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The Agony of D' Feet

The foot is a delicate yet strong collection of oddly shaped and spaced bones. The feet support hundreds of pounds of weight in some people. The foot is divided into three main parts: the hindfoot (heel), midfoot, and forefoot (toes). There are many joints in the foot that are held together by ligaments.

Injury to the midfoot is rare in nonathletic adults. But it's the second most common foot injury in athletes. Football offensive linemen are the most likely athletes to be injured in this way. It only takes a low-velocity, indirect force to disrupt the ligaments when the foot is in just the right position. Other athletes affected include soccer, baseball, and basketball players. Cross-country athletes with a midfoot sprain have also been reported.

Such a midfoot sprain can tear the Lisfranc ligament. This ligament is the largest in the midfoot area. It connects the cuneiform bone in the midfoot to the base of the second toe bone. Dislocation of the bone can occur if there is enough damage to the ligament and capsule.

Doctors at Duke University recently identified a way to diagnose and classify this problem. They found that X-rays in the standing position (weight-bearing) are the best for showing separation between the bones. Bone scans are another form of imaging and are 100 percent sensitive for bone injuries. Bone scans show minor changes in bone metabolism and blood flow when other tests appear normal.

This information is important because it helps doctors choose the best tests and treatment. Athletes want to return to their sport as quickly as possible with no pain and full function. The wrong treatment can delay this by weeks to months.

References: James A. Nunley, MD, and Christopher J. Vertullo, MBBS, FRACS. Classification, Investigation, and Management of Midfoot Sprains. Lisfranc Injuries in the Athlete. In American Journal of Sports Medicine. November/December 2002. Vol. 30. No. 6. Pp. 871-878.

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