FOOT AND ANKLE – a prevalent injury

FOOT AND ANKLE Pain

ANATOMY OF THE FOOT AND ANKLE

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    • The term “sprain” indicates injury to the soft tissues of the ankle, usually the ankle ligaments.
    • There are three ligaments that make up the lateral ligament complex (located on the outside of the ankle)

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  • Three ligaments are the anterior talofibular ligament (ATF), calcaneofibular ligament (CF), and posterior talofibular ligament (PTF)
  • A sprain results in tearing of the ligaments which may be complete of incomplete
  • An inversion injury is the most common cause of sprain

Treatment:

  • RICE (Rice, Ice, Compression, Elevation) will help control swelling
  • Pain relievers such as Advil, Aspirin, and Tylenol will help control the pain
  • Crutches will help the patient stay off of that foot
  • Ankle wraps, ACE bandages will help support the ankle and combat instability

PLANTAR FASCIITIS (Heel Spur)

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  • One of several causes of heel pain, sometimes called a “heel spur”
  • Plantar Fasciitis causes pain on the bottom of the foot/heel when bearing weight on the foot
  • The Plantar Fascia is a structure that runs from the front of the heel bone (calcaneus) to the ball of the foot. It supports the “arch” of the foot.
  • Classic symptoms include a gradual onset of severe pain which is worse in the morning or after rest, and improves after moving around.
  • Pain is aggravated by weight bearing, and becomes progressively worse when you’ve been on your feet all day.

Treatment:  

  • RICE will help the swelling for acute injuries.
  • NSAIDS will help with pain and swelling.
  • Foot strapping (by a podiatrist) may alleviate severity of pain during weight bearing.
  • Supportive devices such as night splints, arch supports or orthotics are available from your podiatrist to help solve chronic problems.

*Caution: avoid  corticosteriod injections, for they have been associated with tendon rupture in the plantar fascia! (J-Bone-Surg-Am. 1978 Jun; 60(4): 537-9)


ACHILLES TENDONITIS

Discussion:

  • Pain associated with the back of the heel of the human footf5
  • The Achilles tendon is the large tendon that connects both the gastrocnemius and the soleus muscles to the heel bone (calcaneus). These two muscles groups conjoin to form the thickened tendon at the back of the leg.
  • Most Achilles problems are mechanical in nature, meaning they are caused by injury. This structure can become inflamed and damaged due to inward/outward tilting of the heel, excessive weight bearing, over-use (during activities such as running, tennis or other sports).
  • Chronic inflammation may lead to a weakening of the tendon, in which case tendon rupture may occur. An Achilles rupture is almost always associated with injury or trauma to the tendon. It causes a sudden onset of severe pain as well as a loud “gunshot” type noise that can be heard by others.

Treatment:

  • RICE will help control swelling
  • NSAIDs will help with the pain and inflammation
  • Devices such as the Achilles Tendon Strap are available to help support the tendon, and claim to be good for over-use injuries that runners would experience.
  • A ruptured Achilles Tendon must be corrected with surgery.
  • If you experience an injury in which you hear or feel a “pop” at the back of your heel, and you lose the ability to flex your foot…go to the emergency room, or see your doctor immediately!

TURF TOE

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  • Turf toe is an injury to the first metatarsal/phalangeal joint of the foot (where the big toe meets the foot).
  • Hyperextension is the most common cause of this type of injury. This is commonly a football injury and occurs when lineman push off out of a croutched stance.
  • Turf toe can be an extremely debilitating injury in competitive football players.
  • There may also be associated dislocation of the big toe.
  • The primary symptom of turf toe is limited range of motion of the big toe following an injury. It is usually accompanied by pain, swelling and redness.

Treatment:

  • Activities must be reduced weeks to months depending on the severity of the injury.
  • RICE and NSAIDs will help control swelling and pain.
  • The patient can gradually return to activity and shoe wearing when the symptoms resolve.
  • The patient usually must wear a splint that blocks dorsiflexion (the normal bending of the great toe) during athletic activities.

INGROWN TOENAIL

Discussion:

  • An Ingrown nail is a condition in which the nail is cutting into the flesh of the toe.f8
  • A nail is considered “ingrown” when one or both sides or corners of the nail grow into the skin surrounding the toe.
  • The toenail is usually very painful and may appear red, swollen and warm around the edges.
  • An ingrown nail is usually associated with infection of the toe or nail bed.
  • This may be a serious problem in patients who are diabetic, or have vascular problems because untreated it may lead to the loss of a limb. Care and treatment should be sought immediately from a family doctor or podiatrist.

Treatment:

  • Warm water soaks with Epsom salt provide good irrigation of an ingrown area.
  • Topical ointments such as Neosporin may stop the spread of an acute infection.
  • Most recurrent ingrown nails must be removed by a podiatrist or family doctor.
  • The best prevention is wearing shoes that fit, keeping feet clean, and practicing correct filing of the toenails.*

*CAREFUL Toenails should be cut straight across, leaving the nail slightly longer than the toe, and then filed straight across with a nail file. 

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