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How do Lisfranc injuries like Alysha Clark’s happen and how could it affect her play for the Mystics this season?

We spoke to Dr. Damian Roussel, a podiatrist at The Centers for Advanced Orthopaedics to find out more.

Phoenix Mercury v Washington Mystics
Alysha Clark’s recovery from a Lisfranc injury last year shouldn’t be career-altering in and of itself.
Photo by Scott Taetsch/Getty Images

The Washington Mystics missed the WNBA Playoffs in 2021 in large part because they didn’t have two of their key players, forward Elena Delle Donne and forward Alysha Clark for most or all of the season, respectively.

We spoke to Dr. Lucas Wymore about back injuries like Delle Donne’s and the need for rest after them last fall. Thankfully, Delle Donne said she was “pain-free” in media availability on Feb. 1.

But given the moves some other WNBA teams like the Phoenix Mercury and Chicago Sky have done during free agency, it’s important that the Mystics get a healthy Clark back on the court as well.

Clark, a two-time WNBA All-Defensive team selection, missed last season due to a Lisfranc injury in her right foot and had surgery to repair it. She suffered the injury while playing a game for Lyon in France when she felt a pop in her right foot while trying to drive to the basket, and couldn’t put weight on it, according to Jenn Hatfield of The Next.

At this point, Clark went through much of the standard rehabilitation from the injury since she had surgery last April.

But that said, I still wasn’t exactly sure what a Lisfranc injury was and what the timeframe of recovery would be for a typical athlete, not necessarily just her.

To help all of us learn more in detail about Lisfranc injuries, I spoke to Dr. Damian Roussel of The Centers for Advanced Orthopaedics. Dr. Roussel is a podiatrist and much of his practice focuses on athletes. His practice is based in Frederick, Md., about a one-hour drive northwest of Washington.

As a disclaimer, the answers Dr. Roussel gave should be considered as general trends among people in a similar situation as Clark’s, and are not to be taken as medical advice. The information below is also not an indication of what Clark herself has experienced or is experiencing. Please consult your specific doctor for your specific situation.

And now the Q&A. Some of the text was edited for clarity.

Bullets Forever: Dr. Roussel, what is a Lisfranc injury?

Dr. Roussel: Lisfranc injuries come from the Lisfranc joint complex. This complex is located at the junction of the midfoot and the forefoot [the part of the foot up to where the toes are]. The Lisfranc ligament connects a bone called the medial cuneiform to the second metatarsal, the bone that is at the midfoot below your second toe. The ligament is small but important because it helps to stabilize the midfoot and it helps to preserve the arch of the foot. It’s been called the ‘cornerstone of the foot’ because once it’s compromised, the entire midfoot can become unstable.

A Lisfranc injury occurs when there’s a severe twisting force on the midfoot with the forefoot stuck in place. Most injuries are rather obvious and traumatic.

In basketball, it could happen when a player steps on someone’s foot and twists her own foot while getting out of a situation. So she could be coming down from a rebound, land, and she twists her foot awkwardly. Or a player could drive to the basket and plant with the ball of the foot, and then suddenly twists to change direction, which is what happened in Clark’s case. But in all cases, the injury happens when the front part of the foot, the ball of the foot’s on the ground and the body is twisting.

BF: How common is a Lisfranc injury in basketball and what is the timetable for recovery?

Dr. Roussel: The Lisfranc injury happens more often in football than basketball. In football, the injury was often career-ending for skill position players like running backs until about 10 years ago when some players were able to make a successful return to play because of improvements in medicine.

It takes about 6 to 12 months for a player to get back to playing after this injury. But it takes about 12 to 18 months to return to a high level of play. This timetable is for most running and agility sports, including basketball.

BF: Based on your timetable as a guide, Clark should be ready to play this summer. But at the same time, is she still able to play defense at an All-Defensive team level? Clark will also be 35 this year and could decline anyway due to age.

Dr. Roussel: First, most Lisfranc injuries are treated quickly with surgery, which is usually to fixate the midfoot. This is sometimes done with plates and screws. Depending on the case, these fixations may be removed. Regardless, a player like Clark usually ends up with some stiffness of the midfoot.

When Clark returns, I would expect that she can return to the same level of play as she was pre-injury, at least initially. But does that stiffness of the midfoot affect her skills? Her lateral movement may feel a little bit different because the middle part of the foot doesn’t twist like it used to. It could affect her speed as a defender, and will she still be able to get that quick first step? And could there be subsequent foot problems? Those would be the factors that could negatively affect her performance down the road in addition to natural aging.

BF: People’s feet take the biggest beating on their bodies, and basketball players’ feet certainly take an especially big one due to their movement. Given the pictures of some NBA players’ deformed feet on social media, is that something that could put them at higher risk of a Lisfranc injury?

Dr. Roussel: It is not uncommon to see high-level athletes, like basketball players have foot deformities like bunions and hammertoes because they are really hard on their feet not unlike ballet dancers. That said, these deformities won’t put them at higher risk of a Lisfranc injury. That injury is acute and can happen to anyone at any time.

People who have foot deformities like bunions and hammertoes can still have chronic pain to a point where it’s uncomfortable for them to play. It’s important for them and all athletes to wear comfortable, supportive shoes and avoid wearing uncomfortable ones, like high heels and/or tapering toe boxes.

BF: Here’s a general question. What is the best way for us to prevent chronic foot injuries?

Dr. Roussel: The two most important things for people in that regard, whether you are an athlete or not are stretching exercises and wearing comfortable, supportive shoes,

With stretching, keeping the plantar fascia [that part is located at ball of the heel] and the calf muscle stretched out. So exercises with the toes stretched towards the nose to stretch the calf muscle. And with shoes, wear them potentially with an orthotic to increase arch support. Also, make sure your toes have room to move.

Thank you again to Dr. Roussel for his insight on Lisfranc injuries and foot care in general. We will soon have an interview regarding wrist injuries like the one that is forcing Washington Wizards Bradley Beal to sit out the season, so stay tuned for that! In the meantime, let us know your thoughts on foot injuries like Clark’s in the comments below.