There have been several midfoot sprains in the last couple weeks within the NFL. Most recently it was Calvin Ridley, but Joe Mixon and Chris Carson also have been sidelined the last couple weeks with midfoot injuries. While not as common as a standard ankle sprain, midfoot injuries are common in football athletes.
A midfoot sprain is an injury to the ligaments that hold the bones in the middle part of the foot together. These bones articulate together to make the arch of the foot. In the first set up X-rays below, I have circled the midfoot area. There are multiple ligaments in the foot but the most commonly injured ligament is the Lisfranc ligament (drawn out in blue). The ligament provides stability to the arch of the foot. If completely torn, the bones lose the stability that the ligaments provide and the arch collapses.
A midfoot sprain is an injury to this ligament and are graded based on severity. A mild midfoot sprain results in an incomplete tear of the ligament and can be treated with rest, immobilization and therapy. Moderate or severe midfoot sprains are complete tears and result in loss of the integrity of the ligaments.
The second X-ray shows a case in which the ligament has completely torn. The circled area shows the widening that we see on the X-ray, indicating lost stability. If you compare to the uninjured foot you can see the difference. Moderate or severe injuries need to be treated with surgery. In my athletes, I typically use weight bearing X-rays combined with an MRI to determine injury severity.
A midfoot sprain without widening doesn’t need surgery, just time to heal. One can return to activity once the pain and swelling subside. This can take several weeks depending on position and severity of injury. Usually these result in lost playing time for 3-4 weeks, sometimes longer. The midfoot sprains that require surgery are season ending.