Explaining Anthony Davis’ mid-foot sprain

Dr. Raj, DPT details the Lakers’ big’s foot injury including why it’s surprising, two likely scenarios, the physio and return to play process AND some good news

Hey it’s Raj from 3CB.

Lakers big Anthony Davis suffered a rough looking injury vs the Utah Jazz which was originally labeled as an ankle sprain but officially diagnosed as a “midfoot sprain” following an MRI.

Surprising official diagnosis

The official diagnosis was quite surprising because AD’s mechanism – the ankle rolling inwards aka inversion – nearly always results in damage to the lateral (outer) ankle ligaments. That’s what I detailed in my original injury possibility video. However, that still may or may not be the case.

Two likely scenarios

There’s two scenarios here:

Firstly, the Lakers medical staff may be listing Davis’ more significant injury as the official. When the ankle rolls like that, it’s not that uncommon to also have damage to midfoot ligaments, specifically:

The bifurcate ligament which is a Y-shaped ligament with two parts, between the calcaneus and cuboid bones and the calcaneus and navicular

The talonavicular ligament which connects the talus to the navicular.

And/or or the capsule of the midtarsals which is kind of like a ligament that encapsulates the joints of the midfoot.

However  – and this is the second scenario – there are rare cases where this inversion mechanism results in no damage to the lateral ankle ligaments but there is damage to midfoot ligaments, most commonly the bifurcate ligament.

In these cases, there will be swelling on the outside of the foot/ankle and pain with inversion (inwards) movements of the ankle – both of which mimic symptoms of a lateral ankle sprain. This would help explain why AD was originally manually diagnosed with a lateral ankle sprain during the game.

I’ve heard some concern about the dreaded LisFranc injury but that typically happens when you’re up on the ball of the foot and there’s load applied and the pain location is higher up the foot and more medial (middle) rather than on the outside.

Return timeline

The team has given a four week re-evaluation period for Davis. The first scenario aligns if AD has a bifurcate ligament injury (typically 4+ weeks) and a grade 2 lateral ankle ligament injury (typically 3-4 weeks). The second scenario – bifurcate only – also aligns.

Good news

The good news is that it doesn’t sound like surgery is required which can be indicated in severe midfoot ligament tears.

Physio & Return to play

Rehabbing midfoot injuries can be tricky because of the biomechanics of the midfoot and the transitional force it takes on as the connecting conduit between the fore and rear of the foot.

As always, the key is a methodical activity progression – especially now since this is AD’s 2nd extended absence of the season after just returning from a grade 2 MCL tear so he will be at greater fitness deficits.

I’ll keep you updated as we learn more.

Thank you for reading and thank you for your time. As a subscriber, feel free to leave any feedback and/or suggestions for future pieces.

Dr. Rajpal Brar, DPT, (@3cbperformance) is a physiotherapist, movement expert, strength and conditioning/fitness coach, sports scientist and mindfulness coach. He runs the LA and online based physiotherapy and athletic performance clinic 3CB Performance and you can subscribe to his Youtube channel (which posts a variety of sports injury, performance, and fitness related content).

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