Foot and Ankle Injuries

1. Foot and Ankle Injuries

2. FYI • The foot and ankle support the weight and transfer force as a person walks and runs. • The feet and lower legs work to maintain balance and adapt to various surfaces. • Ankles are the most common and most frequent injured joint.

3. Preventing Foot and Ankle Injuries • Taking care of the foot and ankle is essential to injury prevention and continuous athletic participation • Preventative measures may include: • Wearing shoes that provide ankle and arch support. • Using supportive ankle taping • Strength and conditioning programs

4. Treating Foot and Ankle Injuries and Conditions • Since the feet and legs form the foundation on which an athlete walks and runs, injuries to ligaments, tendons, muscles, and bones can be disabling.

5. Ligament Injuries • Sprain-stretching or tearing of ligaments and usually occurs as a result of trauma to a joint that is forced to the extreme of its range of movement. • Sprains commonly occur at the great toe, arch, lateral ankle joint (outside), and the medial ankle joint (inside)

6. Great-toe Sprain • Great-toe helps kick a ball, push off when walking or running, and maintain balance. • If excessive force is applied to this area, such as forced flexion and extension, the ligaments can be sprained. • Some feel turf causes more great-toe sprains than real grass. • ATC will recommend RICE • When athlete returns to action, the great-toe can be taped and padded to provide support and decrease pain.

7. Arch Sprain • Can be caused by running on a hard surface, improper footwear, or repetitive stress • Athlete will report significant pain over the involved arch and will experience difficulty walking or running • ATC will notice swelling and some discoloration over the plantar surface • PRICE (protection, rest, ice, compression, elevation) • An arch pad may relieve some of the pain

8. Lateral and Medial Ankle Sprains • 85% of ankle sprains are caused by excessive inversion • Deltoid ligament is very strong compared to the lateral ligaments and the fibula prevents severe eversion • When the ankle inverts, the lateral ligaments are injured • Severity will depend on the amount of force, the amount of taping, the type of shoe, and the strength of the muscles

9. Lateral and Medial Ankle Sprains • Athlete with an injury must be evaluated to determine its severity • Shoe and sock must be removed • Swelling and discoloration may occur • ATC will determine the severity based on the athlete’s ability to move the ankle • if no decrease in range of motion or strength, athlete may be allowed to play with the ankle protected by a brace or tape • Any decrease in range of motion will be treated with PRICE

10. Ankle Dislocations • Can occur either anteriorly or posteriorly • Anterior dislocation occurs when the heel of the foot strikes the ground forcefully • Posterior dislocation occurs with a blow to the anterior aspect of the leg while the ankle is in plantar flexion • Deformity, obvious pain, rapid swelling will occur • ATC will splint the lower leg and ankle, call 911, give the athlete ice, and remove athlete from the field • *Physician must put the bones back in place because the ligaments, nerves, and blood vessels can be damaged

11. Muscle and Tendon Injuries • Strains occur as a result of overstretching or putting a muscle or tendon under excessive tension • Tendonitis-inflammation of a tendon • Typically occurs as a result of a repetitive stress (running or jumping) • Common tendon injuries and strains in the foot region involve the Achilles tendon

12. Achilles Tendinitis • Achilles tendon is the strong tendon joining the gastrocnemius muscle in the calf to the heel • Any sport involving repeated running, jumping, and landing may cause cells in the tendon to break down prematurely—causing tendonitis • ATC will note swelling, tenderness, and expression of pain. • Rest and ice will need to be done by the athlete

13. Achilles Tendon Rupture • Feels as if someone shot him in the back of the lower leg • Occurs when there is forced dorsiflexion of the foot, a blow over the Achilles tendon, or a sudden forceful contraction of the gastrocnemius • Athlete will feel the tearing • ATC will notice swelling and a depression where the tendon used to be attached • The tendon must be repaired surgically

14. Bone Injuries • Direct impact to an area and repetitive use can cause fractures • Common symptoms include pain, pressure, and inability to move the body part • ATC can splint the injured area • Athlete must go to a doctor to get X rays and a cast

15. 5th Metatarsal Avulsion Fracture • Most common avulsion fracture-aka Jones fracture • The ankle is forced into inversion, the muscles contract forcefully to stabilize the later aspect of the ankle, the peroneus brevis tendon pulls part of the bone away at its attachment • ATC uses PRICE and refers athlete to the team physician

16. Epipyseal Injury of Distal Tibia and Fibula • Epiphyses-growth plates • Distal tibia and fibula epiphyses become injured when the ankle is forced into plantar flexion and inversion • Athlete will experience pain and swelling • ATC will splint the injury and refer him to a physician for X rays • Possible for the epiphysis to close prematurely, which will stunt bone growth at that site

17. Stress Fractures • Most commonly occur to the tibia, fibula, and metatarsals • Repetitive stress due to running is usually the cause • Pain becomes more intense at night and after the activity • A bone scan can be used to verify a stress fracture • An X ray will not show a stress fracture until 2 weeks after the initial injury when a callus begins to form at the site • Takes 4-6 weeks of rest

18. Other Common Injuries • The weight-bearing lower extremities are prone to other injuries

19. Shinsplints • Common term used for pain in the lower leg • Muscle fibers on the medial side of the tibia become torn and irritated • Athlete complains of pain and inability to run or walk properly • Treatments-PRICE, changing training activities, taping is possible. • Recommended to get new shoes, stretching and arch supports

20. Contusions • Bruising • Soccer and field hockey players are prone to contusions of the lower leg • RICE • ATC may tape on additional padding to protect area from further impacts

21. Toe Abnormalities • Hammer Toe-middle joint of the toe is flexed and the joint (phalange and metatarsal) is hyperextended • Halux valgus (bunion)-pressure on toe toward the midline of the body at the great toe • Ingrown toenail-nail grows into the surrounding soft tissue