Chet Holmgren's Lisfranc Injury: From the View of Foot and Ankle Surgeon

Inside the Thunder looks to get insight on Chet Holmgren's foot injury from an expert who would know best.

Late last month, Oklahoma City Thunder rookie center Chet Holmgren suffered a Lisfranc injury that would result in him missing the entire 2022-23 season. After suffering this foot injury, he's now successfully had surgery and will begin his recovery. 

While he is expected to be ready for the start of the 2023-24 season this time next year, what does this mean for Holmgren longer term?

We spoke to David S. Levine, MD, foot and ankle surgeon at Hospital for Special Surgery (HSS) to see how this affects the Thunder's potentially generational center.

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Q: Can you give us the simplified version of what this injury actually is and how it occurs?

A: A Lisfranc injury is a sprain (tear) of the ligaments that tightly hold the multiple Midfoot bones together. Normally, the Midfoot is a stable, immobile part of the foot when compared to the mobile/flexible Hindfoot (Ankle) or the Forefoot (ball of the foot/toes). If this injury is a minor/low-grade sprain, the Midfoot remains stable and surgery is not necessary. However, when the injury is a high-grade sprain, the stability of the Midfoot has been compromised. These injuries do not do well left alone and surgical treatment is necessary to restore the normal Midfoot stability. While there are still those Lisfranc injuries that occur in car accidents and falls from a height, more and more these injuries are seen in sports. Classically, an athlete is running, jumping, leaping or landing and comes down ‘awkwardly’ (on someone else’s foot, for example). The Midfoot ‘buckles’ tearing the Lisfranc ligaments. The result in an ‘unstable’ Midfoot which is painful and unable to bear weight.

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Q: What’s the real risk of this impacting Holmgren’s performance upon recovery?

A: The risk to future performance is the development of arthritis in the Midfoot. Midfoot arthritis causes pain and an inability to efficiently transmit power from the muscles of the leg to the ball of the foot for push-off.  This can manifest as a negative impact on quickness. The result could be less effectiveness on offense or defense or both.

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Q: Does Holmgren's size and weight have anything to do with the injury happening? Does being 7-feet tall with large feet make the injury any more concerning?

A: With a rare exception, larger size / weight individuals are matched by appropriately larger and stronger muscles, ligaments, tendons with which to withstand the former.

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Q: In what way could this type of injury affect Holmgren’s career in terms of late stages (ex: at age 35)?

A: The cumulative effects of high impact activity (ie running) over time are often responsible for the development of arthritis in the weight bearing joints of the spine and lower extremities over years/decades of play. The potential mechanical effects of a Lisfranc injury can accelerate the development of Midfoot arthritis. Thus shortening the ‘effective duration’ of a professional athlete’s career.

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Q: We’ve heard mention of arthritis and foot discomfort as a symptom post recovery - is this common?

A: Midfoot arthritis is a common negative effect of a Lisfranc injury. While not universally accepted, the treatment algorithm of Lisfranc injuries has shifted towards a greater acceptance of a limited Midfoot fusion as the treatment of choice for these injuries among orthopedic foot & ankle surgeons. When compared to traditional ‘repair’, Midfoot fusion avoids the challenges of later Midfoot arthritis and given the stable nature of the normal Midfoot, does not create any untoward consequences.

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Q: What’s the difference between a basketball player vs football player recovering from this?

A: Both basketball and football are considered high impact sports that involve frequent running, jumping, leaping, landing and change of direction. As a result, Lisfranc injuries are common in both sports. Depending on when an injury occurs in a given season, these injuries and their recovery are frequently ’season-ending’ occurrences. Perhaps due to the contact nature of football, career length in the NFL is one year shorter than that of the NBA (3.3 years vs 4.5).

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After hearing this insight, Inside the Thunder is of the impression that the injury, while unfortunate, seems better to happen now rather then a couple of years down the line in terms of recovery and long term effects. It’s an example of how his size may be an issue in the future not in terms of his ability to play in the league but with injuries and muscle strength.

Arthritis, may be in the cards in the future due to the injury but modern advancements continue to help most injuries in side effects and long term impact on the careers of the players. 

Regardless, there's still optimism that Holmgren will return from injury and still be a generational player. He'll have an entire year to study the NBA game up close and also get stronger while gaining weight. As long as the arthritis doesn't affect him long-term, this injury could end up meaning nothing by the time Holmgren is in his prime.

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