Could Better Footwear, Insoles Be the Solution to Football’s Lisfranc Injury Problem?

With college football officially underway and the NFL regular season starting soon after, player safety will be at the forefront of the discussion. While the devastating consequences of concussions will surely hog the spotlight, lower body injuries can be just as debilitating and are statistically much more prevalent, accounting for 50.4% of all player injuries, according to the NCAA. Lisfranc fractures make up a small proportion of these lower body injuries, but Lisfranc’s impact on college and professional football is immense.

What is a Lisfranc Injury?

A Lisfranc fracture is a dislocation of the joint connecting the midfoot and the forefoot caused by trauma or sudden twisting. The cause of a Lisfranc injury can be categorized in one of two groups—direct or indirect. The severing of the Lisfranc joint through trauma delivered by an outside force is considered a direct injury. For example, this could occur when a lineman accidently stomps on another player’s midfoot. Indirect Lisfranc fractures, however, are caused by the sudden twisting or rotation of a foot. This typically happens when a player’s foot gets planted forcibly and unnaturally while changing direction on turf. After sustaining the fracture, pain in the midfoot is immense and the vast majority of athletes are unable to finish the game, let alone the season. Depending on the severity, a Lisfranc fracture can even require surgery to realign the dislocated bones and could be a career killer.       

Read a more in-depth Lisfranc fracture explanation at the MMAR Pain & Injury Center.

Lisfranc Injury on the Field

Offensive linemen are typically the most likely to sustain a Lisfranc injury, but college and NFL players in many other positions have suffered from the fracture as well. Jake Locker, Ben Roethlisberger, Dion Lewis, Brandon Marshall and Le’Veon Bell are just a few examples of skill position players that have struggled with the injury in recent years. Locker, a former first-round draft pick, was ultimately unable to return to form after his injury and retired early at the age of 26.

One of the most successful signal callers in the game, BYU quarterback Taysom Hill, is returning after being sidelined for an entire season by an indirect Lisfranc fracture he suffered while cutting up field against Nebraska. Just a year removed from a different season-ending injury to his knee, Hill fought through the pain of the Lisfranc fracture and played the majority of the game before finally bowing out. Following the game, he had screws surgically implanted in his midfoot to reconnect the joints and began an arduous 11-month rehabilitation process.

Are Cleats to Blame? 

Many athletic trainers and podiatrists are pointing their fingers at lightweight, minimalist cleats as the menace behind the increase in Lisfranc injury on the football field. The major athletic shoe brands (Nike, Adidas, Under Armour, etc.) have moved toward technology that emphasizes flexibility and arch support has greatly suffered as a result. This flexibility can allegedly lead to the indirect Lisfranc fractures sustained when changing direction.

In order to begin rectifying this issue, Nike partnered with Taysom Hill in the offseason to create a custom cleat with increased arch support to avoid reinjury. With Hill returning to action this fall, Nike will be able to monitor his recovery and expand the use of the custom cleats if proven successful. In addition to new cleats with rigid arch support, Hill was given custom insoles. 

While most believe that cleats play a factor in the increased prevalence of Lisfranc, others claim it’s simply a result of players progressively getting bigger, faster and stronger. It’s the new norm for lineman to tower over competition at 6’3” and weigh upwards of 300 lbs, and players like this weren’t in the league 20 years ago. The average weight of an offensive tackle has increased by over 40 pounds since 1980. Another possible factor behind the increase in Lisfranc is the improved ability of trainers to successfully diagnose the injury. In the past, the injury was often misdiagnosed because the hurt Lisfranc joint will sometimes naturally return to its original position before it’s inspected by training staff. Increased awareness has led to midfoot injuries being inspected more closely.

The Importance of Orthotics & Footwear

Ultimately, the increasing prevalence of Lisfranc fractures highlights the importance of the correct use of orthopedic insoles and athletic footwear. Most modern cleats do not provide the essential arch support necessary to prevent foot and ankle injuries. Players should add orthotics that complement their foot styles. In addition, their shoes should be tailored for the specific position they play, the playing surface (turf or grass) and the outside temperature.

Even if you’re an amateur, consult a podiatrist concerning your personal arch support needs before you play on the gridiron this fall. Insoles like the Prothotic motion control sport insole do wonders in ensuring your feet and ankles remain healthy.

The Truth About Concussions in the NFL

During the last few NFL seasons, the dominant discussion has been about player safety—particularly when it comes to concussions. In 2009, the NFL formally admitted that players were indeed at higher risk of developing Chronic Traumatic Encephalopathy or CTE, particularly those that suffered repeated concussions. CTE is a degenerative brain disease that can result in dementia, memory loss, confusion, and depression, and due to studies performed over the past two decades, has been linked to repetitive head trauma, which is likely for NFL players to experience.

