treatment ed

Let’s Be Franc!

Written By: DrGayedDPT - Oct• 05•12

Revis goes down with and ACL tear and is out for the year – oh, and despite what coach Rex Ryan will tell you, Revis is definitely out for the year – and now Holmes is out. The Jets’ season is looking as grim as ever as the fans seem to to be at the end of their ropes as cries for Tebow time get louder at MetLife stadium. If you are a Jets fan and looking for some consolation well…you wont find it here. What you will find is details on Santonio’s relatively uncommon injury and you will hopefully learn what to expect in terms of his comeback.

First, a little background on the anatomy of the foot. As you can see in the picture, there are 26 bones in the foot. No need to go through all of them for this injury but the main ones to look at are the 5 I have numbered in the picture. These bones are called metatarsals and make up your mid foot. Most importantly for the Lisfranc injury that Santonio sustained is the 2nd metatarsal. This is the main bone that is affected in this type of injury. You might be saying, “Oh that’s not that bad. That isn’t even the big toe.” Well yes, while walking and running you mostly push off that big toe but take a look at the picture again. Which of those metatarsals is the apex of the natural arch in the foot? You guessed it. Its the 2nd metatarsal. The arch in the foot is vital to proper mechanics during walking and running. It essentially acts as a natural shock absorber.

Think of how much you weigh…now look at your foot. Your foot has to be able to hold and propel (obviously with the help of muscles) your body wherever you want it to go. It must be able to withstand all those various terrains we negotiate as well as handle all the pulls in various directions from the muscles acting on the foot. Without boring you with details, the arch in your foot allows it to efficiently complete the aforementioned tasks.

Obviously the bones do not just magically float in that arch; they are held together by many ligaments. These ligaments are small, strong, and most are rarely injured. In the case of the Lisfranc injury, the demand on that arch exceeds the compliance of the ligaments and, well…something’s gotta give. And in the battle of turf vs foot arch…turf triumphs.

At the moment Santonio incorrectly steps on that foot, the demands on the ligaments supporting that second metatarsal and essentially holding that arch are asked to hold more than they can handle. Snap! The ligament tears. Now the bones that are not supported in the arch come crashing together like a huge wave hitting the shore line. As the bones smash together it can cause some of the bone to chip off and at the very least it will damage the cartilage surrounding the bones (cartilage allows for smooth gliding of joints – cartilage is around all the bones of your joints throughout your body).

As with Santonio’s mechanism of injury; his was a fairly “textbook” Lisfranc injury. This type of injury is most common in football and soccer players who roll over the front part of their foot. This injury is really painful and makes walking, or even standing, nearly impossible secondary to pain.

Ok, ok…that is enough detail on the injury. You’re asking, “When is this dude coming back?!” News on recovery can be pretty scary. For starters, let’s just get it out of the way and say that Santonio will not be playing football this season. With that said, recovery is variable with these injuries; recovery is highly dependent on the extent of the injury. How many ligaments were damaged? How much bone was damaged? How much cartilage damage was there?

They have not announced it yet, but most likely with an actual fracture (bone breaking off from the impact of the bones following ligament failure), Santonio will likely need surgery. Following surgery he will not be allowed to bear weight through the foot to allow healing for about 6-8 weeks; this is to allow proper healing before stressing the foot again. Then, again depending on the extent of the injury and at the surgeons discretion, Santonio will be allowed to bear partial weight through the foot for another roughly 4-8 weeks. We are already at 4 months of him not bearing weight through the foot. Recent studies have shown that muscle atrophy can set in after less than a week of weightlessness. One study detailed that astronauts experienced atrophy after as little as 3 days of not weight-bearing.

So what does that mean? By the time Santonio is ready to rehab, there would have been 4 months of non or partial weightbearing through his whole leg. That is a good amount of atrophy! Don’t freak out Jets fans…they have equipment out there to stimulate the muscles in the thigh and calf to keep these muscle active, contracting, and ultimately healthy throughout the non-weightbearing period but none are as good as the real thing!

Essentially, following the 4 months of non to partial weightbearing, you are looking at at least another 4 months of rehab, more likely 6 months. And again, depending on how severe the injury is, a high level athlete like Santonio may never return to his old self. But that is the worst case scenario.

Look for Santonio to be out on the field with his fellow Jets a year from now. Not that it makes the biggest of differences; with Santonio on the field, the Jets put up a whopping zero points this past Sunday…but who knows, a year from now maybe another quarterback will be throwing it his way. Tebow! Tebow! Tebow!

Breakdown
Time out: 8-10 months
Severity:

85 %

Chance of Reinjury:
20 %

Performance Upon Return:
85 %

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