Common Foot and Ankle Problems In Athletes
Ankle sprains are the most common sports injuries, with an estimated 25,000 occurring every day in the US. Sprains can happen with any sport. Ankle sprains are most common in ball sports such as football, basketball, soccer, volleyball and others.
An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. Ankle sprains are common injuries that occur among people of all ages. They range from mild to severe, depending upon how much damage there is to the ligaments.
Most sprains are minor injuries that heal with home treatments like rest and applying ice. However, if your ankle is very swollen and painful to walk on — or if you are having trouble putting weight on your ankle at all, be sure to see Dr. Collins.
Without proper treatment and rehabilitation, a more severe sprain can weaken your ankle—making it more likely that you will injure it again. Repeated ankle sprains can lead to long-term problems, including chronic ankle pain, arthritis, and ongoing instability.
Ligaments are strong, fibrous tissues that connect bones to other bones. The ligaments in the ankle help to keep the bones in proper position and stabilize the joint.
Most sprained ankles occur in the lateral ligaments on the outside of the ankle. Sprains can range from tiny tears in the fibers that make up the ligament to complete tears through the tissue.
If there is a complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes. Over time, this instability can result in damage to the bones and cartilage of the ankle joint.
Your foot can twist unexpectedly during many different activities, such as:
- Walking or exercising on an uneven surface
- Falling down
- Participating in sports that require cutting actions or rolling and twisting of the foot—such as trail running, basketball, tennis, football, and soccer
- During sports activities, someone else may step on your foot while you are running, causing your foot to twist or roll to the side.
A sprained ankle is painful. Other symptoms may include:
- Tenderness to touch
- Instability of the ankle—this may occur when there has been complete tearing of the ligament or a complete dislocation of the ankle joint.
If there is severe tearing of the ligaments, you might also hear or feel a “pop” when the sprain occurs. Symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation.
Dr. Collins will diagnose your ankle sprain by performing a careful examination of your foot and ankle. This physical exam may be painful.
- Palpate. Dr. Collins will gently press around the ankle to determine which ligaments are injured.
- Range of motion. Dr. Collins may also move your ankle in different directions; however, a stiff, swollen ankle usually will not move much.
If there is no broken bone, Dr. Collins may be able to tell the severity of your ankle sprain based upon the amount of swelling, pain, and bruising.
Almost all ankle sprains can be treated without surgery. Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately.
A three-phase program guides treatment for all ankle sprains—from mild to severe:
- Phase 1 includes resting, protecting the ankle and reducing the swelling.
- Phase 2 includes restoring range of motion, strength and flexibility.
- Phase 3 includes maintenance exercises and the gradual return to activities that do not require turning or twisting the ankle. This will be followed later by being able to do activities that require sharp, sudden turns (cutting activities)—such as tennis, basketball, or football.
This three-phase treatment program may take just 2 weeks to complete for minor sprains, or up to 6 to 12 weeks for more severe injuries.
For milder sprains, Dr. Collins may recommend simple home treatment.
The RICE protocol. Follow the RICE protocol as soon as possible after your injury:
- Rest your ankle by not walking on it.
- Ice should be immediately applied to keep the swelling down. It can be used for 20 to 30 minutes, three or four times daily. Do not apply ice directly to your skin.
- Compression dressings, bandages or ace-wraps will immobilize and support your injured ankle.
- Elevate your ankle above the level of your heart as often as possible during the first 48 hours.
Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help control pain and swelling. Because they improve function by both reducing swelling and controlling pain, they are a better option for mild sprains than narcotic pain medicines.
Learn more about ankle sprains:
Turf toe is a sprain of your big toe joint resulting from injury during sports activities. The injury is usually caused by excessive upward bending of your big toe joint. Jamming the toe, and repeatedly pushing off when running or jumping are common causes. Although most common in football players, those who play soccer, basketball, wrestling, gymnastics and dance also are at risk.
The injury is called “turf toe” because it’s especially common in athletes who play on artificial turf. The less-supportive, flexible shoes worn on this surface and the foot’s tendency to “stick” to turf are some reasons why artificial turf may be partly to blame.
The signs and symptoms of turf toe can include pain, swelling and limited joint movement. If turf toe iscaused by repetitive actions that cause injury, the signs and symptoms will usually begin slowly and can gradually worsen. Turf toe can also be caused by a direct injury leading to damage of the bone beneath the cartilage. If direct injury is the cause, the signs and symptoms may begin suddenly and get worse over a 24-hour period.
DIAGNOSIS TYPICALLY INCLUDES:
Physical exam of the foot
X-ray to rule out any broken bones.
TREATMENT TYPICALLY INCLUDES:
Compression and elevation
Switching to less-flexible footwear
Surgery is usually only necessary for severe cases .
A stress fracture is a common overuse injury. Usually, a fracture, or broken bone, is caused by an acute event, such as a car crash or a fall. When this is the case, the bone experiences a very high force that causes the fracture. A stress fracture occurs when the forces are much lower, but happen repetitively for a long period of time; these injuries are also known as “fatigue fractures.”
