Is it a Foot Sprain or will it need Foot Surgery?

49ers' receiver Arnaz Battle may have an undiagnosed foot injury.

This weekend's football injury report included San Francisco 49ers' receiver Arnaz Battle having a "foot sprain." Right now he is listed as questionable for next week’s game against the Miami Dolphins. The interesting part is that this is first time that Battle has returned to the gridiron action since sustaining a foot sprain back on Oct. 26. All he did was return some punts and he aggravated the injury in the second half.

This smells of a more serious injury.

The classic midfoot injury that needs surgery happens in either a high impact trauma or a lower impact twisting injury. The classic case is sustained in an a car accident. You have your foot on the brake, smack into the car in front of you and all of the force causes the midfoot joints to be dislocate or fracture. The area injured is a collection of joints called Lisfranc’s joint. For trivia buffs, Lisfranc was Napoleon’s surgeon. These injuries are very often misdiagnosed as a “midfoot sprain.”

In 2004, I began a research project to determine how accurately different doctors were able to diagnose Lisfranc’s injuries. The results of that study were quite scary. We found that primary care physicians and emergency room physicians were only able to recognize 1.6 % of all identifiable features of these injuries on x-ray. That means that more than 98% of these injuries could be missed, if not evaluated by a foot and ankle specialist. That may be the case with Battle.

As a result of this research, I won an award from the American College of Foot and Ankle Surgeons. Since that time I have seen many patients that came into the office having been misdiagnosed. In most cases they bring their x-rays from the emergency department. Unfortunately, in many of these cases, the injury is visible. It was just not noticed. In every case, the doctor told the patient that it was just a sprain and would get better. And they didn't. The difficulty is that we know in fact, these will not get better unless appropriately treated.

It can happen in car wrecks, motorcycle accidents, football, running, mountain biking or baseball. The big clue is pain in the mid-foot (above the arch) with swelling or bruising. Bruising on the top of the is a very bad sign. If it happens to you, get checked immediately. Whether you are a pro or a weekend warrior, you can;t afford to be listed as "questionable" for next week!


Dr. Christopher Segler is an author, inventor and award winning foot surgeon with a surgical podiatry practice in Chattanooga. He invented and a patented surgical instrument designed to simplify bunion surgery and midfoot surgery. He publishes articles teaching other foot doctors about his methods to prevent pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.