Foot Injury - Football

Abstract

HISTORY: A 23-year-old collegiate football quarterback sustained an injury to his right foot while being tackled in the fourth quarter of a midseason game. An axial load was applied to his foot while it was in extreme plantar flexion. The player was attended to by the athletic trainers and then assisted off the field. PHYSICAL EXAMINATION: Examination on the sidelines revealed pain and swelling over the midfoot region, and the athlete was taken to the training room. Non-weight bearing AP, lateral, and oblique radiographs did not reveal any abnormalities and the athlete was placed in a walking boot and treated for a midfoot sprain. Two days later significant swelling and ecchymosis were evident. The athlete also complained of considerable tenderness and was unable to bear weight DIFFERENTIAL DIAGNOSIS: Midfoot sprain Lisfranc fracture/dislocation Navicular fracture TEST AND RESULTS: Standing radiographs: exaggerated diastases between the second metatarsal and first cuneiform, and between the first and second cuneiforms. avulsion fracture from the first cuneiform possible medial sub luxation of the first cuneiform on the navicular Computed tomography: fracture of medial cuneiform near base of second metatarsal two small fracture fragments between intermediate and lateral cuneiforms suggestion of widening of intermediate and lateral cuneiform joint space extensive surrounding soft tissue edema FINAL/WORKING DIAGNOSIS: Lisfranc fracture/dislocation TREATMENT AND OUTCOMES: Immobilization with walking boot and no weight bearing prior to final diagnosis. Open reduction and internal fixation of first cuneiform fracture and Lisfranc dislocation eight days subsequent to injury. Foot was casted for immobilization with no weight bearing for four weeks followed by a walking boot for six weeks Following removal of walking boot pool, strengthening, and proprioceptive exercises were started. Hardware was removed 18 and 24 weeks post surgery. Rehabilitation continued resulting in return to competitive football at pre-injury level.