Sports
Topics > Foot & Ankle Injuries
The more severe sprains warrant
more aggressive evaluation and treatment. Though your wise old grandmother
was able to tell the difference between a sprain and a fracture,
I need an x-ray to make sure we aren’t dealing with a broken
bone. If no fracture is seen, then the sprains that have lots of
swelling and bruising should be treated with a cast and crutches.
After the pain and swelling abates, usually two to three weeks,
then an aggressive rehab program is started with a physical therapist
or athletic trainer. Return to sport is not until pain is gone and
strength has returned to normal. This athlete is usually supported
with taping or bracing for the remainder of the season. Athletic
trainers are really skilled at taping techniques! Surgery for ankle
sprains is rare and usually is indicated only if the ankle is unstable
and “gives out” on a regular basis.
If, however, a fracture is seen, the season is over and treatment
is either a cast or surgery. Fortunately, high school athletes have
amazing healing powers and will recover from most ankle fractures
without any permanent disability.
There are other ligaments around the hindfoot which hold the heel
bone (or calcaneus) connected to the ankle. These ligaments are
less commonly torn, but are also treated like the above-mentioned
ankle injuries.
Tendinitis
Tendinitis around the ankle can be due to a twisting injury, or
may result from chronic or repetitive stress. The tendons that connect
the muscles of the calf to the foot run across the ankle in tight
tunnels or “sheaths.” If a tendinitis is ignored and
the athlete plays through pain, the tendon can rupture and surgery
is needed to repair it. Treatment of these painful, inflamed tendons
is again based on rest, anti-inflammatory medication, and gradual
return to play. A cast is sometimes applied in severe cases. The
Achilles tendon is an example of a tendon which is prone to rupture
if it becomes inflamed and is not treated appropriately.
Fractures and Dislocations
A fracture is the same as saying a “break.” They can
be the result of a crushing blow in football and a twisting fall
in gymnastics. We have already mentioned fractures around the ankle
joint, and the need for treatment. If the bones are out of place
and the joint is not lined up properly, then surgery will be needed
to realign the joint and put everything back into place. The ankle
does not function properly unless it is lined up just right! Other
fractures in the foot can be slow to heal and one is known to be
at risk for not healing at all, or what is called a “nonunion.”
Bone is like any other tissue in the body, in that it needs a good
supply of oxygen-rich blood flowing through to help with healing.
The bottom of the 5th metatarsal (on the outside of the midfoot)
is one bone that has a hard time healing if it is fractured, possibly
due to disruption of the blood supply in the area. These fractures
occur when the foot is twisted much like an ankle sprain, but due
to the forces on the foot, the bone breaks before the ligaments
tear. Treatment is always non-operative at first, but if there is
no sign of healing on the x-ray after a few weeks, then a small
screw is inserted across the fracture. The other bones of the midfoot
and forefoot usually heal without surgery, as long as they are lined
up properly on the x-ray.
Dislocations of the ankle and foot need to be put back into place
as soon as possible. If an injury occurs on the field and there
is an obvious deformity, then a splint should be applied to the
foot and ankle in the position in which the ankle is found, and
transport to the hospital emergency room should be arranged immediately.
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