Injuries in sports are seldom epidemics, but there are patterns that bear investigation.
When a number of NFL players are injured, especially when they come in different manners as well as on different teams and in different positions, it's time to take a look and see what changed.
When you look at the various foot injuries around the league to stars like Jamaal Charles, Ahmad Bradshaw, Maurice Jones-Drew and Dwayne Allen, it also bears examining if there is some underlying issue.
While those three are running backs, the increase in foot injuries around the NFL is not limited to the ball-carriers. We have seen a major increase in Lisfranc injuries—both fractures and sprains—as well as an increase in foot fractures, especially to the fifth metatarsal (the bone on the outside of either foot) as well as plantar fasciitis and turf toe.
These injuries are often blamed on artificial turf, but a glance through the data shows that many of these injuries happen on grass, enough so that turf in its various forms is unlikely to be the sole causative factor.
The increase in Lisfranc injuries is probably the most notable. This is in part due to perception, but the injuries are also devastating and usually a season-ender, as it was for Jones-Drew.
The injuries are named after a Napoleonic-era gynecologist (seriously!) who discovered the issue. Lisfranc's answer for the problem was amputation, but he did lend his name to the injury, which is easier to say than tarsometatarsal dislocation, which is the more precise medical terminology.
The Lisfranc fracture is a de facto dislocation rather than a fracture, but the result is the same. It can be seen as both, depending on the amount of force. The injury is seen more in snowboarding due to the location of the bindings over the midfoot and in high-energy car crashes. (Trust me, tomorrow you're going to look at your foot hitting the brake and you'll get it.)
For football players, the mechanism is almost always another player landing or stepping on his foot while plantarflexed (toes pointed down.) While this is tough to visualize, imagine a player pushing off or being pushed back. At some point, the foot appears to be "on tip toes," with the foot pointed directly down and all the weight on the toes. The stress at that point is too much for the bones to take, causing the injury.
I spoke with Dr. Jene Bramel, who writes about sports medicine and football at Footballguys.com, explained:
Athletes struggle to play through foot injuries because their body weight is supported over such a relatively small area. Each foot is subjected to a force that's multiple times higher than the body weight with every stride.
Dr. Bramel added why it's such a tough injury to come back from:
It's very difficult to manage that biomechanical load with a stress fracture, turf toe or strain of any kind. Any slight change in the stability of the foot is further magnified when the athlete cuts and changes direction. And recovery can be delayed by poor blood supply to certain structures of the foot.
There is an associated, but different, condition where the midfoot ligaments can be stretched or ruptured, which is a Lisfranc sprain. The mechanism is similar, but the ligaments give before the bone and usually have a twisting element to the mechanism.
This mechanism isn't new, which leaves us to wonder what has changed. It's not merely the forces since there is an increase in traumatic action. That suggests something else.
As Mars Blackmon once said, "It must be the shoes!" While "Must" is a strong term, there are suggestions in scientific studies that better shoes might come with a price.
The increased friction of better shoes and better contact between shoe and surface, no matter the surface, could be the cause. Most of the studies have focused on lower friction leading to ACL injuries, but the converse is true for the foot. It's not an ideal trade-off.
There are some possibilities for prevention. The U.S. Naval Academy used a type of orthotic insert to help their undersized linemen avoid foot injuries, including Lisfrancs and turf toe. Their study showed that the addition of bracing helped players using the now-standard lightweight, but high-performance, shoes. The reduction in injury offers an easy solution for prevention across a broad population, or a change to the shoes themselves.
There is no easy solution, but as we see more names added to the list of foot injuries, NFL teams are going to have to try something new in terms of prevention. If a journey begins with the first step, the NFL is going to have to start with what is on its feet.
Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and Football Outsiders. All quotes obtained firsthand unless otherwise noted.