Examining the Irish: Injury Report and LisFranc Sprains

As the Thin Blue Line continues to get thinner, here's a look at Notre Dame's injury situation following Saturday's loss to Louisville:

• Jarron Jones = LisFranc sprain; out vs. USC
• Cody Riggs = Stress fracture in the foot; currently in a boot but will attempt to practice this week
• Daniel Cage = Knee injury; will practice this week and will likely be available
• Sheldon Day = MCL sprain; out vs. USC
• Drue Tranquill = ACL injury; out vs. USC

For some background on the knee injuries to both Day and Tranquill, check out One Foot Down's previous post on the subject.

LisFranc Joint

A LisFranc injury is a fairly common trauma that occurs when significant force is applied to a plantarflexed foot.  Plantarflexion describes the orientation of the foot when the toes are pointed.   The opposite of plantarflexion is dorsiflexion, which describes the position of the foot when the top of it is pulled back and up toward the shin.

To begin, the name LisFranc belonged to a French military surgeon who served during the Napoleonic Wars.  Other than that, and more relevant to our discussion, it refers to the joint between four of the five tarsal bones and the metatarsal bones in the foot.  The LisFranc joint is also referred to as the tarso-metatarsal joint.  The five tarsal bones are (names in bold are involved in the LisFranc joint):

• Navicular
• Medial cuneiform
• Intermediate cuneiform
• Lateral cuneiform
• Cuboid

Blausen.com Staff

Here's an X-ray showing a LisFranc injury:

James Heilman, MD

This is an image of the left foot taken from above.  The bright green line indicates the extent of the LisFranc joint, where the tarsal bones articulate with the metatarsal bones.  The joint itself is held together by ligaments running in approximately the same direction as the metatarsal bones.  These ligaments are found on the dorsal and plantar surfaces of the foot, and are damaged during sprains or dislocations of the LisFranc joint.

So to recap: LisFranc does not refer to a bone, nor does it refer to a single ligament, but multiple individual joints and ligaments forming a single overall joint that imparts stability and flexibility on the middle of the foot.

LisFranc injuries

As previously mentioned, LisFranc injuries occur when force is applied to a plantarflexed foot.  To illustrate, imagine you are kneeling on both knees with your toes pointed directly behind you.  As you remain on your knees, perhaps praying that ND's patchwork defense can muster up some magic this Saturday, some inconsiderate Michigan fan walks behind you and "accidentally" steps on the sole of your pointed foot with all his weight.  If he brought his weight down in the middle of your foot, the metatarsal bones would be displaced dorsally in relation to the tarsal bones, causing a LisFranc dislocation.  It is also likely that you would have experienced a fracture of at least one of the metatarsal bones, and in fact, LisFranc sprains or dislocations are often accompanied by fractured metatarsals.  In the X-ray image presented above, three of the metatarsal bones are fractured. Naturally, such a fracture would complicate the injury, increasing both the likelihood of surgical intervention and extending the recovery time.

Another scenario, one much more likely in football, occurs when the foot is plantarflexed and someone lands on the injured player's heel.  In this scenario the tarsal bones would be displaced dorsally.  Either way, the damage occurs at the same joint between the tarsal bones and the metatarsal bones.  As a final note, LisFranc injuries are often seen in motor vehicle accidents wherein the driver plantarflexes the foot as he slams on the brakes. The force of impact drives the brake pedal against the foot, causing a LisFranc injury.

Fans should be glad to hear that Jarron Jones only has a LisFranc sprain. A sprain of the LisFranc joint involves just the ligaments holding the joint together; no dislocation of the metatarsal bones, as well as no fractures of either the metatarsals or tarsals are present.  The prognosis of this type of injury tends to be excellent, with treatment being immobilization of the joint for six weeks and no surgery indicated.

Summary

• The LisFranc joint occurs between the tarsal bones and metatarsal bones in the middle of the foot
• Force applied to the sole of a plantarflexed foot can cause damage to the joint
• LisFranc injuries are often accompanied by fractures of the metatarsal bones which increases the need for surgical repair and prolongs recovery time.
• Beat Southern Cal

**UPDATE**

It now appears that Jarron Jones has a tear of one of the tarso-metatarsal ligaments which will require surgery.  As mentioned above, surgical intervention greatly increases a player's recovery time. Therefore, he will most likely be inactive for the next 4-6 months.  His activity levels should remain in the back of everyone's mind as the Irish approach spring practices.