Put Your Best Foot Forward: Top Five Foot & Ankle Injuries in Athletes
Do you know the top five foot and ankle injuries in athletes? If you’re an athletic trainer, an athlete or the parent of an athlete, these are the five “bad boys” to know. They can take you out, but it doesn’t have to be forever. The trick is to get the right treatment on time. (Emphasis on time.)
“If you wait too long to seek treatment, certain injuries become much harder to treat,” says Dr. Murken, a board certified orthopedic surgeon at Panorama Orthopedics & Spine Center. “In some cases, such as an Achilles tendon tear, it might not be repairable at all if you don’t get treatment on time.” (More on that later.)
In practice for more than a decade, Dr. Murken has seen some athletes wait six months to a year to finally get help. He cautions that playing this kind of waiting game can threaten the athlete’s entire career; although he understands why.
“A lot of people are scared to see us when they hear the word ‘surgeon,’” Dr. Murken says. “They think they don’t need surgery so they wait until the injury gets worse. Or they avoid us altogether. A lot of people don’t realize that surgeons treat many orthopedic injuries nonsurgically and we are often the ones who help athletes prevent surgery.”
If you suspect you have any of the following topfive foot or ankle injuries, don’t hesitate to call an orthopedic surgeon – even if you suspect your injury doesn’t need surgery.
Top Five Foot and Ankle Injuries
1. Sprains (High and Low): Sprains are the most common ankle injury in athletes. They fall into two categories, low and high.
Low Sprains are the least serious of the two and are categorized by three levels: mild, medium and severe. With mild sprains, the ankle may feel tender, swollen or stiff, while severe sprains make it difficult to walk. Often seen in volleyball players, basketball players and soccer players, low sprains are what most people commonly think of as a classic step and roll sprain (the bottom of the foot faces inward and rolls onto the outside). Sprains can be diagnosed with a physical exam, although Xrays may be needed to rule out a fracture. Low sprains are often treated nonoperatively with antiinflammatories, elevation, taping, ice and bracing. If the sprain is severe, it may be treated with a boot cast and physical therapy. In the case of a mild to medium sprain, the athlete can expect to return to sports within a few weeks to a month. Severe sprains may require four to six weeks.
High Ankle Sprains are less common than low ankle sprains and are the more serious of the two. Patients with high ankle sprains often experience pain just above the ankle. They also feel severe pain when walking, with relief upon rest. Significant black and blue may also appear in the heels. Often seen in sports with a cutting action, such as rugby, football and lacrosse, the majority of high sprains occur when the athlete rotates the knee and upper leg internally or externally in relation to the foot on the ground. As a result the ligament that hold the tibia (shin bone) and fibula (outside leg bone) together tears. In effect, the rotation peels these two bones apart. High ankle sprains are treated differently depending on the grade of the injury. They range from grade one to three, with three being the most severe. High sprains can be diagnosed with an examination and/or with an MRI. Treatment includes ice, antiinflammatories, rest, and either a laceup ankle boot or a boot cast, which may be worn while sleeping. It may take eight to 10 weeks to return to sports.
2. Stress fractures often occur in the tibia (shin bone) when an athlete suddenly ramps up his or her training.
Think crosscountry runner returning in the spring. Symptoms may vary but include localized pain in the shin that doesn’t go away with rest. Stress fractures are common in basketball, tennis, cross country running and soccer. Because they’re overuse injuries, they’re treated with rest and possibly a boot. Often mistaken for tendonitis, stress fractures can be diagnosed with a physical exam and confirmed by an MRI. Upon examination, the athlete can often point to the exact spot on the shin where the pain occurs. Typically, the athlete can expect to return to sports in six to eight weeks.
3. Achilles Injuries are most common in acceleration and rebound sports and may present as either tendonitis or a complete rupture.
The Achilles tendon is a large band in the back of the ankle that connects the calf muscle to the heel bone. They most often occur in patients in their late 20s and 30s. One of the best ways to avoid an Achilles injury is to stretch before and after activity.
Achilles Tendonitis often presents itself as pain behind the ankle joint, swelling and difficulty walking. Tendonitis can be diagnosed with a physical exam and treated with antiinflammatories, ice, a boot and physical therapy. The athlete can expect to return to sports in six to eight weeks.
Achilles Rupture occurs when the Achilles tendon snaps. Athletes often report hearing a loud pop with the sensation of being kicked or hit. An Achilles rupture results in severe pain that makes it immediately impossible to walk. A rupture can be diagnosed with the Thompson Test, a physical exam that involves squeezing the calf muscle. In a normal patient the Achilles tendon will pull the foot downward when the calf is squeezed. But if the Achilles is torn, the foot will not move. This is a definitive test. Surgical repair is the preferred treatment because a nonsurgical approach takes longer to heal and the Achilles is more likely to rupture again. A surgical repair involves reattaching the patient’s tendon back together. However, if the patient waits too long for surgery, a cadaver tendon may be required, which has a significantly greater failure rate compared to using the patient’s own tendon. It takes six months to a year to return to sports.
4. Jones Fractures occur in the 5th metatarsal bone near the outside of the foot.
This type of fracture may result in bruising, swelling and pain when putting pressure on your foot. Jones fractures must be diagnosed with an Xray. Often seen in basketball, football and baseball players, they result from repeated motion or a sudden injury. Jones fractures can be treated with ice, elevation and a special hardsole shoe or a boot cast for four to six weeks. Moderate to severe injuries may require a surgical bone graft if the injury doesn’t improve with nonsurgical treatments. A Jones fracture may keep the athlete sidelined for six months to a year, especially in the case of highstress sport, such as basketball.
5. Sesamoid Injuries of the foot occur in the sesamoid bones located under the ball of the big toe.
Unlike most bones, the small sesamoid bones are not connected to other bones but are embedded within tendons and muscles. Symptoms of a sesamoid injury include pain in the ball of the foot with possible pain when bending the big toe. Swelling and bruising may or may not be present. Sesamoid injuries are often seen in endurance runners, volleyball players, soccer players and basketball players. They can be diagnosed with an MRI and treated with a walker, boot cast and rest. In severe cases, surgical intervention may be required to remove bone fragments. Athletes can expect to return to sports in six to eight weeks, depending on the severity of the injury. Sesamoid injuries are sometimes referred to as a “nuisance injury” because athletes often return to their feet too soon to allow for complete healing.
Dr. Murken sees a wide spectrum of athletes from ages six to eighty. That’s Colorado for you. We’re home to millions of passionate athletes who want to stay active for a lifetime. This is where orthopedic surgeons come in because their training is among the most extensive of all medical specialties.
With ten years of medical training, including a footandankle fellowship, Dr. Murken is knowledgeable about the biomechanics of the entire body. That’s a big deal because it’s not just about an isolated foot or an ankle, as any serious athlete can tell you. It’s about all of the pieces and parts working together seamlessly in peak condition.
Dr. Murken sees patients at Panorama’s offices in Golden and Highlands Ranch. Golden Appointments: 303-233-1223; Highlands Ranch Appointments: 303-233-1223.