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December 19, 2024
The right diagnosis is always important, but in Logan Mispagel’s case it made a huge difference in her senior year. Instead of getting surgery and months of rehab, Logan was able to recover in time for basketball season. Her care team at the health system made sure that was possible.
A 'pop' and then pain
It all started in spring 2024 at an Olathe East High School soccer practice. Logan says her foot got caught on the grass as she was dribbling and popped.
"I instantly felt pain," she says.
She stopped practice, went home and rested, but the next day was worse – she couldn’t walk on the foot.
"I’ve had ankle injuries before, so I knew it’s not my ankle but don’t know what it is," Logan says.
So she went to school and sought out Erin Washington, an athletic trainer with the health system who works out of Olathe East.
"I trust Erin, which is why I was able to go to her so easily," Logan remembers. "Erin realized that I’m not really a person to complain about pain."
Washington quickly referred Logan to the sports medicine team at the health system for further evaluation.
Getting it right
Bryan Vopat, MD, orthopedic surgeon at the health system, examined Logan and ordered a diagnostic X-ray. He determined she had a Lisfranc injury. Dr. Vopat explains that these are commonly misdiagnosed. In fact, older literature shows it was missed about 35% of the time.
There are also 2 types of Lisfranc injury.
Bryan Vopat, MD:
So, there's two different types. One's a stable injury and one's an unstable injury, and that's why you have to probably look at it with X-ray. And here at the health system, we have something called a weight-bearing CT scan. If we are a little bit concerned about it, we're the only ones in the region that have that. And that can also help better differentiate whether it's stable or unstable. If it's a stable injury like Logan had, we can treat these non-operatively. However, we have to make sure that it's not unstable, because those are the ones that need to be fixed and can cause the long-term issues.
Thomas Katzfey, DO, a sports medicine physician at Olathe Health, now part of The University of Kansas Health System, explains exactly what a Lisfranc injury is.
Thomas Katzfey, DO:
So, what you see with the Lisfranc is the medial cuneiform attaches to the second metatarsal, and so that's where this ligament connects, and we see the rupture there. But at the bottom left of that medial cuneiform bone, just to the bottom left of that circle, you can see some whiteness that's there. There's some bone edema, which is at the medial aspect of the medial cuneiform, and that's due to the direct impact of the type of injury that she had sustained. The thing we see here, that's actually reassuring, Dr. Vopat kind of alluded to it as well, is we don't see a major separation between the first and second metatarsal, which is good, because that would be indicative of a more stable type of an injury.
Logan had a stable Lisfranc injury and was able to avoid a surgery that would insert hardware and at least 6 months of recovery. Instead, she wore a boot to allow the midfoot to rest and calm down for about 6 weeks. Then she transitioned to a carbon fiber insole and started physical therapy.
"What we really want to do is get these athletes back as quickly as possible," says Dr. Katzfey. "We need to strengthen that lower extremity and make sure that we don't develop any stiffness, which is pretty common when you're immobilized for so long. It also allows her to get back to sports-specific training so she can get back to sports as quickly as possible."
"I went to physical therapy with this beautiful lady named Renee (Hollowell)," Logan says. "She's amazing. I love her. We worked on a lot of stuff with planting because that was important. Especially with basketball and soccer, you have to be quick and move back and forth a lot. And basketball season is coming up, so now it's just being consistent with still doing my workout so I don't get reinjured."
Washington explained Logan’s physical therapy exercises and how they help her recovery.
Erin Washington:
She’s doing a lot of hand-eye coordination and focusing on that foot agility. So, a lot of her injury is right at the arch in her foot, and it needs to be able to be stable, to absorb those loads with the full body weight and onto your toes. So, she was doing the agility ladder. And then those pods are reaction lights, she has to go and tap them, and she gets timed. It’s really neat. It’s a Bluetooth type of application that the physical therapist has on her phone to see how she’s improved. And then she has to quickly react and change direction, which is all really good for her and her foot to get better. And this is one of her last days of physical therapy, so she’s at her max and just kind of testing out on this day. So, she did great.
A full recovery – mind and body
As Logan prepares to enter her senior season on the varsity basketball team, followed by a final soccer season in the coming spring, she’s reflecting on how she was challenged not only physically, but mentally, by this injury.
"I think as an athlete getting injured, sometimes your mental health is overlooked,” Logan says. "Watching everybody being healthy and playing a sport that you've played your whole life, that you love, can be a little mentally straining."
She says she felt lucky to have a strong relationship with Washington, her school athletic trainer, in those moments.
"Right when I got hurt, Erin was like, ‘I'm always here just if you want to come hang out with me,’" Logan says. "Having her to talk to and tell somebody about what you're going through is great.”
And Washington says she is grateful to be a part of the process and help athletes, like Logan, during these crucial moments.
"That's the best part of being an athletic trainer, being in the high school with them, is not only do I get to know them beforehand, I get to help them with their injury and get to see the successful outcome," Washington says. "So that's a unique experience that not every profession provides."