Foot Injuries in Large Athletes, a Primer

October, 29, 2008
Oct 29
1:52
PM ET
Print

Today Greg Oden is getting an MRI on his right foot.

What does that mean? What's at stake here?

Here are the clues: The team has said that he has a mid-foot sprain and that x-rays were inconclusive. There is video. Blazer broadcaster Mike Barrett, who is plugged in, says it "doesn't sound too serious." There are other details from the Oregonian's Jason Quick:

Oden, who wore a protective black boot after the game, said he landed on the foot of Lakers guard Derek Fisher on the games third possession. However, replays showed he rolled his right foot while attempting a shot under the basket with about 9:20 left in the first quarter. Oden continued to play, albeit with a pronounced limp. After leaving the game two minutes later with his second foul, Oden returned in the second quarter and appeared to move freely, but he did not return to the court after halftime.

Coach Nate McMillan said Oden initially wanted to start the second half, but after being instructed to run in the Staples Center hallways, he experienced pain and was held out. Oden played 12:51 and did not score, finishing 0 for 4 from the field with five rebounds, two turn
overs and one block.

"I was taped. I was trying to run," Oden said of his halftime jaunt. "But it wasn't happening."

I put all that together, and really have no idea how to respond to all those people who are already proclaiming Greg Oden to be the second coming of oft-injured Sam Bowie. 

Stephania Bell is an injury expert for ESPN.com. She is a physical therapist who is a Board Certified Orthopedic Clinical Specialist and a Certified Strength and Conditioning Specialist. She agreed to share some knowledge:

Why are lower extremity injuries both so common, and so scary, in very tall athletes?
It really comes down to physics.

The joints in the lower extremity have to absorb the impact of their body weight (along with the force of gravity) as the legs hit the ground with running, jumping, etc. The further down the chain (i.e. the foot is further down than the knee), the more impact.

There is also a counterforce of the ground back towards the body (ground reaction forces) that the joints have to absorb. You know the saying, the bigger they are, the harder they fall. Well, in this case, the bigger the big men, the more forces through those joints.

Having seen the video, and heard the team explanations, what are some of the likely diagnoses? And what is the recovery time like?
It was hard to make out the exact injury from the video clip. Hearing Oden's description of landing awkwardly and rolling his foot leaves it wide open.

The initial diagnosis of a midfoot sprain tells us that the injury is in the middle of the foot (of course), which is essentially the region between the base of the toes and the ankle.

This region is critical because it represents the arch of the foot. Forces are transferred from the rearfoot to the forefoot through the midfoot every time a player pushes off his foot to run and jump, and likewise in reverse when landing from a jump. The midfoot also has to absorb a lot of rotational or torsional stress when spinning or pivoting. Any injury to the midfoot can result in instability, which then means the area cannot absorb and distribute stress as well, and the player can't perform those movements without creating pain or increased injury.

The term "Lisfranc" is almost always associated with the more severe type of midfoot injury that we see, but really it describes the region of the foot that is involved. The name comes from a surgeon in Napoleon's army.

A sprain would indicate some injury to the ligaments that support the midfoot. The big issue comes down to the degree of sprain. If minor, meaning there is little visible disruption on MRI, it might mean resting a few games, wearing a protective boot to allow the tissue to heal, easing back into weight-bearing activity, then return to play, perhaps with something protective in the shoe.

If there is greater ligament damage or any instability, the rest time becomes longer. Can be up to about 12 weeks to allow the tissue to fully heal.

The most serious situation would be a Lisfranc fracture-dislocation.

In these instances the ligaments can be sprained badly enough that the bones separate, move out of position (the dislocation) and potentially crack or break (the fracture). This is a situation that most often requires surgical stabilization (pins and screws) to help restore the proper alignment and stability.

The athlete is then non-weight bearing for a while, sometimes up to six-to-eight weeks, and then it is a several-month process to resume normal weight bearing, then gradual increased activity and eventually sport.

In between, there is often a surgical procedure to remove some of the hardware, and the athlete may end up wearing a more rigid foot support in his shoe going forward.

What we know so far is that X-rays were inconclusive (not negative). That means that they couldn't visualize everything as well as they needed to to come to a definitive conclusion.

This can happen because of the angle of the film, swelling in the area after injury (which can cloud the picture), etc. That's why they go to MRI, which is much more sensitive. X-rays will only show bone damage and potential malalignment. Does not show any ligament injury. So it sounds like they questioned and examined Oden, deduced the injury was to the midfoot but could see no direct evidence of bone injury. Therefore they call it a sprain and await MRI results. A protective boot would be issued immediately anyway to help support the foot and minimize any weight bearing.

Blazer fans have been anticipating the Oden era for a long time already. How worried should they be at this point?
Worried, but not panicked. Midfoot injuries are never what we like to hear. Keep in mind that this is the same leg on which he had the microfracture procedure. Don't want to see injury to one area of the kinetic chain impact another, previously affected area. That may be a factor in terms of how quickly they bring him back, just being cautious and respectful of what he has gone through already with the knee.

Then again, this could turn out to be a mild sprain and he will have gotten away with one.

Sort comments by: Most Recent | First Posted