Did everyone see how Ravens CB Jimmy Smith’s foot injury changed today? Smith went down in Week 8 with what the Ravens were careful to call a, “midfoot sprain.” Immediately after the injury, coach Jim Harbaugh was very vocal and precise about exactly what the injury was (and wasn’t) when he said this:
Jimmy is going to be out for a few weeks,” Harbaugh said. “It’s not a Lisfranc deal. It’s a mid-foot sprain. He’ll be out for a few weeks, but he’ll be back soon.
Almost two weeks later, it was revealed that Smith required surgery on his foot, and that he would miss the rest of the season. Today, Smith confirmed that his injury was indeed a Lisfranc injury… the very thing that Harbaugh insisted it was not.
I want to be clear on this, I am not suggesting anything fishy here. Lisfranc injuries are tricky to diagnosis, especially early on. Sometimes the true extent of an injury like this is not known until later when the swelling has gone down or when more conservative treatments have failed to help. I have no reason to think that Harbaugh was not being 100% honest when he gave that quote. I believe that all the information that the medical staff had led them to that conclusion, and that it was a proper conclusion based upon the evidence they had at that time. There, that’s fair, right?
This sort of thing does happen pretty frequently with Lisfranc injuries though. Darren McFadden and Maurice Jones-Drew both had similar timelines in which coaches insisted that they “only” suffered from midfoot sprains rather than the more serious Lisfranc injury. Having seen this sort of thing play out in the past, it makes my ears perk up when I hear a team insisting on carefully wording an injury as, “midfoot only.” Can anyone tell me where else we’re seeing that right now? Oh, yeah, that’s right… Denver RB Ronnie Hillman, who I wrote about here. It’s not like Jimmy Smith’s injury history makes Hillman’s injury more likely to be Lisfranc, it’s just that it strikes me as a case of deja vu. I feel like I’ve heard this song and dance before… but I need to point out that I can’t prove a damn thing about what Hillman really has. Just because Lisfranc injuries often start out as misdiagnosed midfoot sprains, that does not mean that all midfoot sprains deteriorate into Lisfranc injuries. But again, that doesn’t keep my (flawed) brain from making that connection and getting suspicious when I hear, “midfoot sprain,” being used by a coach. It probably doesn’t help that there are recent reports coming out that Hillman’s injury is more severe than originally thought. Even if my overly-suspicious mind is correct and Hillman has a Lisfranc injury, we might not know for quite a while.
It doesn’t help that “Lisfranc injuries” can range from sprains to fracture-dislocations, and not being a physical therapist or podiatrist I haven’t even really been able to parse out the differences between a “midfoot sprain” and a “Lisfranc injury (sprain)”. I guess different ligaments/locations are involved, but maybe Harbaugh was using Lisfranc colloquially as shorthand for a Lisfranc FRACTURE?
Teasing out these issues has been a problem for me in my own datasets.