The preseason edition of ESPN’s Monday Night Football featured one of the NFL’s most intriguing teams, The Jacksonsville Jaguars. This team is no short story lines, Urban Meyer, one of the most prominent college football coaches, coaching in the NFL; Number one overall pick Trevor Lawrence, one of the most sought after quarterback prospects since Andrew Luck; the team who took a chance on Tim Tebow to play tight end; and owner who has been trying to move this franchise to London. But those all took a backseat after rookie running back Travis Etienne Jr. left the game with initially thought to be a sprained left foot.
Following further testing…
Anatomy Review
What are Lisfranc Joints?
The Lisfranc Joint Complex is comprised of a series of bones and ligaments that connect the forefoot to the midfoot.
They consist of 5 metatarsal bones and the 3 cuneiforms, cuboid and navicular tarsal bones.
The cuneiforms, cuboid, and navicular form the arch of the foot.
A Lisfranc injury occurs when either the ligaments stabilizing the bones are damaged or the bones fracture and dislocate. Lisfranc injuries, like many injuries, can range in severity. From an increased joint space between the any of the metatarsal bases, disruption of the articulation surfaces of the cuneiforms, cuboid, and navicular, or a combination of the two with dislocation of the metatarsals and the tarsal bones that they articulate with.
They are usually categorized into several categories:
- Sprain: stretching of the ligaments that hold the bones together
- Fractures
- Dislocations
- Homolateral: Metatarsals displaced in the same direction
- Isolated: 1 or 2 metatarsals are displaced from the others
- Divergent: Metatarsals displaced with fracture involvement of tarsal bones.
How do they occur? The joint(s) can be injured through direct contact or indirect force. Direct contact includes high impact landing from a significant height or an object landing on the foot or the foot being rolled over. Indirect forces include cutting or jumping and planting on a plantar flexed foot.
How are they diagnosed? They are typically diagnosed with an X-ray in the weight bearing position. With an X-ray, you are looking for any potential fractures and dislocations and also to evaluate the joint space between the bones. An MRI can be used to determine further soft tissue involvement such as muscle tendons and ligaments.
Photo Credit: Bartleby and Gray’s Anatomy.
Signs and Symptoms
The top of the foot can be swollen and painful where the injury occurred.
Pain that is worse with weight bearing (standing, walking, pushing off on that foot). Asking an athlete to go up on their toes can cause a significant amount of pain since the forefoot and midfoot and being loaded.
Pain with joint play and movement of the metatarsal bones and the tarsal bones involved. Holding the rearfoot stable and moving the midfoot and forefoot can also reproduce the pain as well, indicating that stability could be compromised.
The most evident sign if there is bruising on the top and bottom of the midfoot.
Outlook and Return to Sport
As reported by many prominent NFL outlets and Insiders. His season is over after undergoing surgery. There are several different types of surgeries he could have undergone all influenced by the severity of the damage. Ian Rapoport reported there were no fractures seen on his X-rays but significant ligament damage required surgery. His season is over and cannot return this season given the way he was designated by the franchise.
Expect to see Travis Etienne next season and likely will start rehabilitation very soon.
