10/03/2012 09:52 am ET Updated Dec 03, 2012

Santonio Holmes' Lisfranc Injury: A Foot Surgeons Perspective

The cat is out of the bag -- Jets wide receiver Santonio Holmes has the dreaded Lisfranc injury. He will miss the rest of the season. But what exactly is a Lisfranc injury anyway?

Before we get into detail about Lisfranc injuries, I will tell you, that as a Reconstructive Foot Surgeon with major foot trauma experience, Lisfranc injuries can be the most devastating, traumatic injuries of the foot (because they tend to rehab poorly and can go onto midfoot arthritis). But right now we don't know the extent of the damage in Holmes' foot, so can't speculate too much on what this will mean for his career. Hopefully just a blip.

Lisfranc injuries occur in approximately 1 in 55,000 people per year. There are varying degrees of injury, making it difficult to classify them. In the non-athletic world these injuries often go misdiagnosed. Interestingly, women are susceptible to Lisfranc injuries from falling in high heels -- something I call the high heel foot fracture.

A Lisfranc injury, in the most basic form is a severe midfoot sprain. The midfoot arch (called Lisfranc joint) is a complex interlocking articulation of nine bones with strong ligamentous attachments. These ligaments keep the midfoot bones stable!

Damage to Lisfranc ligaments could mean, one of three things:
  1. Lisfranc Injury = simple stretching/sprain of the ligaments,
  2. Lisfranc Fracture = complete rupture of the ligaments with a small bone chip,
  3. Lisfranc Fracture Dislocation = malalignment of the boney structure.

As of now, with regard to Santonio Holmes, we just know that there is an injury. It is still not clear if there are hidden bone fractures, or if the midfoot is completely stable. It is my suspicion that there may be an associated fracture -- obvious ones can be picked up on MRI, but a CT scan is really helpful.

The presence of a small fracture raises the question as to whether or not the midfoot ligament integrity is stable. Often manual stress exams are performed when the suspicion is high, and if instability is seen then surgery is indeed an option. Surgery for a Lisfranc fracture dislocation/instability can be quite extensive, and involve placing wires, screws and/or metal plates.

There are still some missing pieces with regard to Holmes, but for now he is out for the season. So long as his midfoot is structurally stable (and doesn't need surgery), we may never find out if his Lisfranc injury was really a Lisfranc fracture.

--Dr. Blitz
New York City

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