Lisfranc Sprain

When it comes to infamous injuries, a Lisfranc sprain is up there with ACL tears and concussions. A mystery to many, this devastating injury plagues a few NFL players each season and has been shattering the dreams of fantasy football players for years. NFL players diagnosed with a Lisfranc injury over the last few years include Maurice Jones-Drew, Ben Roethlisberger, Matt Schaub, Santonio Holmes, Cedric Benson and most recently, Pittsburgh Steelers rookie running back Le’Veon Bell.

 

What is a Lisfranc Injury?

The Lisfranc joint is where the long bones that lead up to the toes (metatarsal bones) and the bones in the arch (tarsal bones) connect (green on the picture). It was named after its founder Dr. Jacques Lisfranc de St. Martin who happened to be a gynecologist/surgeon (I wouldn’t send my girlfriend to that guy).  Like any other joint, the Lisfranc complex stabilizes motion between bones using multiple ligaments, or bands of tough tissue, to connect one bone to another. The Lisfranc joint transfers force generated above the ankle through the foot and into the toes, allowing them to point and push off the ground among other motions, making a stable Lisfranc complex crucial for walking, running, jumping and cutting. An injury occurs when something heavy (usually another player), falls on the heel while the foot is in a plantar flexed (on tip-toe) position.

Prognosis/Treatment

The prognosis of a Lisfranc injury is often hard to determine. Depending on the severity of the injury, surgery may be required but for less severe injuries, treatment can be non-operative. A full tear of the ligament or a fracture accompanying partial tears, may warrant the more invasive approach, whereas with proper treatment and rehab, recovery time for a less severe injury can be as little as six weeks.

The early signs of a Lisfranc injury can mimic those of an ankle sprain. Common symptoms include swelling, bruising or blistering of foot and arch, pain through the mid-foot when pressure is applied, and the inability to weight-bear. 

My Fantasy Draft Pick has a Lisfranc Injury, Now What?

For an athlete with a Lisfrac injury, physical therapy is used to restore range of motion in the foot and ankle, increase joint mobility, maintain calf/ankle muscle length and strength. Some players come back and don’t show any signs of injury, almost like nothing happened. Others are never the same. I think the player’s position and the severity of the injury are the two most important factors in predicting whether they will return to full strength. For players like Matt Schaub and Ben Roethlisberger, speed and agility are not huge parts of their game, so restoring close to normal mechanics and strength, causes only a minimal decline in productivity. But for a RB like Le’Veon Bell and a WR like Santonio Holmes, speed, elusiveness, and change-of-direction are key, so it’s much harder to predict how they will come back or if they ever will make a full recovery at all.
I know you loved reading all about Lisfranc injuries but the real question is when will Le’Veon be back and his he worth drafting in your fantasy league? The latest news is that Le’Veon had only a minor sprain to his mid-foot and was less serious than first expected. He hopes to be back by week 2 of the regular season making him an appealing player in upcoming fantasy drafts. Just remember, sprains to this area of the foot often linger. Although, he may be back in the upcoming weeks, I expect him to have some lingering issues throughout the season if rushed backed too quickly. I would draft him in the later rounds (8-9) if available and stash him on your bench as he has tremendous upside if he fully recovers.

Ryan McDevitt, DPT

3 Dimensional Physical Therapy