Utah Utes Football: All You Want To Know About Lisfranc Injuries

Oct. 6, 2012; Chicago, IL, USA; Miami Hurricanes linebacker Eddie Johnson (44), linebacker Denzel Perryman (52) and linebacker Gionni Paul (36) pray before the game against the Notre Dame Fighting Irish at Soldier Field. Notre Dame won 41-3. Mandatory Credit: Matt Cashore-USA TODAY Sports

Editors Note: As everyone knows by now, Gionni Paul has a Lisfranc injury to his foot.  I thought it would be helpful to have this injury explained by a medical professional.  In this case, my wife who is finishing her 3rd year of medical school.  She also kindly serves as the Hoyo’s Revenge Medical Expert.  After this you’ll all be experts on Lisfranc injuries.

In light of Gionni Paul’s injury during this week’s practice, the Lisfranc injury is making news here at Hoyo’s Revenge.  Rarely does a gynecologist make news on a sports blog, but we owe this entry to French gyno Jacques Lisfranc de Saint-Martin.  He served in Napoleon’s army, and his claim to fame had nothing to do with delivering babies and everything to do with chopping off frostbit, gangrenous feet on the Russian front.  He amputated soldiers’ feet at the tarsal-metatarsal (TMT) joints, effectively severing the midfoot.  This established the Lisfranc injury as any disruption of the anatomy of these joints in foot.

The mechanism if the Lisfranc injury most commonly involves a crush injury or excessive force applied to a planted foot.  LB Gionni Paul’s injury is consistent with this mechanism, as he and RB Devontae Booker collided during Tuesday’s practice.  He hopped off the field and was immediately evaluated.  On X-ray and physical exam, the arch of the foot may appear abnormally flat with bruising and swelling.

The Lisfranc ligament provides support to the arch of the foot with perpendicular ligament fibers.  Unlike many joints that have separate ligaments supporting the joint in different planes, the Lisfranc ligament is the main support of the TMT joints.  Disruption of the Lisfranc ligament (ranging from a sprain to complete tear) renders the foot very unstable and the arch may collapse without support.

Weight bearing is extremely painful following the injury and the midfoot is so unstable weight-bearing is discouraged in order to avoid further injury.  In addition to injuring the ligament, bones of the foot may also be fractured, although fracture is not the defining characteristic of the Lisfranc injury.

Although we do not know the exact status of Gionni’s injury, Utah confirmed that he has been evaluated by an orthopedic surgeon and surgical repair is planned.  The goal of repairing a Lisfranc injury is stabilization and fixation of the bones of the midfoot so the ligament and any associated fractures may heal, restoring the integrity of the arch.

The diagram and X-ray below demonstrate a typical open fixation of a Lisfranc injury.  The tarsals are the square bones and the metatarsals are long bones.  Screws are placed between the tarsals and metatarsals, so the normal shape of arch is securely held in place during healing.

Typically, weight bearing is restricted for 6-8 weeks, at which point weight bearing may resume.  Screws are later removed after several months when X-rays confirm appropriate healing, at which point an athlete may usually progress to running and jumping.

Gionni is a young, healthy athlete who received high quality medical care immediately following his injury.  Many of the complications and prolonged recoveries are associated with delayed diagnosis and repair, where someone walks on the injured foot for days or weeks.  Because of the quick diagnosis and treatment, it is likely Gionni will be cleared to play on the early side of the 5-6 month time frame and perhaps sooner than that.

We have great hope that his surgery will have the anticipated outcome, his recovery will be uneventful, and he will see him on the field at Rice-Eccles in the fall.