Cam Newton and recovery from Lisfranc injuries for NFL players

I did a radio interview late last week on a station in North Carolina about the Lisfranc injury of Cam Newton. The host, like I’m sure were most of his listeners, was frustrated by how long it was taking for Newton’s foot to heal and for the former Auburn star to return to the field. In that interview, and in my latest newspaper column, I explain midfoot sprains, and specifically Lisfranc injuries, as well as share data on how long these injuries can keep NFL players out of action.

The slow recovery of Cam Newton’s Lisfranc injury

The speculation swirling around Cam Newton intensified in recent days as reports emerged that the Panthers’ franchise quarterback traveled to get a third opinion on his Lisfranc injury. Now the team looks set to sit him out for the rest of the season.

In a video he posted on YouTube, Newton confirmed he suffered a Lisfranc sprain in the Panthers’ third preseason game against the New England Patriots. Cam claimed he made the injury worse in Week 2 of the regular season in a loss to the Tampa Bay Buccaneers.

Stating his ultimate goal is to win the Super Bowl, Cam acknowledged he needed time to rest and get his injury to heal.

Explanation of a Lisfranc injury and its treatment options

A Lisfranc injury is one in which a ligament in the midfoot, around the arch of the foot, is injured. When the Lisfranc ligament ruptures, the first and second metatarsals (the long bones of the midfoot) or other bones in the midfoot can separate.

While it’s not a very common injury, it more often occurs in football than other sports. The injury usually results from a twisting motion to the foot or landing on the foot with the ankle pointed toward the ground.

Treatment of a Lisfranc injury depends on its severity. A sprain of the ligament with no separation of the midfoot bones usually can be treated without surgery. But even a mild injury often requires the athlete to be in a boot or cast for weeks. If there is significant displacement of the bones, surgery to align the bones and hold them with screws or other implants is performed.

Cam Newton travels to see a specialist for another opinion of his foot injury

For weeks, fans have been frustrated with Newton’s seemingly slow recovery. Then news surfaced that he traveled to Green Bay to see renowned foot and ankle specialist – and former Panthers assistant team physician – Dr. Robert Anderson.

On Sunday, NFL Network’s Ian Rapoport reported that surgery was not recommended or planned. Newton, doctors and the team hope more rest will help the Lisfranc injury heal without needing surgery that would keep him off the field for months.

While Rapoport noted that placing Newton on injured reserve was an option, the Panthers have so far not elected to do so. On Monday, head coach Ron Rivera offered no timetable for Cam’s return.

In the meantime, backup Kyle Allen has helped the team to a 5-3 record and looks set to guide the Panthers for weeks to come.

Are midfoot sprains – and Lisfranc injuries specifically – simple injuries?

Midfoot sprains, which Newton was initially reported to have suffered, are usually thought to be mild injuries. Two studies looking at midfoot sprains in football players show relatively quick times for return to play.

In one, athletes returned to practice in an average of 13.8 days and were fully healed in an average of just over 40 days. In the other study, players who didn’t need surgery returned in 11.7 days, while those who needed surgery were out much longer, if not the rest of the season.

Many surgeons, though, worry about quick return after a Lisfranc injury for athletes who perform cutting and twisting movements, which are clearly an important part of Newton’s game.

Return to play after Lisfranc injuries for NFL players

A 2016 study in the American Journal of Sports Medicine looked specifically at Lisfranc injuries among NFL players. The data collected by those researchers is more discouraging.

NFL players with Lisfranc injuries treated without surgery missed an average of 6.2 months and seven games. Players who underwent surgery missed an average of 11.6 months and 10 games. The timing of the injury during the season and extension of the recovery into the offseason likely play a role in those return times, but it still suggests bad news for Carolina fans.

Fortunately, the authors of that study found that offensive players had no statistically significant drop in on-field performance or career length after a Lisfranc injury.

Wait and see for Cam Newton and Carolina Panthers fans

Carolina did not put Newton on IR initially, which suggests the team believed he could heal quickly. Now that we know he won’t take the field this season, fans can hope he finally gets healthy enough to return to the physical ability we saw in his 2015 MVP-winning season.

Note: A modified version of this article appears as my sports medicine column in the November 6, 2019 issue of The Post and Courier.

References:

Why the Panthers didn’t put Cam Newton on IR is complicated, but it’s all about hope. By Brendan Marks. The Charlotte Observer. November 4, 2019.

Panthers need to move Cam Newton to injured reserve — the only move that makes sense. By Scott Fowler. The Charlotte Observer. November 3, 2019.

Cam Newton out several more weeks, weighing options. By Ian Rapoport. NFL.com. November 3, 2019.

Cam Newton’s continued absence a cautionary tale for optimistic timetables when it comes to foot injuries. By Jonathan Jones. CBSSports.com. November 1, 2019.

Update on Cam Newton. Panthers.com. November 1, 2019.

Panthers’ Cam Newton Opens Up About Lisfranc Injury, Timetable for Return. By Adam Wells. Bleacher Report. September 27, 2019.

McHale KJ, Rozell JC, Milby AH, Carey JL, Sennett BJ. Outcomes of Lisfranc Injuries in the National Football League. Am J Sports Med. 2016 Jul;44(7):1810-7.

Osbahr, DC, O’Loughlin, PF, Drakos, MC, Barnes, RP, Kennedy, JG, Warren, RF. Midfoot sprains in the National Football League. Am J Orthop. 2014;43(12):557-561.

Meyer, SA, Callaghan, JJ, Albright, JP, Crowley, ET, Powell, JW. Midfoot sprains in collegiate football players. Am J Sports Med. 1994;22:392-401.