Newswise — Orthopaedic surgeons are finding an increase in the number of serious foot injuries among elite athletes according to a study presented at the American Orthopaedic Foot and Ankle Society's (AOFAS) annual summer meeting today. These include Lisfranc (midfoot) injuries, potentially career ending injuries often misdiagnosed as sprains. The study found that aggressive surgical repair is often necessary in such injuries to allow a return to the sport.
"Injuries of the foot are increasing among elite athletes while all other injuries are decreasing," said Robert Anderson, M.D., Charlotte, NC, senior author of the study and team physician to the North Carolina Panthers. "Lisfranc injuries in particular are a concern because they are often misdiagnosed as sprains. Physicians need to be aware that any midfoot injury is potentially serious and aggressive treatment may be needed." Dr. Anderson attributes the increase in foot injuries to three factors: 1) Elite athletes are physically stronger, bigger, and faster, increasing the forces that athletes' feet are exposed to; 2) Elite athletes are wearing light weight shoes so they can run faster; and 3) changes in playing surfaces.
The Lisfranc injury is the rupture of a key ligament connecting the midfoot to the forefoot. The injury is often misdiagnosed as a simple foot sprain because X-ray abnormalities can be very subtle.
To understand the correlation between lisfranc injuries and elite athletes, Dr. Anderson, and his fellow Matthew Dean Hammit, MD, studied two collegiate and seven professional football players injured from October 2000 to August 2003. All were diagnosed with a variant of the Lisfranc injury. Seven of the nine patients underwent surgery, and all nine patients returned to full athletic activity.
The study found that elite athletes are especially at risk for Lisfranc injuries. Football players typically sustain this injury when their feet are planted and they get tackled from behind. The tacking motion puts great force on the mid-foot, causing a rupture of the ligament.
New types of more forgiving playing surfaces are being developed that may reduce foot injuries. The newest product, called Turf, combines a plastic-like grass with tiny balls of rubber that act as padding, and appear like mud when seen on television. This surface is less abrasive, but athletes wear longer cleats for traction, and injuries still occur.
"A midfoot injury in a football player should be scrutinized because what may seem like a sprain initially could actually be a Lisfranc injury, which is potentially serious," said Dr. Hammit. "Often, Lisfranc injuries will be recognized as sprains, and go untreated leaving the foot unstable."
When elite athletes are improperly diagnosed they can suffer career ending injuries. Lisfranc injuries result in the inability to run and push off with their foot. "This injury to mid-portion of foot can have drastic consequences on an athlete's ability to perform at a high level and can be debilitating," said Dr. Hammit.
To ensure a proper diagnosis, Dr. Hammit recommends that patients see an orthopaedic surgeon and have a standing X-Ray taken. Standing X-rays put pressure on the foot, and allow an experienced doctor to see the subtlety of the injury. For proper recovery, Dr. Hammit stresses that the only real option is surgical treatment, rather than treatment with a cast.
Dr. Hammit noted that injury cannot be avoided completely, but "when properly diagnosed, the opportunity to achieve a full recovery can be reached."
The AOFAS is the leading professional organization for orthopaedic surgeons specializing in disorders of the foot and ankle. Orthopaedic surgeons are medical doctors with extensive training in the diagnosis and treatment of the musculoskeletal system that includes bones, joints, ligaments, tendons, muscles, and nerves.
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