NFL's Lisfranc's Foot Fracture Epidemic: What's Causing It?

EAST RUTHERFORD, NJ - SEPTEMBER 30:  Santonio Holmes #10 of the New York Jets is carted off the field in the second half agai
EAST RUTHERFORD, NJ - SEPTEMBER 30: Santonio Holmes #10 of the New York Jets is carted off the field in the second half against the San Francisco 49ers on September 30, 2012 at MetLife Stadium in East Rutherford, New Jersey.The San Francisco 49ers defeated the New York Jets 34-0. (Photo by Elsa/Getty Images)

As a reconstructive foot surgeon, with significant Lisfranc fracture experience, I am somewhat amazed to see three NFL players to succumb to the dreaded Lisfranc injury, in only one weeks time.

Football rarely heard of this devastating midfoot injury, and now there are three in a week? What's going on?

Lisfranc fractures first got the spotlight when Santonio Holmes Jets star receiver required foot surgery and was placed on season ending injured reserve. The following Sunday, two more Lisfranc injuries emerged. Cedric Benson, running back for the Green Bay Packers was placed on the injured reserve with a Lisfranc sprain. Ryan Kalil, Carolina Panthers center sustained a Lisfranc fracture requiring surgery.

Lisfranc injuries occur when the front of the foot is torqued against the back of the foot. Football is clearly a rough game, and the foot can be injured just like any part of the body.

There are a several possibilities for the increased Lisfranc injuries.

  1. Fluke or coincidence: This is indeed a possibility.

  • Players are taking more physical chances: As the competitiveness of football increases, players may be placing more physical demands on their bodies and the result is injury.
  • Doctors are better at making the diagnosis: Lisfranc injuries are the silent disabler in the foot as these injuries historically go undiagnosed or missed -- especially outside of athletics. There is an increased awareness of these injuries in sports medicine today, and doctors may have a high index of suspicion for Lisfranc injuries -- as such the diagnosis is being made properly.
  • There is a shoe gear problem: It's not clear if the players cleats have anything to do with these recent injuries. Theoretically, a cleat that is too flexible may not be able to support the foot's demand for high-level activity. One would hope that teams are checking their players footgear.
  • Clearly, three injuries is not an epidemic but their occurrence in such a short amount of time is highly uncommon. What's come of these recent injuries is awareness of Lisfranc injuries.

    Even with surgery, Lisfranc injuries tend to rehab poorly, and can be a career ending event. Only time will tell if we see more Lisfranc injures. If so, teams are going need to take a closer look at their players feet before they lose more players out on injured reserved.

    --Dr. Blitz
    New York City

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