A potentially career-ending foot injury is occurring in increasing numbers among elite football players, according to research reported last week.

The particular foot injury, which can be mistaken for a simple sprain, is probably on the rise due to a combination of bigger and faster athletes, lightweight footwear and new turf designs, according to Dr. Matthew Dean Hammit, a Houston orthopedic surgeon.

Hammit completed a fellowship last year under Dr. Robert Anderson, a Charlotte orthopedic surgeon who also serves as an assistant team physician for the Carolina Panthers NFL team. Anderson presented a report on the injuries last week at a meeting of the American Orthopaedic Foot and Ankle Society in Seattle.

In an interview, Hammit noted that Anderson had treated seven NFL players and two college football players for what turned out to be “a kind of variation” of the so-called Lisfranc injury. Hammit explained that the Lisfranc injury occurs when a ligament that connects the midfoot to the forefoot ruptures.

The Lisfranc injury occurs most often in car accidents, and usually bones as well as ligaments rupture, Hammit said. But the type of injury seen in these football players is “a more subtle injury.” The ligament itself ruptures, but none of the bones in the foot break, he said.

“It can look like a simple sprain,” Hammit commented. And because the injury is subtle, it can be difficult to see on a normal X-ray.

But he said that doctors can use a standing X-ray, in which pressure is put on the foot, to diagnose the injured ligament. An MRI scan may be used to confirm the diagnosis.

There is some controversy about the best way to treat this type of Lisfranc injury, according to Hammit. Some doctors believe that, as with other fractures, putting the foot in a cast may allow proper healing.

But for elite athletes, the healing may not be enough to restore them to their pre-injury level of performance, Hammit said. In those cases, he’d recommend surgery to correct the injury.

Most likely a combination of factors has led to this type of injury in elite athletes, in Hammit’s opinion.

First, athletes today are bigger, stronger and faster than they used to be. This means that athletes’ bodies, including their ligaments, are subjected to stronger forces, Hammit explained. If an athlete’s foot gets stuck in the ground and he gets tackled from behind, the ligament in the foot may not be able to handle the heavy-duty impact, he said.

Another factor, Hammit noted, is that many athletes prefer lightweight, flexible shoes. Although this footwear may be great for speed and finesse, it does not offer as much protection as heavier shoes.

Finally, many players wear shoes with longer cleats to get traction in new types of artificial turf, Hammit pointed out, and this could increase the risk of foot injury.