Monday, June 28, 2010

Sports Injuries Of The Foot

Athletes, or anyone participating in a sporting activity,
are prone to injuries due to the very nature of that
activity. Injuries involving the ankle are quite common,
especially in sports like basketball where the ankle
receives a great deal of twisting stress. Sports injuries
of the foot are just as common, but are not as well known.
This article will discuss some of the more common sports
injuries affecting the foot itself, and how they are
typically treated. It should be stressed beforehand that
all foot injuries should be medically assessed by a foot
specialist due to the complex nature of the foot's
structure and function, as minor issues ignored can often
lead to complex future foot problems.

There are several common parts of the foot that become
injured in sports, each with it's own cause and treatment.
What follows is a description of each condition, its cause,
and how it is typically treated

Plantar Fasciitis: One of the most common foot injures in
athletes and sedentary people alike, plantar fasciitis
involves inflammation and microscopic tearing of a broad
band of tissue (plantar fascia). This tissue runs from the
heel bone to the ball of the foot. It is seen primarily in
people with flat feet as well as those with high arches.
Flat feet cause chronic stretching of the fascia, while
high arches allow for poor shock absorption leading to
fascia injury. Stepping on hard, blunt objects like a rock
or over-stretching the foot on a stair or ladder rung can
directly injure the fascia, although these injury patterns
are less common. The fascia can also rupture if the force
of the injury is severe enough. Plantar fascial ruptures
are far more common in sports injuries than during any
other typical situation in which the plantar fascia becomes
injured. The pain of typical plantar fasciitis is usually
felt on the inner side of the bottom of the heel where it
meets the arch, and is noticed after arising from a chair
or bed, as well as after extended activity. This condition
can persist for years if untreated, leading to a chronic
state of scar tissue and thickening. Treatment is fairly
simple, and involves stretching, inflammation reduction
with icing, medication, and cortisone-like injections, as
well as orthotics ( specialized shoe inserts) to provide
flat feet greater support and high arches more shock
absorption. Only in a few cases is surgery needed,
although newer techniques and technologies have made this
procedure easier to recover from.

Peroneal Tendonitis: The peroneal tendons are two tendons
(one short, one long) that run behind the outside of the
ankle from the leg and insert on the side of the foot and
underneath the arch, respectively. These tendons help to
roll the foot up and out, and are important to the walking
cycle. When a strong force rolls the foot inward, or when
activity on uneven surfaces (like gravel or a field with
divots) goes on for awhile, one or both of these tendons
can become inflamed, fray, or partially torn. Peroneal
tendon partial split tears are quite common, although one
can have a partial tear and not even feel it due to the
flat nature of the tendon. The degenerative process
affecting the peroneal tendons can take awhile to develop,
but can be fairly disabling when it becomes severe.
Treatment involves icing, anti-inflammatory medications,
therapy, and bracing to allow the tissue to heal and become
strong again. Tendons that won�t heal will need surgical
intervention. Surgical intervention involves repairing any
tear found, healing the tendon with a newly developed radio
frequency wave device, and augmenting any weak or frayed
area with a special tissue graft that essentially turns
into the tendon material it covers. In severe cases the
tendon may need to be transfered to give it better
functional capability.

Sesamoiditis: The sesamoids are two small egg-shaped bones
found under the big toe joint, just behind where the toe
meets the foot. Chronic, stressful activities such as high
impact jumping or hard surface running can lead to
inflammation and bruising of one or both of these bones.
This bruising slowly develops over time, and continued
stress will multiply the tissue damage. Eventually this
damage may lead to stress cracks of the bone. Immediate
injuries can even occur, causing outright fracturing of the
bone if the injury force is severe enough, and this can
also be seen with long term stress damage if the bone is
weakened without relief. The pain of this condition is
felt just underneath the big toe joint, usually in a very
specific location. Pressure on the inside ball of the foot
becomes painful, and running or jumping will become
difficult. Unless a fracture has occurred, swelling and
bruising are usually not seen. Treatment centers on
reducing the inflammation by reducing the stress to this
site. This can be accomplished by the use of special pads
or prescription inserts which direct pressure away from the
sesamoids. The usual injury treatment regimen of icing,
rest, and anti-inflammatory medications is also used.
Sesamoiditis cases can be injected with steroid medication,
while a stress fracture or full fracture should be treated
otherwise. More serious injuries may need to be
immobilized in a walking boot for a few weeks to months
depending on the severity, and fractured sesamoids that
wont heal may need to be removed surgically.

Stress Fractures: Any bone in the foot can be at risk for
developing a stress fracture. Unlike a regular fracture, a
stress fracture does not involve a true break across the
bone, but rather an injury to the structure within the
bone. Repetitive activities, such as running consistently
on a hard surface, can lead to bone bruising, and then
ultimately to a partial break in the honeycomb structure of
the inner bone. Other factors include tight muscles that
lead to abnormal foot functioning during intensive
exercise, stiff, high arched feet, bone density or
menstruation issues in women, and anatomic abnormalities.
These injures are usually not seen on standard x-rays until
after several months. The most common sports-related
location of stress fractures in the foot are the long
metatarsal bones and the heel bone. When the injury is
untreated and at-fault activity is continued, these stress
fractures have the potential to turn into full fractures.
Treatment involves rest, immobilization in a walking boot
or cast, and time to mend. Stress fractures are notorious
for taking longer to heal than a fresh fracture, and
patience is often needed during the healing process to
achieve full recovery. Electronic bone stimulators can be
used for cases that have stalled healing, although
insurance coverage of these expensive devices varies.

Turf Toe: Turf toe is an injury so-called because the
pattern of injury usually involves the big toe striking the
ground (turf) during a kicking motion, such as seen in
soccer. The big toe joint has strong tissues surrounding
it to keep the joint in place. Collectively known as a
capsule, these tissues are essentially the combined
ligaments that bind the two bones together that form the
joint. When an injury occurs that forces the toe up, down,
or off to one side, in excess of the strength of this
capsule, a strain or partial tear will occur. Although the
original turf toe described the toe flexing downward into
the ground, it can be used to describe excess motion in any
direction. In this condition, although the big toe will
not dislocate as the tearing of the ligaments is only
partial, it will become inflamed and quite tender to move.
Since all walking and running requires the big toe joint to
move upwards frequently, sports activity becomes quite
difficult. Treatment involves simply allowing the tissues
to heal by icing the inflammation, taking oral
anti-inflammatory medications, taping the toe, using a hard
soled shoe, and resting from activity until a slow gradual
return to sports is tolerated.

While all the above conditions are easily treated, many
athletes often delay obtaining proper treatment out of a
fear of having to discontinue their activity. Treatment
delay not only allow the injury to worsen, but it also can
lead to a more complicated injury pattern that is far more
difficult to properly heal from. Sports injuries of the
the foot, even seemingly minor ones, should have a proper
evaluation by a foot specialist due to the unique nature of
the foot in relation to our body and the requirements of
walking.

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Dr. Kilberg provides compassionate and complete foot and
ankle care to adults and children in the Indianapolis area.
He is board certified by the American Board of Podiatric
Surgery, and is a member of the American Podiatric Medical
Association. He enjoys providing comprehensive foot health
information to the online community to help the public
better understand their feet. Visit his practice website
at http://www.inpodiatrygroup.com/

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