Foot & Ankle Injuries

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Foot and ankle injuries are often thought of as sports injuries. But you don’t  have to be an athlete or even a “weekend warrior” to turn  your ankle and hurt it. Something as simple as walking on an uneven  surface can cause a painful, debilitating sprain.

The injuries can happen to anyone at any age. However, men between  15 and 24 years old have higher rates of ankle sprain, compared to women  older than age 30 who have higher rates than men. Half of all ankle  sprains occur during an athletic activity. Every day in the U.S., 25,000  people sprain their ankle. And more than 1 million people visit  emergency rooms each year because of ankle injuries. The most common  ankle injuries are sprains and fractures, which involve ligaments and  bones in the ankle. But you can also tear or strain a tendon.

Inside your foot lies machinery that would impress any engineer. A total  of 26 bones, 33 joints, and more than 100 tendons, muscles and ligaments  work in tandem to support your weight and propel you through your daily  routine. Just as the highest-tech machine can malfunction, flaws in the  inner workings of your feet—or overwhelming demands from the  outside—can cause injuries. Here are several common problems that can strike your  feet, along with solutions.   

Neuromas

Too-tight or  high-heeled shoes, among other causes, can compress the nerves between  your toes. Most often, this occurs between your third and fourth toes, a  condition called Morton’s neuroma. The pain, tingling, and numbness of a neuroma can often be relieved with padding, icing, orthotics, and wearing shoes with a wide toe box and low heels.  

Stress Fracture

Among the more severe sports injuries,  stress fractures often occur when you overdo a high-impact activity  like running, dance or basketball. Fatigued muscles transfer stress to  the bone. A small, hairline crack forms, causing potentially severe  pain. Though stress fractures can occur in any part of your foot, they most often form in the second  and third metatarsals, or long toe bones. Rest allows your bones to heal, usually in 6 to 8 weeks.  

Plantar Fasciitis

Does the first step out of bed in the morning have you howling in pain? You likely have plantar fasciitis,  an inflammation of the band of tissue—facscia—connecting your toes to  your heel on the bottom of your foot. High-impact sports, extra weight, and jobs that require walking or standing on hard surfaces increase your  risk. Stretch your foot and calf frequently, and consider wearing a  night splint that lengthens your plantar fascia while you sleep.  

Heel Spurs

Heel Spurs occur when calcium deposits build up on the bottom of your heel bone.  Often, they don’t cause pain themselves—but they can irritate the  plantar fascia, triggering pain along the arch and heel. Calf and foot  stretches work well to relieve it; rarely is surgery to remove the spur  necessary.  
 

Bunions

This bump of bone and tissue at the base of your big toe forms when the joint connecting  it to your foot shifts out of place. Narrow-toed and high-heeled shoes cause most cases, though heredity plays a small role. Left untreated, bunions can cause pain so severe it limits your ability to walk. Fortunately, treatments like ice, over-the-counter foot pads, and wearing shoes with wider toe boxes often bring relief.  

Sesamoiditis

Your  sesamoids—two pea-shaped bones lodged in the tendon beneath the ball of  your foot—help the big toe move normally. Activities that place strain on the ball of the foot, including running and golf, can injure the  bones, tendons, or surrounding tissue. Padding, strapping, or taping the foot can relieve pressure on the sesamoids, while anti-inflammatory drugs reduce pain and swelling. 

An ankle injury occurs when the ankle joint is twisted too far out of  its normal position. Most ankle injuries occur either during sports  activities or while walking on an uneven surface that forces the foot  and ankle into an unnatural position. The unnatural position of the  ankle in high-heeled shoes or walking in unstable, loose-fitting clogs  or sandals is also a factor that may contribute to ankle injuries. In  addition to wearing faulty footwear, an ankle injury can happen as a  result of:

• Tripping or falling
• Landing awkwardly after a jump
• Walking or running on uneven surfaces
• A sudden impact such as a car crash
• Twisting or rotating the ankle
• Rolling the ankle

The symptoms of a sprain and of a fracture are very similar. In fact,  fractures can sometimes be mistaken for sprains. That’s why it’s  important to have an ankle injury evaluated by a doctor as soon as  possible. The signs include:

• Pain, often sudden and severe
• Swelling
• Bruising
• Inability to walk or bear weight on the injured joint

With a sprain, the ankle may also be stiff. With a fracture the area  will be tender to the touch, and the ankle may also look deformed or out  of place.

If the sprain is mild, the swelling and pain may be slight. But with a  severe sprain, there is much swelling and the pain is typically  intense.

Tendinitis and acute tears of the peroneal tendon result in both pain  and swelling. In addition, the ankle area will feel warm to the touch  with tendinitis. With an acute tear, there will be a weakness or  instability of the foot and ankle.

Tendinosis may take years to develop. Symptoms include:

• Sporadic pain on the outside of the ankle
• Weakness or instability in the ankle
• An increase in the height of the foot’s arch

With the subluxation you will notice ankle instability or weakness.  You also may notice sporadic pain behind the outside ankle bone and a  “snapping” feeling around the ankle bone.

The  first thing a doctor will do is ask questions about how the injury  occurred. Then the doctor will examine the ankle, noting the amount of  swelling and bruising. The physical examination of the ankle may be  painful because the doctor needs to move the ankle to evaluate the pain  and swelling in order to make a proper diagnosis.

The doctor may order an ankle X-ray to determine whether there  are any broken bones. In addition to an ankle X-ray, your doctor may ask  for X-rays of the leg and foot to determine whether there may be other  related injuries. If the doctor suspects a stress fracture, the doctor  will ask for other imaging scans such as an MRI, which will show more  detail about the injury. If there is a fracture, the doctor may also ask  for a stress test, which is a special X-ray taken with pressure applied  to the joint. This will help the doctor determine whether surgery is  needed. 

Fractures can be treated either surgically or nonsurgically. The  doctor may treat the break without surgery by immobilizing the ankle if  only one bone is broken, and if the bones are not out of place and the  ankle is stable. Typically the doctor will do this by putting on a brace that works as a splint or by putting on a cast. If the ankle is  unstable, the fracture will be treated surgically. Often, the ankle is made stable by using a metal plate and screws to hold the bones in  place. Following the surgery, the ankle is protected with a splint until  the swelling goes down and then with a cast.

It usually takes at least six weeks for the bones to heal. Your  doctor will probably ask you to keep weight off the ankle during that  time so the bones can heal in the proper alignment. Ligaments and  tendons can take longer to heal after a fracture is fully mended. It can  take as long as two years to completely recover full pain-free motion  and strength after an ankle fracture, although most people are able to  resume their normal daily routine within three to four months.

After the doctor has determined it is safe for you to start moving  your ankle, you may need physical therapy to provide gait training, balance, strengthening, and mobility exercises. The therapist will  develop a home program that you can use to regain your previous normal  function. It can take several months to return to a normal walking  pattern without limping.

The treatment for sprains depends on the severity of the injury. They are graded as mild, moderate, or severe.  One should consult with a doctor or foot specialist for proper assessment and treatment. Surgery is not usually a treatment option unless the damage is extensive, involves more than the  ligaments, or when other treatment options fail.

Options for treating tendon injuries are similar to options for treating sprains. They include:

• Immobilization using a cast or splint
• Oral or injected anti-inflammatory drugs to reduce pain
• Physical therapy for range of motion, strength, and balance
• A brace to provide support during activities
• Surgery to repair the tendon or tendons and sometimes to repair the supporting structures of the foot