The public and media conversation surrounding the issue is broad. Some opinions can be extreme and insensitive:

But there are also a lot of activist groups forming that are concerned about player safety in football:

Most people seem to have slight skepticism on both sides of issue:

But how has the NFL been dealing with it?

The controversy surrounding concussions in football started over 20 years ago when former NFL commissioner Paul Tagliabue denied the risk of concussions in football by essentially saying it was media hysteria.

The league went on to continue denying the link between concussions and football, even as they paid former NFL center Mike Webster disability benefits due to his "total and permanent" dementia that resulted from head injuries.

After Mike Webster's death in 2002, his brain was examined, and for the first time Chronic Traumatic Encephalopathy (CTE) was cited as a reason for his mental condition. He was only 50 years old when he died.

In the ensuing years, previously published NFL studies that claimed there was no connection between concussions and brain damage were contradicted by new, independent research.

Finally, after the league was compared to the tobacco industry in a congressional hearing, the NFL admitted that concussions are linked to long term mental health issues.

"It's quite obvious from the medical research that's been done that concussions can lead to long-term problems." – Greg Aiello, NFL Spokesman

So what has been done?

Since 2009, a number of rule changes have come to fruition that are intended to reduce the number of concussions in the league including:

• It is an illegal "blindside" block if the blocker is moving toward his own endline and approaches the opponent from behind or from the side, and the initial force of the contact by the blocker's helmet, forearm, or shoulder is to the head or neck area of an opponent. Penalty: 15-yards.
• It is an illegal hit on a defenseless receiver if the initial force of the contact by the defender's helmet, forearm, or shoulder is to the head or neck area of the receiver. Penalty: 15 yards.
• A player who has just completed a catch is protected from blows to the head or neck by an opponent who launches.
• All "defenseless players" are protected from blows to the head delivered by an opponent's helmet, forearm, or shoulder.
• Kickers and punters during the kick and return, and quarterbacks after a change of possession, are protected from blows to the head delivered by an opponent's helmet, forearm, or shoulder, instead of just helmet-to-helmet contact.
• The ball is declared dead at the spot if a runner's helmet comes completely off.

-NFL.com

But of course with the rule changes, there comes an entirely new form of controversy and concern for the integrity of the game, particularly on the defensive end of the ball.

With NFL players getting bigger, stronger and faster each year, the league certainly isn't devoid of big hits, even with the rules changes.

And with hits like these, it's no surprise that concussions are still a common injury. Even if helmet-to-helmet hits were completely eliminated from the game, it wouldn't even cover the majority of the causes of concussions.

In fact, the trend seems to be continuing upward:

This of course could partially be due to new guidelines for when players are allowed to return to a game after a blow to the head , which would have previously gone unreported.

So that leaves improvements in equipment technology. The NFL and GE have partnered to award up to $10 million each year to companies and individuals developing the latest advances in protection from traumatic brain injury.

There are also discussions about helmet technology.

Head Impact Telemetry System (HITS) sensors are also being incorporated by many football programs, especially in the NCAA, in an effort to better detect when a serious impact to player's head has occurred. While these systems aren't currently able to be used diagnostically, funding from the NCAA and other organizations has allowed researchers to make great advancements in determining how concussions occur and the severity of these types of hits.

By now the seriousness of the concussion issue has permeated every level of football, and awareness is at an all-time high.

Hopefully through awareness, taking better precautions and preventive measures, and developing more effective technology, we will be able to curb the rate of concussions in football and allow players to remain healthy throughout the rest of their lives.

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15 Most Common Football Injuries

Between youth football, high school football, college football, and professional football, millions of Americans take the field every year to sport their teams’ colors. Football is America’s game, but is also a physically demanding, high-impact, collision sport that can take a toll on the body. No matter what level you’re playing at, it’s important to make sure you take care of your body and address any injuries that arise as soon as they happen to prevent problems later on in life.

Here’s a list of the top 15 most common sports injuries in football:

General

1. Broken Bone

Any bone can be broken when playing football- from small bones like fingers and toes to large bones like legs and even spines. Broken bones should be splinted immediately by a trainer if possible and x-rays should be done to determine the location and type of break so that they can be properly set.

