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Injuries in English: Cleveland Browns OG Joel Bitonio's foot issue

In our second edition of "Injuries in English", Brandon talks about Joel Bitonio's foot injury and what's next for the Browns standout guard.

The Browns' injury woes continued this week as the news for Joel Bitonio got worse. Bitonio sustained a midfoot injury in a week five matchup against the Patriots, and underwent surgery performed by Dr. Robert Anderson on Tuesday of this week to address the problem.

What is it? The foot can be separated into three different regions and are named the hindfoot, midfoot and forefoot. All three are named for their location, as the hindfoot refers to the portion of the foot towards the heel bone, the midfoot refers to the portion of the foot in the middle and the forefoot refers to the portion of the foot closest to the toes. The joint line that is found in the midfoot between the metatarsals (the long bones in the foot) and the cuneiform/cuboid bones is termed the Lisfranc joint. An injury to the midfoot, as in the case of Joel Bitonio, can be a sprain or fracture and is termed a Lisfranc injury; the namesake coming from a French physician in the 1800's. When a Lisfranc injury occurs, the bones that make up the joint can dislocate or fracture. The ligaments that work to stabilize the joint may also be overstretched or sprained. The midfoot serves an important purpose to provide stability to the foot while walking, running etc. If the midfoot becomes compromised in any fashion, as in the Lisfranc injury, the ability to function normally to meet every day demands is altered.

How is it fixed? Management of midfoot injuries are based on severity, with the initial goal being conservative management versus surgical intervention. Conservative management involves a period of immobilization in a cast that will prohibit the individual from bearing weight through the involved foot, followed by period of regaining strength and range of motion through the foot and ankle. While the foot/ankle is immobilized it is important to maintain adequate strength and range of motion of the joints proximal (closer to the midsection of the body) to the injury site as to avoid further complications. Unfortunately for Bitonio, his midfoot injury required surgical intervention. Surgery for Lisfranc injuries is indicated to reposition the joints in the midfoot as to allow for proper functioning during day to day activities. This procedure can involve the use of pins, screws and plates (internal fixators) in order to realign the joints of the midfoot; the usage of the aforementioned internal fixators is determined based on injury severity. Following surgical intervention, the individual will undergo a phase of non-weight bearing through the affected foot similar to a midfoot injury managed conservatively. Once x-rays of the surgically repaired foot are cleared by the surgeon, weight bearing as tolerated will be initiated. Again, an effort is made to improve range of motion and strength of the foot and ankle as to regain functional mobility and return to sport activities. Once further removed for surgery, surgeons will typically transition the patient into a shoe with extra support or orthotics to provide better stability.

My take. This certainly wasn't the best news for the Browns as Bitonio is now lost for the remainder of the 2016 campaign. Provided he does not experience any setbacks, I anticipate Bitonio will be ready to go for the start of the 2017 season.

Brandon Bowers, PT, DPT, is a graduate of the University of Toledo, Doctor of Physical Therapy Program and currently practices in Columbus, Ohio. He is an avid Cleveland sports fan and has experience rehabbing athletes of all levels and from a variety of sports. Follow Brandon on Twitter for more Cleveland Browns injury insight and analysis: @blbowers12

The information provided is the professional opinion of Brandon Bowers, PT, DPT and is based on his clinical experience and the most current clinical evidence available. This information should not be interpreted as or substituted for medical advice for a specific condition or diagnosis.


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