Etiology and Biomechanics of Tarsometatarsal Injuries in Professional Football Players

BACKGROUND Tarsometatarsal (TMT) dislocations are uncommon yet debilitating athletic injuries, particularly in American football. To date, the mechanisms of athletic TMT dislocation have been described only anecdotally. This lack of information confounds the development of preventative countermeasures. PURPOSE To use video analysis to provide direct, independent identification of the etiologic and mechanistic variables responsible for TMT dislocations in professional football players. STUDY DESIGN Case series; Level of evidence, 4. METHODS Sixteen professional National Football League players who sustained publicly reported TMT dislocations were identified. Publicly broadcast game footage of the plays in which injury occurred was reviewed by a panel of 5 biomechanists. Consensus was reached regarding the details surrounding injury, and a weighting was assigned to each detail based on the panel's confidence. RESULTS Roughly 90% of injuries occurred while the injured player was engaged with or by another player, a detail that has heretofore been undocumented. Few injuries resulted from direct loading of either the foot or the ipsilateral limb; however, the injured foot was frequently subjected to axial loading from ground engagement with the foot in plantar flexion and the toes dorsiflexed. Injurious loading was often due to external rotation of the midfoot (86%). Fifteen of 16 injuries were season ending. CONCLUSION TMT dislocations are frequently associated with engagement by or with a second player but infrequently caused by a direct blow to the foot. Axial loading of the foot, external rotation, and pronation/supination are the most common conditions during injurious loading.