Stress fractures are commonly seen in athletes who run and jump on hard surfaces, such as distance runners, basketball players and ballet dancers. A stress fracture can occur in any bone, but most common in the foot and shin bones.
If you increase your level of activity over a short period of time, a stress fracture is more likely. The increased demand placed on these bones causes them to remodel and become stronger in the areas of higher stress. However, if the response of your bones can’t keep up with the repetitive demands, a stress fracture may result.
Dietary and menstrual irregularities can also contribute to stress fractures, as both contribute to overall bone health. Poor nutrition, anorexia, bulimia or unusual menstruation may place you at a higher risk for these injuries.
DIAGNOSIS TYPICALLY INCLUDES:
Physical examination and medical history
X-ray, which may show a bone attempting to heal around a stress fracture
MRI or bone scan, if the initial diagnosis is unclear.
TREATMENT TYPICALLY INCLUDES:
Resting the injured leg
Icing the injured area
Wearing proper equipment, especially footwear
Increasing activity gradually
One rule of thumb (but not an absolute rule) is: if there is pain, don’t do it. If jogging causes pain where you have a stress fracture, don’t jog. If walking causes pain in that location, use crutches. If pain develops and persists, see Dr. Collins.
Tarsal Tunnel Syndrome
The tarsal tunnel is a space in your foot formed between bones and overlying fibrous tissue. Within the tarsal tunnel lies a nerve called the posterior tibial nerve. The tarsal tunnel is walled on one side by sturdy bones, and on the other by tough fibrous tissue.
When the posterior tibial nerve is pinched in the tarsal tunnel, numbness over the bottom of the foot is common, as is pain, burning and tingling over the base of the foot and heel. Occasionally, tarsal tunnel syndrome is confused with plantar fasciitis, or heel spurs.
It isn’t always possible to pinpoint the cause of tarsal tunnel syndrome, though fractures, bone spurs, ganglions and other benign tumors, muscle impingement, and foot deformities can lead to the condition.
TREATMENT TYPICALLY INCLUDES:
Possible injection of cortisone around the nerve
Using different footwear, possible including orthotics.
If none of these measures helps, then a procedure called a tarsal tunnel release may be necessary. During this procedure, an incision is made to open up the tarsal tunnel and decrease pressure on your posterior tibial nerve. This surgery is very similar to a carpal tunnel release in the wrist.
Achilles Tendonitis or Tendon Tear
Achilles tendonitis is irritation and inflammation of the large tendon in the back of your ankle. It’s a common overuse injury in recreational athletes that causes pain and swelling. This is different from Achilles tendinosis, which is caused by degenerative, microscopic tears within the tendon, and also results in swelling and pain.
Achilles tendonitis is typically caused by a lack of flexibility, over-pronation, recent changes in footwear and recent changes in exercise training schedules. Middle-aged recreational athletes are most susceptible to Achilles tendonitis, due to a loss of flexibility in the tendons as you age.
The main symptom is pain behind the heel, usually in an area two – four centimeters above the location where your tendon attaches to your heel. The most significant pain usually occurs after you’ve been inactive – such as when you first walk in the morning, or when you get up after sitting for a long period of time. Running, jumping and other similar activities may also be painful. Achilles tendonitis pain associated with exercise is most significant when you’re pushing off or jumping.
TREATMENT TYPICALLY INCLUDES:
Icing the affected area
Resting the tendon
Crutches or immobilization of the ankle may be required
Medication, injections or surgery may be needed for more serious cases.
An Achilles tendon tear occurs when the tendon attaching your calf muscle to your heel is completely torn. This injury is common, especially in middle-aged, male, “weekend warriors.”
This injury causes sudden pain behind your ankle. You may hear a ‘pop’ or a ‘snap,’ and will almost always feel as though you’ve been kicked in the heel. If you experience this injury you’ll have difficulty pointing your toes downward, and may have swelling and bruising around the tendon.
About 15 to 20 percent of patients have symptoms of Achilles tendonitis before they experience an Achilles tendon tear, but most patients have no prior history of Achilles problems. More than 75 percent of Achilles tendon tears are associated with playing ball sports, especially basketball or tennis. Other risk factors that are associated with Achilles tendon rupture include cortisone injections into the Achilles tendon, gout and fluoroquinolone antibiotic use.
Dr. Collins will examine your ankle for continuity of the tendon. A defect in the Achilles tendon can often be felt after a tear. In addition, flexing your calf muscle should cause your foot to point downwards, but if you have a torn Achilles tendon, your foot won’t move. Dr. Collins may also order an X-ray to check for other potential conditions including ankle fracture or ankle arthritis.
There are surgical and non-surgical treatment options. If you opt for surgery, it’s likely you’ll be able to get back to the sports you love more quickly, and there is probably a smaller chance that you’ll re-tear the tendon. If you opt for a non-surgical approach, you’ll avoid any potential risks associated with surgery, and your long-term results should be similar to patients who do have a surgical procedure. Discuss the pros and cons of each approach with Dr. Collins.