheduled at 6 months for all
patients, and return to sports without restriction was allowed
at 8 months with the guidance of a physical therapist.

Clinical Outcomes
Clinical outcomes were assessed with the FAOS. The FAOS
is a validated, 42-item questionnaire assessing patient-relevant outcomes in 5 separate subscales including pain,
symptoms, function in daily living, function in sport and
recreation, and foot and ankle-related quality of life.
Patients answer each question from 5 standardized answer
options. Each question gives a mark from 0 to 4. These
marks are then normalized to a score out of 100 for each
subscale, where 100 indicates no symptoms and 0 indicates
extreme symptoms. The subscale marks are then averaged to
give an overall score out of 100. Any complication experienced by the patient was recorded.

Sports and Physical Activities
Sports and physical activities were assessed with a retrospective 15-item Sports Questionnaire specifically designed
for the study. The questionnaire was completed via mail,
telephone, or email. Patients were asked to document which
sports and physical activities they participated in pre- and
postoperatively and how frequently (times per week) they
participated. All sports and physical activities were later
classified as either high or low impact.
The difference between preinjury and postsurgical intensity of exercise was recorded, with response options "no
difference," "mild difference," "moderate difference," and
"significant difference." Patients were asked to record any
restriction of activity postoperatively with dichotomous
response options (yes or no). Similarly, patients' assessment
of foot stability and weakness when walking and exercising
were each recorded with dichotomous response options
(yes or no). Patients' assessment of pain at rest, when standing, walking, and exercising were each recorded from 0 to
10, with 0 signifying no pain and 10 being unbearable.
Responses to all survey questions were weighted equally,
and an overall Sports Questionnaire score was calculated.

Statistical Analysis
Statistical calculations were performed using SPSS version
25 for Mac (Armonk, NY). Descriptive statistics were presented as mean and range for continuous variables.
Correlation between overall FAOS and the Sports
Questionnaire scores was calculated using Spearman's rank
correlation coefficient (rs). A P value of less than .05 was
considered statistically significant.

Table 1. Patient Participation in Sports Prior to Lisfranc Injury
and Following Open Reduction Internal Fixation Surgery.
Sport

Impact

Running
Walking
Soccer
Surfing
Swimming
Weights
Rugby
Basketball
Yoga
Bike

High
Low
High
High
Low
Low
High
High
Low
Low

Preinjury, Postoperative, Change in Sport
n
n
Activity, %
14
10
9
7
5
5
4
2
2
2

9
9
6
5
5
5
3
1
1
2

−36
−10
−33
−29
0
0
−25
−50
−50
0

Informed consent was obtained from all participants.
The study was approved by the Human Research Ethics
Committee (16/016).

Results
Sport Questionnaire
Patients participated in 66 activities across 16 different
sports preoperatively and 55 activities across 17 sports
postoperatively. The most common activities both pre- and
postoperatively were running, soccer, and walking. Fifteen
activities were stopped across 13 patients, while 4 activities
were started in 4 patients postoperatively. Nine of the 15
discontinued activities were high impact. Thirty-one of 33
(94%) patients returned to some level of physical activity or
sport postoperatively. The percentage of decreased sport
activities are detailed in Table 1.
Comparing pre- and postoperative sports and physical
activities, 22 of 33 (67%) patients were able to participate at
the same or more frequently (times per week), and 11 (33%)
practiced less frequently. Most of the patients who played at
the same frequency also could play at the same or higher
level of intensity (17/22), whereas more than half of the
patients in the less frequent group (6/11) could play at only
a decreased level of intensity.
Among the 22 patients who played with the same or
higher frequency, 13 were asymptomatic, 5 reported some
ongoing pain, and 4 reported ongoing weakness or instability. As with the 11 patients who played less frequently, 5
were asymptomatic but playing less due to lifestyle reasons,
while 6 had ongoing pain (Figure 2).
Despite 11 of the 33 (33%) patients reporting ongoing
pain, 27 of 33 patients (80%) were not limited by their injury
and any ongoing symptoms experienced, indicating that
postoperative symptoms, if present, were likely minor in
nature. Of note, 6 patients were forced to reduce their level
of exercise because of residual symptoms, predominantly

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