Feet Don't Fail Me Now
A concise guide to five runners' foot maladies
This article appeared in our October 2011 issue.
Like the tires on your car, your feet are your direct connection to the dirt, rocks and roots—and they take a beating. As a result, foot injuries are common among trail runners. Below is a quick reference guide to five run-stopping injuries, by the Rock ‘N’ Roll Marathon’s Medical Director.
First Cuneiform (left) -- First Metatarsal (right)
Second Cuneiform (left) -- Second Metatarsal (right)
First Metatarsal (left) -- First, Second and third Cuneiforms (right)
Dorsal dislocation of second metatarsal (left) -- Cuboid (right)
Lisfranc Foot Injuries
Although the press regularly writes about Lisfranc season-ending injuries in professional football, runners get these injuries as well. Lisfranc foot injuries occur in the mid-foot. They’re named after French surgeon Jacques Lisfranc de St. Martin, who in the 1800s, as a member of Napoleon’s army, first described an injury sustained by mounted soldiers whose foot got caught in the saddle’s stirrup as they were thrown from the horse.
Nowadays, the injury happens when stepping into a hole in the trail, twisting the foot on uneven terrain or pushing off roots or rocks with force as a football lineman might do. These injuries can be ligament sprains, dislocations of the joints between the forefoot and mid-foot or fractures of the bones in the mid-foot complex.
Anatomically, the Lisfranc joints are between the tarsometatarsal joints involving the cuneiform bone and metatarsal bones, as shown in the illustration. Only a small percentage of Lisfranc injuries are fractures or dislocations; most are sprains involving the ligaments.
After feeling the foot and twisting the mid-foot (which would cause more pain if injured) and checking the pulse on top of the foot (because the artery there can sometimes be injured, too), a doctor will generally order standing and non-weight-bearing X-rays. However, Lisfranc injuries that are not fractures or dislocations will not be seen on X-ray. An MRI will then be ordered to check for a ligament sprain; the doctor will also look for bone-marrow edema (fluid within the bone marrow) indicative of stress injury or stress fracture.
Treatment varies depending on whether the injury is a sprain or a fracture. A sprain will usually be treated in a cast or removable, non-weight-bearing cast boot (meaning that you cannot walk on the cast and will have to use crutches) for about six weeks. After removal, physical therapy and a gradual return to the trails usually takes eight to 12 weeks. Fractures and dislocations will require surgery with wires and/or screws to properly align the bones. The cast and non-weight-bearing post-surgery will last about six weeks, followed by another six to eight weeks in a walking cast or cast boot. After that, you will need physical therapy for another eight to 12 weeks before getting back to running.
Quick Guide Lisfranc Foot Injuries
Symptoms: Pain in the mid-foot.
How it occurred: Stepping in a hole, twisting the foot or pushing off with force.
What the doctor may do: Complete medical history. Palpate the area. X-ray. MRI.
Likely treatment: If injury is a sprain, physical therapy. Platelet-Rich Plasma (PRP) injection has shown some promise in speeding healing. If injury is a fracture or dislocation, may require surgery. Cast or cast boot (non-weight-bearing), six weeks. Exogen bone stimulation. PRP injection for a fracture is still experimental but shows promise.