Tuesday, October 8, 2013

Julio Jones' foot injury

There are reports that Julio Jones has sustained a season ending foot injury while playing last night in the Atlanta Falcons' 30-28 loss to the New York Jets.  According to reports, Jones continued to play through the injury.  Jones had a 5th metatarsal fracture in 2011 - the same foot that was injured last night.  A specific diagnosis has not been reported yet, as Jones is seeking a second opinion, but there has been speculation that the injury is a Lisfranc ligament tear.

What is the Lisfranc ligament and how is it injured? 

The Lisfranc ligament is a strong ligament in the midfoot that helps to stabilize the foot.  As pictured in the image above, it is attached from the medial cuneiform to the 2nd metatarsal base.  When this ligament is disrupted, there will be a displacement of the bones.  This displacement can lead to instability of the foot as well as degenerative joint changes (arthritis) in the future.  The ligament can be disrupted from a direct or indirect force on the foot.  An example of a direct force on the foot would be a heavy object dropping on the foot.  An indirect force on the ligament would be from a rotational force on the foot while the foot was pointed downwards.  

How is a Lisfranc injury diagnosed and treated?  

A Lisfranc injury is diagnosed clinically with the help of imaging studies such as x-rays and MRIs.  Lisfranc injuries can vary in severity - from a mild sprain to a tear in the ligament to fractured bones.  X-rays reveal if there is any displacement of the bones.  If there is no displacement but pain when pushing or stressing the Lisfranc ligament.  In these cases, an MRI may reveal a mild sprain of the ligament.  In these cases, the patient is casted and immobilized with a cast for about 6 weeks before progressing to a walking boot.  If x-rays show a displacement of the bones and/or fracture(s) of the midfoot, surgery is indicated in athletes, as even a small displacement of the bones can lead to long term disability and pain.  Surgery is done to realign the ligament and reduce any associated fractures that may be present in the foot.  Recovery after surgery requires 6 weeks in a non-weightbearing cast before transition to a walking boot for 2 weeks.  Typically an athlete will require a few months of rehab before returning to their sport depending on the severity of the injury.  

Does Julio Jones have a Lisfranc injury? 

With the limited information that we do know - it is possible that Julio Jones may have a Lisfranc injury.  Seeing as he was able to play through the injury is encouraging as it likely means it is a fairly mild injury.  However - he was able to play through a foot fracture in the past so his pain tolerance may be more than most.  With a average timeline of 3 to 4 months for return, it fits the timeline of him missing the rest of the season - which is what early reports indicate.  If he does have a Lisfranc injury, it is important to have the bones realigned if they are displaced to maintain stability of the bones in the midfoot.  Once they are realigned and the ligament is healed there should be minimal to no residual problems for him in the future.  It is possible that he may have a new fracture in his 5th metatarsal as well.  With a surgically repaired 5th metatarsal Jones fracture, a screw is often used to fix it.  The screw can occasionally serve as a stress riser and put the bone at risk for a stress fracture.  In fact, a CT scan is a clue that the problem is likely boney rather than involving soft tissues (like a Lisfranc ligament) unless the Lisfranc ligament tear had an associated fracture.

Update: Julio Jones does indeed have a fracture in the area of his previous injury and is scheduled to have surgery on Monday October 14th, 2013.  The procedure is likely to remove the previous hardware, clean up the fracture, and fix it again with screws and/or plates.  A period of 6-8 weeks immobilization is needed to allow for healing of this fracture.  Due to the lack of blood supply to the Jones fracture site, it may take longer.

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