Eagles Lane Johnson Suffers A Lisfranc Injury. Here’s What That Is

The word “Lisfranc” may sound like someone saying “listen Frank” very quickly. But Lisfranc injury the name of the injury suffered on Sunday night by Philadelphia Eagles right tackle Lane Johnson to his left foot. And Lisfranc-ly, you may have suspected something was afoot when the six-time Pro Bowler Johnson left the game against the Detroit Lions in the first quarter and never returned to what would eventually be a 16-9 victory for the Eagles. Word is now that the Eagles will be missing Johnson for at least four to six weeks.

What Is A Lisfranc Injury

I’ve done the here’s-what-this-means thing when Joe Burrow and Jayden Daniels went down with their injuries earlier this NFL season. So here’s the same with what Johnson is left with after injuring his left foot. A Lisfranc injury is any type of damage to your Lisfranc joint. That may be self-explanatory if you happen to know where the Lisfranc joint is located. But many people probably aren’t that familiar with this joint named after French surgeon and gynecologist Jacques Lisfranc de St. Martin, who was the first to document fractures to this area in the early 1800s.

Your Lisfranc joint is kind of mid. It’s located in your mid foot. The Lisfranc joint is where the metatarsal bones of your foot meet your tarsals. You have a Lisfranc joint in each of your feet, which are presumably no more than two assuming you aren’t a cenitpede. You can see where the metatarsals and tarsals meet in the following diagram of the bones of a human foot:

Different kinds of Lisfranc injuries are possible. You can have a tear in any of the ligaments that span the Lisfranc joint, which is called a Lisfranc sprain. You can have a break in the parts of the tarsal or metarsal bones that form the joint, known as a Lisfranc fracture. And you can have one or more of the bones forming the Lisfranc get dislocated or knocked out of place. Take a wild guess as to what this type of dislocation would be called. The answer if you were on Jeopardy! would be what is a Lisfranc dislocation.

What Causes A Lisfranc Injury

A Lisfranc injury can result when you’re on the ball—on the ball of your foot, that is—and a twist happens—a nasty twist. In other words, you’ve got the ball of your foot firmly planted on the ground and then your entire foot somehow gets twisted or turned. That, in turn, can put a lot of force and stress on your mid-foot, basically to your Lisfranc joint.

Such a motion can happen when you have your foot flexed downwards, ready to push off the ball of your foot to run—say towards the end zone, the bathroom or wherever—when someone or something lands on the back of your foot to twist it. This can also occur when you fall—say from a ladder—or make some kind of a misstep and then land on the ball of your foot while the rest of your foot twists, grinding into your mid foot where once again the Lisfranc joint is located. Another way of hurting your Lisfranc joint is getting your foot gets crushed by something falling on it like a heavy iron statue of Nick Jonas’s head or something pushing into it like what may happen in a car accident.

How Do You Diagnose A Lisfranc Injury

The main symptom of a Lisfranc injury is pain around, you guessed it, your Lisfranc joint. This is typically around the top of your foot in the mid-foot area. Trying to push off the foot such as when you stand or walk on it can worsen the pain. The pain can be so severe that you can’t bear weight on that area. You may get swelling and bruising there too. These symptoms can extend to the bottom of the foot in the mid foot area as well.

A doctor may suspect a Lisfranc injury when pressing on the area and doing the whole “does this hurt when I do this” thing. Your doctor can also try the “piano key” test, which isn’t when he or she drops a piano on your foot but rather when your doctor holds your toes and moves each of them up and down one-by-one sort of like playing a piano to see if such motions elicit any pain in your mid foot area. There’s also the single limb heel rise test, where you stand on one foot and go up to your tippy toes and see if that causes pain. Your doctor may also order imaging like an x-ray, a CT or an MRI of your foot to look for any damage like a ligament tear or a bone fracture or dislocation.

How Do You Treat A Lisfranc Injury

The treatment of a Lisfranc injury depends on what exactly is damaged and the severity of the booboo. Milder injuries may simply get better with RICE, which is not the stuff that’s in sushi but instead is an acronym for rest, ice, compression and elevation as I have described previously in Forbes. When RICE alone is not enough, you may need to keep from bearing any weight on that foot for a while to allow it to heal. This can be achieved by wearing a cast or boot for about six to eight weeks. The next step would be to transition to to bearing weight while wearing a removable cast boot or an orthotic until your doctor deems everything to be fully healed.

Things get more complicated when you’ve got a fracture or dislocation of the bones that won’t heal in place on its own. In such cases, surgery may be necessary. One possible type of surgery is an open reduction internal fixation or ORIF if you don’t want to say so many words. This is where the surgeon open’s up your foot (hence the term “open”), moves everything back in place (hence the term “reduction”) and then uses screws and plates to keep them there (hence the term “internal fixation.”) You typically have to return to the operating room three to five months later to get this hardware removed, unless you want to remain screwed, so to speak.

Another option is to fuse your mid foot area. This is when the surgeon uses screws to fully connect all the bones forming the Lisfranc joint so that they heal together thus eliminating the presence of the Lisfranc joint. In such a case, the surgeon usually doesn’t have to go back and remove the hardware. Such an option may not affect your daily activities that much because your Lisfranc doesn’t move a whole lot anyway.

Any surgery could mean six months to a year of recovery before returning to normal activities. Some people never recover full function. For examplke, arthritis from damage to the cartilage could result.

Early word is that Johnson’s Lisfranc injury won’t need surgery. That means the 35-year-old Johnson should be able to return to the field sometime later this season. In the game against the Lions, the Eagles replaced one of their Johnsons with another Johnson, Fred Johnson. In the meantime, it remains to be seen what will happen to the Eagles’ running and passing lanes without the two-time first-team All-Pro Lane in the lineup.