Midfoot Sprains in Collegiate Football Players

Abstract

We studied midfoot sprains in collegiate football players to define and document incidence, mechanisms, injury patterns, and disabilities. Twenty-three athletes with 24 injuries from 1987 through 1991, with a mean followup of 30.8 months, were identified for the study. The injuries occurred in 4% of the football players per year with offensive linemen incurring 29.2% of the injuries. The location of maximal tenderness on physical examination was an important prognostic indicator such that injuries with medial and global midfoot tenderness to palpation had the longest time loss from participation and time until full healing. Lateral midfoot sprains required short periods of disability, and players were able to return to participation with the use of an orthosis. Nineteen athletes with 20 injuries responded to a questionnaire. Four players reported residual functional problems. Only 1 of these players had to modify his recreational activities because of pain. The other players remained very active with only mild complaints of pain after high-demand activities. Midfoot sprains were associated with acute disability that required prolonged restriction from competition, but for most players the long-term residual problems were minor.

Lisfranc injuries

“…Weightbearing radiographs should be repeated 2 to 3 weeks after the injury to ensure against late displacement. These injuries often require prolonged recovery time; however, patients can generally expect full recovery and return to activity with minimal longterm implications [4].…”

Conservative Management of Subtle Lisfranc Joint Injury: A Case Report

“…15 Occasionally midfoot ecchymosis may be present. 52 The patient may have difficulty weight bearing, particularly on the toes, 48 although in our experience some patients with a subtle injury may only have trouble with sprinting at full speed on the toes. Other authors 43 also report that some patients with athletic Lisfranc injuries are surprisingly active in the acute stage.…”

“…4 Excessive pronation and failure to resupinate are widely assumed to result in the production of deleterious forces through the foot during gait, 3,4,63 particularly during push-off, where Lisfranc instability occurs. 48 Because a key component in resupination of the foot is the development of tension in the plantar fascia (the ''windlass'' effect), which is dependent upon extension of the first metatarsophalangeal joint (MPJ), 16,30 the orthoses were designed to promote first-MPJ extension. To maximize first-MPJ extension, Roukis et al 65 have demonstrated that prevention of dorsiflexion of the first ray during gait is important.…”

“…76 Soft tissue Lisfranc injuries cause painful instability of the foot during the push-off phase of gait as the forefoot is loaded (ie, reproducing the position of Lisfranc injury). 48 They are significant injuries often associated with chronic disability 73,80,81 and may prevent an athlete from returning to sport. 15 A number of mechanisms may disrupt TMT integrity, including a directional change in football, or a severe bending stress, which can occur in equestrian or in sail-boarding accidents when the foot is fixed in a stirrup.…”

“…51 Others advocate treatment in a nonweight-bearing cast for up to 6 weeks, followed by a weight-bearing cast for an additional 6 weeks. 20,23,48,55,68,70 In either case, the athlete is typically unable to return to sport for at least 4 months, even if the diagnosis is a minor sprain. 15,68 Untreated Lisfranc injuries have been associated with poor outcomes.…”