Darren McFadden’s Lisfranc Injury

Darren McFadden, running back for the Oakland Raiders, has reportedly been making great strides in his rehabilitation and training following a season-ending Lisfranc injury last season.  The running back has been reported to have been making cuts at full speed, an indication that he is feeling much better.

The Lisfranc joint is comprised of the tarso-metatarsal joints across the entire midfoot.  This includes the five metatarsals, and their articulations with their respective tarsal bones.  This joint complex is generally very strong, but can be injured in twisting injuries, with axial loading mechanisms of injury, crush injuries, or in high velocity injuries such as falls or motor vehicle accidents. 

Injuries to the Lisfranc joint can be devastating, particularly when they are not addressed properly.  Unfortunatley, this can happen often in the emergency room setting. The reason for this is that many Lisfranc injuries can show up as subtle changes on x-ray, and those unfamiliar with the injury may miss it.  In fact, it is one of the most commonly missed diagnoses. 

The anatomy of the midfoot and Lisfranc joint contributes to its stability, and lends to the relative infrequency of Lisfranc injuries.  Strong ligaments connect the three cuneiforms and the cuboid to their respective metatarsals, and the tendons and fascia of the foot contribute to it’s stability as well. 

For McFadden, his injury was considered a sprain, and was treated non-surgically.  He sat out the remainder of the season after it happened, but it was determined that he would not need surgery on his foot.  For many, this is not the case.

Surgical correction for Lisfranc injuries is recommended in many cases.  These cases often involve fractures of the bones of the midfoot, but may be purely ligamentous injuries.  Surgical correction may involve using screws and/or plates to hold the bones in place while the ligaments can heal.  For fractured bones, they may be pieced back together, and also held in place with screws and/or plates while they heal. 

Another option for treatment is to fuse the joints permanently that are affected by the injury.  This is known as arthrodesis.  Arthrodesis for Lisfranc injuries has become a more popular option, as research has shown that this may lead to a more functional and less painful foot.  Because there is limited motion at the tarso-metatarsal joints to begin with, eliminating motion at the joints altogether does not lead to a great difference in function. 

Non-surgical treatment for Lisfranc injuries is typically to keep the patient non-wieghtbearing in a cast or splint.  Evaluation by a podiatric surgeon is helpful to determine the definitive treatment for the injury.

For McFadden, hopefully he will return to play and will have a great season.  

Central Florida Foot & Ankle Center, LLC 
101 6th Street N.W. 
Winter Haven, FL 33881 
Phone: 863-299-4551 
www.FLFootandAnkle.com