HealthyFeetBlog.com

The human foot is a masterpiece of engineering and a work of art.
-Leonardo Da Vinci

When in doubt, punt!
- John Heisman

In a game with a name like football, it’s surprising how little attention is paid to the feet of the players. After all, the health of a player’s foot can actually make or break a game. One foot injury that has been popping up in the footnotes of sports history more and more frequently is the Listfranc fracture.

Many would argue that the hampered performance of Philip Rivers of the San Diego Chargers was a least partially responsible for the team’s 2006 playoffs loss. Rivers’ Lisfranc injury made it difficult to plant his foot to get the appropriate momentum when throwing passes. When Dwight Freeney of the Indianapolis Colts suffered a Listfranc fracture while playing in a game against the San Diego Chargers, it forced him to spend the rest of the season on the injury reserve list. The Colts rallied from the loss of their star defensive end and went on to win the 2007 NFL Super Bowl against the Chicago Bears, but at the time many sports commentators were convinced that Freeney’s foot injury was a wound the team would be unlikely to recover from.

So what causes these mysterious foot injuries? Do Lisfranc fractures affect the general public or are they an occupational hazard unique to football players? Let’s take a closer look.

What is a Lisfranc fracture?

A Lisfranc fracture is a midfoot injury, either a break or dislocation of one or more of the five bones that make up the top of the foot between the ankle and the toes. These bones are called metatarsals.

Not all Lisfranc fractures are created equal. Depending upon how many and which of the five metatarsal bones has been injured, a Lisfranc fracture may be more or less severe and more or less debilitating.

What causes Lisfranc fractures?

There are many ways to injure the top of the foot. Frequently Lisfranc fractures occur from crushing impacts such as something heavy dropping on the foot or someone stepping on the foot. Stepping into a hole and falling can cause the midfoot to unnaturally twist, dislocating a metatarsal.

When Lisfranc fractures were first discovered in the 1800’s, the injury was usually observed in soldiers on horseback. When a soldier was thrown from a horse during battle his foot would get caught in the stirrup causing both a harsh impact to the top of the foot and an unhealthy torquing motion. Although, military personal and horseback riders still have a higher incidence of this injury than the general population, in modern times football players are by far the most common recipients of Lisfranc fractures. Both American and European (soccer) football players suffer a high risk of developing a Lisfranc injury because their sports involve a lot of feet on feet close contact. Lisfranc fractures can also occur as a result of a severe accident such as a car crash.

What are some symptoms that might indicate a Lisfranc fracture?

The most common symptoms of Lisfranc fractures are swelling, pain, and bruising. Depending on the severity of the Lisfranc fracture, you may or may not be able to walk on the injured foot.

Lisfranc fractures are often initially diagnosed as sprained ankles. The recommended treatment for a sprained ankle is rest, ice, compression, and elevation (RICE). If after suffering a foot injury RICE does not reduce foot pain and swelling; then you should see a doctor as soon as possible. You likely have a Lisfranc fracture. The only way to know for sure is to get an x-ray of your foot.

What is the recommended treatment for a Lisfranc fracture? If my favorite player suffered a Lisfranc fracture, how long would it take him to recover?

There are both operative and non-operative forms of Lisfranc fracture treatment. The non-operative treatment is the more common. It involves the use a either a non-weight bearing cast or a walking cast to help restrict the foot’s movement. As the symptoms decrease the patient is usually advised to wear rigid soled shoes to prevent re-injury from repetitive stress. If dislocation has occurred and the bone needs to be reset, an operation involving fixing the location of the bone with pins, wires, or screws may be necessary before non-operative treatment methods can begin.

Treatment of a mild Lisfranc fracture with no dislocation may take 6 weeks. Treatment of a severe Lisfranc fracture can take over a year. Because the midfoot is responsible for the translation of force during the “toe-off” phase of an athlete’s gait, even if an athlete has recovered enough to walk on the injury, the athlete’s performance may still be affected. Some people never fully recover from Lisfranc fractures. The injury becomes a chronic secondary disability.

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