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Out by a foot Rare midfoot injury can KO even the best of athletes
Updated: Wednesday November 01, 2000 3:42 PM
By Ryan Grove For years, defenses across the NFL have had trouble slowing down Duce Staley. It took a rare foot sprain earlier this season to finally sideline the Philadelphia Eagles' star running back. The injury is called a Lis-Franc injury, a sprain in the tarsometatarsal region of the foot. It can be a debilitating injury, especially for a football player who must run and cut on the foot. The tarsometatarsal region of the foot is also called the midfoot, an area made up of nine bones. Injuries to the midfoot area are rather uncommon and usually involve the Lis-Franc ligament, which connects a bone to the base of the second metatarsal, the long thin bone next to the so-called "big" toe. This injury is commonly accompanied by a fracture and is often misdiagnosed as a simple metatarsal fracture. While the primary attention is placed on the fracture, subtle subluxations or separations between bones may go unrecognized. Any separation that goes overlooked -- most commonly at the base of the second metatarsal -- can cause the entire forefoot to become unstable. A Lis-Franc injury usually occurs when an athlete falls on pointed toes or backwards while the foot (midfoot) is trapped underneath the body. The ligament becomes sprained, causing the potential for displacement of the metatarsals or an unstable midfoot. This type of sprain can be difficult to diagnose because the signs and symptoms may be subtle. The athlete will complain of pain and will be unable to bear weight. Swelling occurs over the top of the foot and the athlete is usually very tender over the first and second metatarsals. In addition, the athlete will have difficulty walking and performing calf raises. To aid in the correct diagnosis, an X-ray and MRI can be used to rule out a fracture and evaluate the severity of the injury. Treatment starts with proper recognition of the injury, education of the athlete and a gradual return to activity. The treatment for acute sprains consists of protection, rest, ice, compression and elevation. The initial treatment goal is to promote healing by protecting the injured area while controlling the bleeding, swelling and pain. For a Grade 1 or 2 sprain (mild to moderate), the amount of stress at the injured site can be limited with crutches and/or a walking cast or boot. After the protection period, range of motion and pain-free exercises are used to increase flexibility, strength and endurance. This is followed by the progression of functional and sport-specific skills until the athlete is ready to return to play. For Grade 3 or severe sprains, surgery may be required to correct any displacements. The amount of time an athlete will miss due to a midfoot sprain is based on several factors, including the severity of the sprain, proper diagnosis, correct treatment, appropriate rehabilitation and the individual athlete. Recovering from this injury can take anywhere from several days to several months before full activity is resumed. It's important to realize the seriousness of this type of injury. Staley's Lis-Franc injury was enough to knock him out of the Eagles' lineup for the rest of the season. It's the only thing that has stopped him so far. Note: A physical ailment cannot be properly evaluated without a full medical examination by a licensed physician. The above is not represented to be a substitute for such and examination. The PFATS and CNNSI.com recommend and encourage you to consult with a physician before beginning any course of treatment for any physical ailment.
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