Head/Neck

2. Pinched Brachial Plexus

Commonly referred to as a "Stinger" or "Burner." A stinger is an incredibly painful nerve injury that results when the nerves in the neck are stretched, causing nerves in the shoulder to pinch or bruise. The result is a sharp pain (like that of an electric shock or lightning strike) and arm numbness and weakness. Effects are usually temporary and subside quickly. If effects linger consult a doctor.

3. Concussion

Concussions are graded 1-3 based on severity and can vary greatly in terms of recovery time. If a player is suspected to have a concussion they need to be evaluated by a medical professional immediately. Certain tests may be run to determine if a player has a concussion and a doctor may order that a player wait days, weeks, or even months before returning to the field.

Back/Shoulder

4. Shoulder Dislocation

An upward and backward wrenching of the shoulder can cause a shoulder dislocation. Once a shoulder is dislocated from the socket it should be popped back in right away to avoid unnecessary pain and additional injury to the area. Depending on the situation x-rays may be needed to determine if any damage has been done to the area.

5. AC Separation

Commonly referred to as a "Separated Shoulder". Many people believe a dislocated shoulder and separated shoulder are the same thing, but they are actually different injuries. A separated shoulder is often the result of a fall, and involves a tear of the ligaments between the clavicle (collar bone) and acromion bone (the highest point of the shoulder blade). The result is that the clavicle will actually stick up. Depending on the severity of the injury cold packs and a shoulder immobilization brace may lessen the pain and allow the shoulder to heal. In other cases surgery may be needed.

6. Back Sprain

Back sprains can come in all shapes and sizes but with ice and the right lumbar back brace back sprains can usually be corrected. It’s always a good idea though to consult a physician, sports therapist, or chiropractor to make sure that they injury isn’t severe, requiring more extensive treatment.

7. Herniated Disc

Commonly referred to as a "Slipped Disc" or "Ruptured Disc." Small spongy discs cushion the vertebrate in your back and act as shock absorbers while you engage in activities like running and tackling. When a disc is overly strained it can bulge or rupture, causing the disc to become herniated. To avoid serious back injuries later in life it’s important to consult a doctor to determine the best course of action.

Leg/Knee/Ankle/Foot

8. Quadriceps Contusion

Contusions to quadriceps can result from impact to the front of the thigh from something like a helmet. Compression and ice are important in the recovery process with quadriceps contusions, and often early motion can also aid in preventing stiffness from developing.

9. Hamstring Sprain

Commonly referred to as a "Hamstring Pull". Hamstring pulls are actually a tear in the hamstring muscle fibers and can result from sudden acceleration or a blow to the body. Hamstring pulls can vary greatly in severity but often plague sufferers with repeat problems throughout an athletic career. Ice, compression therapy and rest are important to properly heal a hamstring pull.

10. Iliac Crest Contusion

Commonly referred to as a "Hip Pointer." An iliac crest contusion is a bruise or a fracture to the iliac crest region of the hip that is treated with ice and padding.

11. Ankle Sprain

Ankle sprains are the most common sport injury and result when damage is done to the soft tissue and ligaments surrounding the ankle because of excessive twisting. The "RICE" method (rest, ice, compression, and elevation) are used to reduce swelling after an ankle sprain. Ankle braces and wraps can help speed up recovery as well.

12. Syndesmotic Sprain

Commonly referred to as a "High Ankle Sprain." A high ankle sprain is caused when the leg and foot twist outward and can be much more serious than a regular ankle sprain. In addition to using rest, ice, compression, and elevation to treat a high ankle sprain, a hinged ankle brace or cast may be necessary in more severe cases.

13. Turf Toe

Turf toe is an injury to the base of the big toe from running or jumping on hard surfaces. This makes basketball players and football players on artificial turf more likely to sustain this kind of injury.

14. ACL/MCL/PCL Tear

ACL, MCL and PCL injuries most frequently result when landing from a jump or changing directions suddenly. When the ACL, MCL or PCL tears often a “pop” will be heard and the knee will give out. These type of injuries are incredibly painful and require highly specialized hinged knee braces, extensive physical therapy, and surgery to recover. Amongst athletes these are some of the most feared injuries due to the long recovery times associated with them.

15. Meniscus Tear

The meniscus is two pieces of cartilage that cushion and support the knee joint. Meniscus tears often accompany ACL and MCL injuries and are very easy to reinjure if not given the proper time to heal fully. Ice, compression, elevation, and physical therapy are essential in healing properly after a meniscus tear. Surgery may even be required depending on the individual circumstance.

About MMAR Medical Group: MMAR Medical Group Inc. is a supplier of medical products including a wide selection of medical grade braces and cold therapy products. To find a quality medical knee braces and supports, please visit MMAR Medical online.