Virginia Via Research Day Book 2026

Medical Student Research Case Reports

30 WHEN STABILITY ISN’T ENOUGH: A MULTIDISCIPLINARY APPROACH TO MANAGING A LIGAMENTOUS LISFRANC INJURY IN A DIVISION I FOOTBALL PLAYER

Caitlin Weaver OMS II; Kyle Hopkins, DO; Alex Black, MAEd, LAT, ATC; Brett Griesemer, MAEd, LAT, ATC, CSCS; J. Randolph Clements, DPM; Matthew Chung, DO, CAQSM, R-MSK, FAOASM; Mark Rogers, DO, CAQSM, FAAFP, FAOASM Corresponding author: cweaver@vcom.edu

VCOM-Virginia, Blacksburg, Virginia Virginia Tech Sports Medicine Department, Blacksburg, Virginia

images did not display any evidence of clinical Lisfranc joint widening. Comments: Due to the complex anatomy of the midfoot and variable mechanism of injury, Lisfranc injuries are frequently misdiagnosed and can be challenging to manage. In athletes, early detection and appropriate management are especially critical, as they can determine the timeline for return to play and long-term performance outcomes. Literature suggests that non-operative management is appropriate when there is radiographic evidence of stability or less than 2 mm displacement. Typical non-operative management includes a course of 4-6 weeks of non-weight bearing immobilization followed by rehab. There is no significant evidence for or against the use of injections such as platelet-rich plasma. Several studies have demonstrated success in non-operative management of collegiate football players in non-displaced injuries, though little data exists on rates of conversion from conservative to surgical treatment of these injuries. Persistent pain and functional loss, even in the absence of radiographic instability may warrant surgical fixation – as demonstrated in this case. Despite ongoing

controversy on the most appropriate management, current studies showed there was no significant decline in athletic performance in NFL and D1 football players treated both operatively and non-operatively for Lisfranc injuries. Diagnosis: Right Lisfranc ligamentous sprain Treatment: To attempt to allow for the athlete to return to football this season, a conservative treatment approach was initially taken with PRP injection, custom orthotic fabrication, and a rehabilitation plan managed by ATC staff. Unfortunately, the athlete was not able to progress through a return-to-play protocol, and while repeat weight-bearing radiographs were stable, the multidisciplinary team elected to proceed with more definitive surgical fixation. Conclusion: Medicine often does not have a simple answer. This case underscores the importance of a multifaceted and multidisciplinary team that works together in the same goal to help an athlete or patient return to their sport or level of functionality.

Context: This case highlights the role of a multidisciplinary team in helping a high-level athlete with a Lisfranc injury navigate the various treatment options both non-operative and operative. Report of Case: A 21-year-old male division 1 college football player presented to the clinic during fall camp with pain between the first and second metatarsal of the right foot. The suspected mechanism of injury was with the foot plantarflexed and toes hyperextended and an opposing force applied to the heel. He endorsed difficulty with weightbearing and tenderness to palpation along the plantar aspect of the second metatarsal. He denied any paresthesias, immediate bruising or prior injuries to the foot. Initially, non-weightbearing plain film radiographs in the training room revealed no apparent displacement of the Lisfranc joint, however an osseous or ligamentous fragment was observed medial and posterior to the second metatarsal of unclear significance. Non-contrast MRI of the foot showed no malalignment but did display signal throughout the Lisfranc ligament and signal through the midfoot sprain on T2 images, consistent with ligamentous sprain. Subsequent weightbearing AP

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68 Edward Via College of Osteopathic Medicine (VCOM)