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

Hammer time? Hammertoes!

Hammertoes are a common condition that is treated by podiatrists. When discussing hammertoes, it is important to discuss exactly which joints of the toes are affected, and how they are misaligned. The picture above depicts the three classic types of hammer digits, each of which has an effect on one or more of the three joints of the little toes on the foot.

In mallet toe, only the distal interphalangeal joint is affected. The interphalangeal joints are the joints within each toe. All of the toes besides the big toe have two interphalangeal joints. The big toe has one. Mallet toe is characterized by a toe that is straight until the last “knuckle” joint of the toe, where it is pointed downwards.

In claw toe, all three of the joints of the lesser digits are affected. The metatarsophalangeal joint, the joint that connects the toe to the forefoot, is deviated upwards, while the two interphalangeal joints are deviated downwards. This creates a claw-like appearance, as is seen in the bottom diagram of the drawing.

The most common form of hammer digits is depicted in the middle diagram. This is the classic form of hammertoes. In this form, the metatarsophalangeal joint is deviated upwards, the proximal interphalangeal joint (the one closer to the middle of the foot) is deviated downwards, and the distal interphalangeal joint (the one further down the toe) may be either normal or deviated slightly upwards.

Besides the aesthetic changes to the toes, hammertoes can be a source of pain for many people. When the joints of the toe are misaligned, it forces the toes to take up more space in a shoe. This can often lead to corns on the tops of the toes, as they are rubbing against the top of a shoe.

Additionally, hammertoes are often pointed towards each other, which cause the toes themselves to rub against the other toes. This can also cause corns and calluses to form, as well as abrasions in between the toes.

Hammertoes are caused by a loss of muscle stability and balance that is formed by the muscles of the foot. The flexors on the back of the leg and the extensors on the front of the leg serve to counterbalance each other on the toes, thereby keeping the toes straight. When the balance is lost from things like loss of function of one muscle or strengthening of another muscle, the toes can become deformed. This problem is often seen in women who wear high heeled shoes.

When treating hammertoes, claw toes, or mallet toes, a podiatrist may use one of two approaches. The conservative approach would be to treat the corns and calluses formed by the toes rubbing against either each other or the shoe. This may be done by burning or shaving off the dead skin causing the pain, as well as modifying the shoe gear to accommodate the misaligned toes.

The other route is to correct the misalignment of the toes through surgery. Several different methods are used depending on the extent of the deformity – only your surgeon will be able to decide which the proper method to use is.

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