Friday, July 19, 2013

Foot sprains - Are they more than just sprains?

Have you ever been diagnosed by your doctor with a “foot sprain” after an accident, fall, or foot-twist?  Were you immobilized with a boot for a short period of time without much relief?  The reality of the situation is that you may have incurred a more debilitating injury in your foot ligaments. 

Some might ask what do the National Football League athletes Santonio Holmes, Ryan Kalil, Matt Schaub, and Dwight Freeney have in common?  They all suffered from a frustrating foot injury commonly referred to as Lisfranc’s injury.

The injury is named after Jacques Lisfranc, a French surgeon in Napoleon’s army.  It refers to a ligament and/or osseous (bone) injury of the metatarsal-tarsal joints and can present with severe dislocations and fractures (1).  The mechanism of the injury involves either a direct force of trauma on a planted foot or indirectly through a complex sequence of twisting motion.

Diastasis noted in the joint complex consistent with Lisfranc ligament injury
Approximately 20% of Lisfranc injuries are misdiagnosed in the emergency room because of their vague presentation and subtle x-ray findings (2).  They are often mislabeled as "foot sprains” and thus, treatment is often delayed which results in:
  • Post-traumatic arthritis
  • Chronic midfoot instability
  • Chronic pain
Lisfranc injuries occur in 1 person per 55,000 yearly.  67% of which are results of motor vehicle accidents, crushing injuries, and falls from heights (2).  Although those injuries are not common in the general population, certain athletes suffer a higher rate of this injury.  It is seen in 4% of football players per year, with offensive linemen incurring 29.2% (3). 

Foot and ankle specialists are trained to recognize the pathology using specific clinical examination and with the help of imaging modalities such as stress x-rays, CT scans, and even MR images.  If recognized early, prompt treatment can limit complications and potentially salvage an athlete’s season/career.

If you have sustained or suspect a foot sprain, then consult with your foot and ankle specialist.  

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