Dr. Martin's notes

Friday February 24, 2017

Foot/Ankle injuries

Ankle Sprains
Sprains are the most common presentation in an orthopaedic practice, and also the most common reason for emergency room visits. There are about 27,000 sprains per day in the United States, accounting for 45% of basketball injuries 31% of soccer injuries, and 24% of volleyball injuries.

The ankle is susceptible to a variety of injuries. which range from muscle strains and ligament sprains to dislocations and fractures. The most common injury is the ankle sprain. The mechanism of injury is usually a combination of excessive inversion and plantar flexion. More than 80 percent of all ankle sprains are of this type. The ligament most often injured is the anterior talofibular ligament. Other ligaments commonly involved in an inversion sprain are the calcaneofibular and posterior talofibular ligaments. Less common is the eversion sprain. On the medial side of the ankle, the tough, thick deltoid ligament helps prevent excessive eversion (turning outward of the heel).

Signs and Symptoms
Whether the sprain is of the inversion or eversion type, it is usually placed into one of three categories: first degree (mild), second degree (moderate), or third degree (severe).
In a first-degree sprain, one or more of the supporting ligaments and surrounding tissues are
stretched. There is minor discomfort, point tenderness, and little or no swelling. There is no abnormal movement in the joint to indicate lack of stability.
In a second-degree sprain, a portion of one or more ligaments is torn (microtears). There is pain, swelling, point tenderness, disability, and loss of function. There is slight abnormal movement in the joint. The athlete may not be able to walk normally and will favor the injured leg.
In a third-degree sprain, one or more ligaments have been completely torn, resulting in joint instability. There is either extreme pain or little pain (if nerve damage has occurred), loss of function, point tenderness, and rapid swelling. An accompanying fracture is possible.

Immediate treatment of an ankle sprain consists of rest, ice, compression, and elevation (RICE). Splinting, taping, or bracing the ankle can help protect it from further injury. All activities that cause pain should be eliminated. For the first 24 -48 hours, ice should be applied for 15 minutes with an hour and a half allowed between applications. Use a compressive wrap around the ankle and up the calf until the swelling subsides. Elevate the ankle above the level of the heart.
To restore function to the ankle, begin range-of-motion exercises. Stretching exercises will also help to loosen the muscles around the ankle and prevent stiffness.

Arch Sprains
Any of the arches of the foot (transverse, medial longitudinal, or lateral longitudinal) can suffer supportive ligament sprains. Once the ligaments are stretched, they fail to hold the bones of the foot in position. When an arch is weakened, it cannot absorb shock as well as it normally does. Causes of arch problems include overuse, overweight, fatigue, training on hard surfaces, and wearing shoes that are nonsupportive or in poor condition.
Treatment, as with other ligament sprains, includes cold, compression, and elevation. Most arch sprains are to the lateral arch or inner longitudinal arch. Taping and arch supports may also be used.

Blisters
Blisters can occur on any part of the body where there is friction. As the layers of the skin rub together, friction causes separation. If the blister is neglected, it may break, creating an open wound.
The goal of blister treatment is to relieve the pain, keep the blister from enlarging, and avoid infection. Small, intact blisters that do not cause discomfort usually need no treatment. The best protection against infection is a blister's own skin. Skin should not be removed from the blister unless it is flapping and causing additional discomfort. Finally, the blister should be covered with a bandage that is changed daily.

Great Toe Sprain (Turf Toe)
Occasionally, the ligaments supporting the toe will become sprained. Turf toe is the name given to such a sprain. Often, the mechanism of the injury is the foot sliding backward on a slippery surface, which forcefully hyperextends the big toe.
As with any acute sprain, immediate care of turf toe is rest, ice, compression, elevation, and support. The physician may take x-rays to rule out a more severe injury.

Plantar Fasciitis
The plantar fascia is a wide, nonelastic ligamentous tissue that extends from the anterior portion of the calcaneus to the heads of the metatarsals, supplying support to the longitudinal arch of the foot. This tissue can become strained from overuse, unsupportive (old) footwear, a tight Achilles tendon, or running on hard surfaces. Most often, the cause of plantar fasciitis is chronic irritation. Cross-country and track athletes are prone to overuse injuries in which the plantar fascia is continually strained from running and jumping. Basketball and volleyball athletes are also susceptible to plantar fasciitis from repeated jumping and landing. Basic treatment includes correcting training errors, icing, and massage. Wearing shoes with more arch support may help decrease stress on the plantar fascia area.

Heel Bruise
The heel receives, absorbs, and transfers much of the impact from sports activities, especially running and jumping. Therefore, the ligaments, tendons, and fat pad of the heel are all subject to stress and injury. The heel bruise is among the most disabling contusions in athletics. Cold application before activity, and cold and elevation afterward, can help reduce swelling and pain.

Heel Spur
A heel spur is a bony growth on the calcaneus that causes painful inflammation of the accompanying soft tissue. This type of condition is aggravated by exercise. The team physician may recommend taping the arch or using shoe inserts to help reduce the plantar fascia's pull on the calcaneus.

Fractures
Fractures of the foot and ankle immediately impair an athlete's ability to perform competitively in virtually any sporting activity. Athletes who suffer an ankle fracture usually cannot bear weight, and have more swelling and pain than those with just a ligament sprain. Often, a site of point tenderness is present, and an obvious deformity may be seen. Fractures of the ankle and foot usually occur acutely in a traumatic episode.