To say that the New York Jets are in a state of flux is an understatement. From the headline-grabbing acquisition of Tim Tebow in the offseason, to the scrutiny of every Mark Sanchez pass, and to head coach Rex Ryan’s profanity-laced press conferences, the Jets offer a blend of entertainment and apparent mediocrity. While the team still sits near the top of the AFC East with a 2-2 record, few Jets fans seem happy with the team’s performance so far.

Breaking NewsCritics point to the futility on offense. Averaging 197.5 passing yards per game, the Jets rank 27th in the NFL in passing offense. It’s reasonable to assume that the loss of their best wide receiver, Santonio Holmes, will make their offensive attack more anemic.

As a receiver for the Pittsburgh Steelers, he made a sensational grab for the game-winning touchdown in Super Bowl XLIII and earned MVP honors. Since his arrival in New York, his mix of highs and lows has earned him the reputation of being mercurial. Last week’s injury might have been the lowest of all.

The Jets completed a short 5-yard quick out to Holmes on the very first play in the 4th quarter. As Holmes attempted to turn up field, he appeared to plant and rotate his left foot. But he quickly collapsed to the ground, grabbing his left leg. Adding insult to injury, Holmes let go of the football. San Francisco DB Carlos Rogers returned the fumble for an easy touchdown.

With rumors swirling Tuesday night, the Jets announced Wednesday that the former Ohio State Buckeye suffered a Lisfranc injury to his left foot. Holmes will require surgery, and Dr. Robert Anderson in North Carolina will likely perform the procedure. The Jets placed Holmes on season-ending injured reserve.

The initial reports suggested that x-rays were negative. Likely the team and its doctors called them negative in the sense that there were no fractures in the bones of that part of the foot. It is impossible to know if doctors noted widening of the first and second metatarsals or the cuneiform bones in the midfoot. An MRI shows tendons, ligaments, muscles, and other soft tissue structures and not only the bones. Holmes’ MRI very likely showed the torn ligaments that occur in these Lisfranc injuries.

A Lisfranc injury of the foot is an uncommon injury in sports, but they can occur in any sport with cutting or pivoting maneuvers. Typically the foot twists, tearing one or more ligaments in the midfoot. Mild Lisfranc injuries can be managed by placing the athlete in a boot or cast. If athletes have significant separation of the bones on x-rays, or an MRI shows the torn ligaments and displacement, surgeons treat them by surgically reducing the joint into proper position and holding the bones in place with screws.

The Dr. David Geier ShowSantonio Holmes’ Lisfranc injury: That’s Gotta Hurt segment from Episode 59

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Even with screws in place to hold the bones in proper position, the joint has to heal that way. Healing often takes three months or more. Surgeons limit weight bearing early in the rehab process. When the joint healing progresses to an acceptable point, the athlete can start walking on that foot, usually in a boot. Jogging starts once the surgery has healed and walking is painless. The complete rehab and return to sports process can take many months, so the player often misses the rest of the season.

Through four games, Santonio Holmes led the team with 41 targets, 20 receptions and 272 receiving yards, along with one touchdown. The Jets must now rely on unproven receivers like Jeremy Kerley and rookie WR Stephen Hill. If they can’t make up for Holmes’ absence, Mark Sanchez and the Jets offense might have a long, difficult season ahead.

I would like to thank Prateek Prasanna for his tremendous help with this article.