It has been one of the more unusual stories in sports: the rash of Lisfranc injuries suffered by NFL players this month.
Wide receiver Santonio Holmes is on injured reserve with a Lisfranc injury. Runner Cedric Benson suffered the same issue as did Carolina center Ryan Kalil. All of those injuries happened within the span of about a week or so. Last year, Matt Schaub had the same injury and in 2007 so did Dwight Freeney.
This is an amazing thing, actually. The prevailing belief is that the rash of Lisfranc injuries is total coincidence. I'm in that camp as are doctors and league people I've spoken to.
But there is a belief that we are seeing one of the repercussions of a faster game featuring bigger and speedier players. There's no proof of this, and I don't buy it. But one general manager told me that's his belief. That players are running at speeds, making cuts and doing things the foot wasn't designed to do.
"These injuries aren't a coincidence," the GM explained.
Outside of football, Lisfranc is a relatively uncommon injury. But football players (and soccer players) suffer from them more regularly. Benjamin Wedro, a physician who writes extensively about sports issues, called them a low-energy injury where a twist to the midfoot is added to a fall where the foot is plantar-flexed, or positioned like a ballerina on point. The same mechanism can happen in a pile-up if the foot is twisted when another player stumbles over top of it.
Wedro gives a fascinating history of how this injury, first examined extensively hundreds of years ago, is so relevant today. Writes Wedro: When Napoleon led his army to disaster in the Russian winter, many of his soldiers suffered from frostbite and developed gangrene of the toes and feet. Dr. Lisfranc detailed the anatomy of the foot and found that cutting through joint spaces made amputation easier. His legacy is that fractures, dislocations and sprains that affect the junction between the upper and lower foot bones bears his name.
The foot is made up of rigid bones and joints near the ankle that don't move and provide stability to the foot. They are connected to the more flexible bones that allow the foot to turn and flex for walking and running. There are numerous joints that connect the two portions, and ligaments hold them in place. On the athletic field, too much torque causes the ligaments to tear, the joint to be unstable and the alignment lost.
This is likely why the injuries are coincidental. Lisfranc injuries come mostly from the foot being bent awkwardly in a pile. Or being stepped on. Piles in the NFL happen, of course, all the time.
But there are some in the NFL who aren't convinced. "Three in that period of time?" said the general manager, "I think we're going to see an increase in these injuries because the game keeps speeding up and the collisions are getting worse."