As I painfully watch Dr. Henne's favorite team in the NFL, the Minnesota Vikings, lose players for all different reasons, I feel the worst for Matt Cassel. This past week when the Minnesota Vikings quarterback hurt his foot we immediately suspected some type of Lisfranc's injury.
A Lisfranc's tear of the ligament or fracture of the joint both are terrible injuries. Usually the mechanism of force in this injury is the metatarsal bones being forced in one direction while the mid foot and rear foot bones are going another. When there is not a fracture associated with a tear or strain, I find these injuries to be grossly under treated.
Whenever I have an athlete in my office who presents with a swollen foot that has difficulty bearing weight I always get an x-ray. If their history is one that involves someone falling on the foot or them recalling pain in their mid foot after a forced dorsiflexion of the foot I am suspecting a Lisfranc's ligament strain, fracture or dislocation. If the x-ray is negative I send the patient for an MRI. I feel strongly that we do these individuals a true disservice if we do not fully investigate these types of injuries. Whether it is a 14 year old football player or an Olympic sprinter training in Clermont, I believe the sequela of this type of injury under treated can lead to potential disability down the line.
If the MRI is positive for a Lisfranc's strain I will immobilize this patient in a cast and make them non weight bearing for 6-8 weeks. I would then have them progress to weight bearing in a pneumatic walking cast for at least a month. If there is a fracture of the Lisfranc's joint with no dislocation I may consider the same treatment as above but the non-weight bearing period of time may be a little longer based on the patients serial x-rays and clinical symptoms. But in many cases this becomes a surgical problem.
If the X-ray and MRI show a fracture with dislocation I believe surgical intervention is paramount for the individuals avoiding a rocker bottom foot deformity in the future. This is not a perfect procedure and comes with its own set of consequences for future foot problems. The surgical approach is determined based on the type of dislocation and fracture. I usually will perform and open reduction with internal fixation to relocate the broken bones or pin percutaneously unstable joints. Unfortunately for the patient, these screws that we put across the joints are only temporary and will require a second surgery for screw removal.
As you can imagine, the road to recovery after this type of surgery is arduous. For a world class athlete the road can be easier as the treatment received may be more expeditious, unlike the bureaucracy and hoops that the average Joe might have to go through in order to even get an MRI approved or come up with their new $12,000 deductible they have now due to the Affordable Health Care Act.(Sorry doctor rant over.)
Matt Cassel most likely will have surgery this week for his foot if he has a fracture or a dislocation of the Lisfranc's joint. This injury though will be season ending for him. If he is your quarterback for fantasy football hopefully you caught wind of this prior to the wavier choices being picked and done. If not, hopefully, you have a really good back-up on your bench!
If you would like to keep up to date on the many types of injuries your fantasy football players may be faced with this season check out our webpage http://centeranklefootcare.com/id81.html home to the "2 Pods & a Microphone" Podcast, where myself Dr. Michele McGowan and my partner in many ways Dr. Henne explore the injuries that matter to the feet and ankles to your fantasy football team:)
I used to play football in colledge too, but I f-worded my knee, so all I can do now is sit back and watch the news. Btw here's a site you all could use http://www.thefantasyfootballers.com/ . Its got news, podcasts and all that type of stuff for the harcore football fan.
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