The Piano Key Test: A Clinical Sign for the Identification of Subtle Tarsometatarsal Pathology

Keiserman, Luciano; Cassandra, James; Amis, James A.

doi:10.1177/107110070302400511

Cited by 28 publications

(13 citation statements)

References 12 publications

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“…A complete inspection of the foot and ankle complex should be noted, including the plantar aspect of the foot. 29,30 Imaging of the midfoot should begin with 3-view weightbearing plain radiographs of the foot. 28 Palpation for areas of point tenderness and range of motion of the individual TMT joints can help identify which joints are affected within the foot.…”

Section: Diagnosismentioning

confidence: 99%

The Midfoot Sprain: A Review of Lisfranc Ligament Injuries

Granata

Philbin

2010

The Physician and Sportsmedicine

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The subtle clinical and radiographic findings of an unstable Lisfranc ligament injury can be easily misdiagnosed as a stable midfoot sprain. Appropriate treatment ranges from conservative management to surgery, depending on the extent of ligament disruption and subsequent joint instability. Initial evaluation with non-weight bearing radiographs is often normal in unstable injuries. The results of missed or inappropriately treated Lisfranc injuries are poor. Chronic joint instability can lead to persistent pain, degenerative joint disease, and decreased functional capacity. Inability to return to previous levels of activity may result from painful midfoot arthritis. It is important to have a high index of suspicion for unstable Lisfranc injuries in patients who present with midfoot pain after low-energy injuries. Stress radiographs and magnetic resonance imaging can help differentiate between stable and unstable ligament sprains. Referral to an orthopedic surgeon is appropriate for injuries that result in joint diastasis. Long-term outcomes are optimized by early anatomic reduction.

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Section: Diagnosismentioning

confidence: 99%

The Midfoot Sprain: A Review of Lisfranc Ligament Injuries

Granata

Philbin

2010

The Physician and Sportsmedicine

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“…We attempted to be very selective by carefully identifying which joint was degenerative. 19 It certainly cannot be assumed that if one MC joint is arthritic then they all must be and the majority of our patients did well with just a single joint fusion. This finding, however, relates only to patients who present with MC joint arthritis without deformity.…”

Section: Discussionmentioning

confidence: 77%

“…Clinical examination involves the piano key test where the foot is stabilised around the midfoot and then the second metatarsal head is dorsiflexed and plantarflexed. 19 This will sometimes cause symptoms, though direct palpation of the dorsum of the second MC joint is often more reliable in reproducing the patient's pain.…”

Section: Introductionmentioning

confidence: 99%

Fusion of the Second Metatarsocuneiform Joint for the Painful Osteoarthrosis

Kilmartin¹,

O'Kane²

2008

Foot Ankle Int.

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“…Diagnosing SLI often requires a high index of suspicion, physical maneuvers, [22][23][24][25] and radiographic findings 17,21,[26][27][28] that will help identify a Lisfranc injury. It is well recognized that missing or under treating Lisfranc injuries can result chronic complaints of pain, a late collapse of the midfoot, and the development of post-traumatic arthritis of the foot.…”

Section: Discussionmentioning

confidence: 99%

“…Even without obtaining these outcomes however, studies have already demonstrated that unreduced or conservatively treated unstable Lisfranc injuries often result in persistent instability of the dorsal arch leading to the onset of posttraumatic arthritis of the midfoot and lower outcome scores. 21,27,[29][30][31] Lastly, although other findings recognizing SLI have been identified, 4,17,22,[23][24][25][26][27][28] some may consider the "jut" as part of the spectrum of these findings rather than as a separate entity for identifying a subtle Lisfranc injury. However, the authors feel that the combination of a late presentation, a previous diagnosis of a sprain and the presence of a midfoot "jut" should be added to the list of physical findings [22][23][24][25] that can be used to help make the diagnosis of SLI.…”

Section: Discussionmentioning

confidence: 99%