Initial reports stated that New York Jet’s wide receiver Santonio Holmes had suffered a foot sprain because x-rays on the foot were negative.
But subsequent MRI exam results were sent to a foot specialist in North Carolina where the Jets’ fears were then confirmed. Jet’s Santonio Holmes did have a lisfranc injury to his left foot. How could this be confused with just a foot sprain? Very easily upon a cursory review. Let’s review the anatomy of the area. The Lisfranc ligament spans from the medial cuneiform to the second metatarsal base. The keystone wedging of the second metarsal into the cuneiform forms the focal point of the lisfranc joint. This anatomy establishes a “weak link” that, with stress, is prone to injury. The illustration below shows the Lisfranc joint anatomy.
FIGURE 4. Bones of the ankle and foot (dorsal view), demonstrating the Lisfranc joint and complex. Note the “keystone” wedging of the second metatarsal into the cuneiforms.
The mechanism of injury is a dorsal dislocation of the proximal base of the second metatarsal when the foot is placed in extreme plantar flexion with an axial load. The illustration below shows the mechanism of injury that can be the source of a lisfranc injury.
FIGURE 5. Dorsal dislocation of the proximal base of the second metatarsal (small arrow) when the foot is placed in extreme plantar flexion with an axial load (large arrow). This dislocation occurs because the base of the second metatarsal extends beyond the horizontal axis.
The lisfranc dislocation or injury is clearly defined in the radiograph below
FIGURE 3. Enlargement of the radiograph shown in Figure 2. Note the fleck sign (arrow), which is a bony fragment indicating severe disruption of the Lisfranc joint. The triangles indicate the malalignment of the proximal base of the second metatarsal and the medial margin of the middle cuneiform.
During the high speed game of football, these injuries are hard to avoid if your foot is plantar flexed then a high axial load due to a tackle that can happen with the mechanism shown above.Treatment is usually a below knee fiberglass cast non-weight bearing for 4-6 weeks with physical therapy or open reduction internal fixation. It is suggested, a displacement of more than 2 mm requires open reduction and internal fixation to avoid a poor outcome, especially in athletes.
If you have suffered a sports injury, call your Atlanta area Podiatrist at American Foot and Leg Specialists.
