Despite his last name, Eagles cornerback Cre’Von LeBlanc is not a student of French history. Until recently, he had never heard of Jacques Lisfranc de St. Martin, or the foot injury that came to be known as the Lisfranc sprain/fracture.
“That’s crazy,” LeBlanc said this week when told the story of how a surgeon in Napoleon’s army came to be an authority on a foot problem that cavalry riders suffered when they were thrown off their mounts and got a foot caught in a stirrup. The Lisfranc is a midfoot stabilizing ligament that helps maintain the arch, and also affects the ability to push off.
A couple hundred years ago, amputation was the preferred treatment. Happily for LeBlanc, injured in this year’s first training camp practice, and for Eagles defensive tackle Malik Jackson, who suffered a season-ending Lisfranc injury in last week’s season opener, more advanced techniques are available today.
LeBlanc’s injury wasn’t as severe as Jackson’s and didn’t require surgery, which becomes necessary if the bones that connect to the ligament spread too far apart and need screws implanted to bring them back in line. LeBlanc had a Lisfranc sprain, Jackson a Lisfranc fracture. LeBlanc is on IR but should be able return to the field around midseason. Jackson almost certainly will have to wait for 2020.
“I just told him, anything he needs, if he wants to chop it up, talk through the thing, we can,” LeBlanc said when asked if he had spoken to Jackson.
Foot injuries, especially the Lisfranc kind, are common in the NFL of 2019. The Eagles don’t give much specific information on such things, but corner Jalen Mills has been out since last Oct. 28 with a foot problem reported to have been a Lisfranc, though Mills said Friday that was not the case. Defensive tackle Fletcher Cox and linebacker Nigel Bradham also said their serious foot injuries, suffered in last season’s playoff loss at New Orleans, were not Lisfranc issues.
Whatever the specifics, foot injuries have outstripped knee injuries in terms of affecting Eagles players so far in 2019. An NFL study showed that Lisfranc injuries increased from 14.2 per season from 2000-2005 to 18.9 from 2006-14.
“It’s kind of like the injury that has popped up on our team this year. It seems like every year it’s a different one,” said Eagles coach Doug Pederson, who last year grappled with a deluge of hamstring and other soft-tissue injuries. Pederson said the Eagles “try to educate our players” on what might cause foot injuries, “whether it be field surface issues, all kinds of stuff.”
The NFL’s foremost authority on Lisfranc and other foot injuries is Robert Anderson, who currently works in Green Bay as a Packers team physician. He does most of the league’s foot surgeries these days, and in a 2017 interview he estimated he gets “four or five texts a day” from agents seeking treatment for their players.
Anderson rarely speaks in detail with reporters, but in 2013 he did an interview on NFL.com about how common serious foot injuries have become.
“It’s a combination of the players being faster and stronger, having higher-energy injuries, and the fact that probably the shoes have changed -- lighter weight and more flexible, bending at the wrong place perhaps -- and then then role of the artificial surface comes into play,” Anderson said then. “What we’re finding basically is that when the cleat engages with turf, if it doesn’t release at a certain level of torque, then injury can occur. … We’re aren’t blaming this on anybody. We’re aren’t saying it’s all the artificial surface’s fault. It’s not the shoemaker’s fault. It’s certainly a combination of multiple factors.”
A source with knowledge of the situation said the NFL is investigating whether the combination of certain cleats and a popular type of artificial surface used in NFL stadiums produces more Lisfranc injuries.
Nobody is going to convince players to go back to the much more stable, Johnny Unitas-style workboot-type cleats, but the Eagles and other teams try to make sure players have good orthotics inside their shoes and that they wear cleat lengths appropriate to the surface.
LeBlanc, six weeks into his recovery, is walking normally now after several weeks of resting the knee of his injured leg on a scooter. He does a lot of toe crunches. He isn’t running yet, he said.
That was about all the information LeBlanc felt comfortable offering. The Eagles ask players not to talk to reporters about their injuries or their treatment. In fact, they turned down an interview request for running backs coach Duce Staley, whose injury in October 2000, when he was the focal point of the Eagles’ offense, introduced the term “Lisfranc” to the Eagles’ fan base.
There aren’t any famous photos of Staley getting hurt in a 38-10 Week 5 victory over Atlanta 19 years ago, but in the field-level lobby of Lincoln Financial Field, there is a blown-up image of another Eagle, taken just after he suffered a Lisfranc fracture, requiring surgery and a long, painful rehab.
Tight end Chad Lewis is sitting in a light powdering of snow in the Linc end zone, arms aloft, the football resting in his left hand. He’d just caught the winning touchdown pass in the January 2005 NFC championship game, sending the Eagles to Super Bowl XXXIX – in which Lewis couldn’t play because of his Lisfranc injury.
When excited teammates came over to congratulate him, Lewis told them he needed their help to stand up, that “I think I broke my foot.”
“It was a back-shoulder pass, I turned back to spin, to catch it. … My foot just popped,” Lewis recalled last week.
Lewis became a free agent that offseason but eventually returned to the Eagles for eight games in 2005 before retiring. Today he’s an associate athletic director at his alma mater, Brigham Young University, and he was on the sideline four years ago when Cougars quarterback Taysom Hill twisted his foot in the season-opener and heard an ominous noise.
Lewis said Hill’s Lisfranc fracture outcome was better than what he experienced. Hill returned to play for BYU the next season and is now the New Orleans Saints’ backup quarterback and utility player.
“You have to go bananas in rehab to try and strengthen your foot back again. Some people will get the pop back in their foot. Taysom Hill obviously got the pop back in his foot,” Lewis said. “But I would say most people do not get the pop and the explosiveness back in their foot at the level they once enjoyed.”
Lewis, who has become something of a Lisfranc crusader, doesn’t think shoes are the root of the problem.
“I’ve talked with so many surgeons, rehab therapists, trainers. Everyone has their own opinion. … People would like to pin it on shoes, the lightness and the flexibility of the shoes,” Lewis said. "They’d like to pin it on diet and nutrition. They’d like to pin it on a lot of stuff. … Soccer players across the world are wearing the same shoes. They’re cutting all day long, back and forth. … I’m not seeing the same numbers that we see in football.
“I believe in football, the load we’re putting on our bodies … At some point the ligaments that are supposed to support the forefront just don’t.”
Lewis said he experienced pain when exercising for two years after his injury and never regained the “spring” he had before catching that fateful pass.
In 2015, Kirk McCullough, then a Kansas City Chiefs orthopedist, presented findings of the NFL’s foot and ankle committee, and he stated that an average Lisfranc patient suffers 1.3 years of discomfort after the injury even if they are able to return to play.
“You’re trying so hard to be there for yourself, your family, your team," Lewis said. "You’ve got the great opportunity, playing in the NFL, and you have a foot that’s healthy. It works. You’re cleared. You’re trying to make it work at a level where you’re still able to make plays in the NFL.
“The Lisfranc, it is a beast of an injury. I wouldn’t wish it on anyone."