Midfoot sprain, also known as lisfranc sprains, are increasingly common traumatic injuries in the National Football League, and the second most common foot injury in collegiate football. In the NFL, Atlanta Falcons quarterback Matt Schaub, Steelers running back Le’veon Bell, and Baltimore Ravens cornerback Jimmy Smith are just a few of the players who have suffered lisfranc injuries in recent years.
What’s a lisfranc and how does this injury happen?
The lisfranc joint complex, where the metatarsal bones of the forefoot connect to the bones in the midfoot, was named after Jacques Lisfranc de Saint Martin (1790-1847), a field surgeon in Napoleon’s army, who discovered the ligament complex when treating cavalry soldiers who fell when their feet were trapped in their horses stirrups. In a lisfranc injury, the ligaments which hold the midfoot together are damaged or torn, and the bones can dislocate and shift out of place if the joint complex is unstable. Lisfranc injuries can be purely ligamentous, or involve bone fractures, and are almost always serious injuries requiring a long period of recovery.
Lisfranc sprains can occur in a high velocity incident, like braking during a car crash, but more commonly happen in a low velocity incident, like during a sports game, or when tripping on a stair. In football, this injury might occur to a lineman in stance when a tackled player falls onto the lineman’s heel, leading the midfoot to be overly flexed. Dr. Robert Anderson, the co-chairman of the NFL’s Foot and Ankle Committee, believes that the rise of lisfranc and other sports injuries is because players are bigger and stronger, wear less supportive footwear, and are often playing on an artificial surface. In basketball or soccer, an injury can occur when a player lands on the top of another player’s foot. Symptoms include severe pain, midfoot swelling, inability to bear weight or walk, and in more serious injuries, bruising on the bottom of the injured foot.
How are lisfranc injuries diagnosed and treated?
Lisfranc sprains are diagnosed through physical examination and weight-bearing X-ray. A lisfranc injury is noted when there is a “gap” between the first and second metatarsal joints in the foot. Additional imaging tests like CAT Scan and MRI assist in diagnosing the extent of the injury and formulating the treatment plan. It’s imperative to get the proper diagnosis because 20% of lisfranc injuries are missed on initial x-ray.
Each midfoot injury is unique, and treatment depends on the severity of the injury. Grade I sprains, where the ligaments are stretched but intact and there is no joint dislocation, are treated conservatively with casting and a period of non- weight bearing. Grade II and III injuries, where bones are dislocated and unstable, must be treated with internal fixation or fusion surgery to stabilize the joint. Recovery takes many months.
What’s the prognosis for athletes?
Although any injury to the midfoot can be serious, most athletes recover from all but the most severe injuries. According to a study published in the American Journal of Sports Medicine, more than 90% of NFL athletes returned to play in the NFL nearly a year from injury, and no statistically significant changes in performance were observed.
If you’re experiencing midfoot pain after a fall or accident, don’t delay. Contact our experienced medical team at Hampton Roads Orthopaedics Spine & Sports Medicine to learn more about treatment options and how we can help you get back to what you love.
