Sports Injuries
What are the commonest Foot & Ankle sports injuries?
Sports injuries are common in this part of the body. The most common injuries are ankle sprains, ankle cartilage injuries, Achilles tendon ruptures, chronic ankle instability, stress fractures and shin splints. Please see out other pages for more in-depth discussion of Achilles tendon ruptures and chronic ankle instability.
Ankle Sprains
What causes ankle sprains?
Ankle sprains are the single most common joint injury in the body. The most common mechanism is to roll over or invert the ankle during sport. This can injure a number of structures around the ankle joint. It most commonly injures only the ligaments but ca also cause damage to the tendons (tears and dislocation of the peroneal tendons), ankle cartilage (talar osteochondral lesions) and bones (fractures or breaks). The most commonly injured ligament in the anterior talo-fibular ligament known as the ATFL.
What are the symptoms?
The symptoms are pain, swelling and bruising.
In simple sprains where the ligaments are only a little stretched out it is generally possible to put at least some weight thru the leg although you are likely to walk with a limp.
In more serious injuries the ligaments may be completely torn or there may be associated injuries to the cartilage, bones and tendons around the ankle. In these circumstances it is often, although not always, too painful to put weight thru the leg.
What are the causes of ankle sprains?
They end to occur during sport due to a twisting injury. People who have high arched feet, previous ankle injuries, poor balance / coordination or generalized ligamentous laxity are considered to be at higher risk of sustaining ankle sprains.
How are ankle sprains diagnosed?
The diagnosis is generally fairly straightforward. If you are able to put weight thru the leg and it recovers in a few days it is likely to be a simple ankle sprain. If it is not possible to put weight thru the leg or it does not settle you should seek medical care fairly urgently. X-rays and scans are occasionally needed.
Can it become worse?
The good news is that almost all ankle sprains recover fully within six weeks and the majority within just two to three weeks.
When symptoms are not settling it is important to ensure there are no other problems or complications such as cartilage or tendon injuries. An MRI scan is very useful here.
How are they treated?
As with any soft tissue injury simple supportive treatment is important to speed recovery
- Try the RICE method: Rest, Ice, Compression (Tubigrip or similar support) and Elevation for 48-72 hours. This is followed by a gentle graded return to activity.
- Physiotherapy is often helpful in regaining strength and balance in particular. The majority of ankle sprains, and even some of the severe sprains, do settle with time and Physiotherapy.
Click here to know more about Sports Injuries - Treatment.
Ankle Cartilage Injury
What is an ankle cartilage injury?
The most common cartilage injury in the ankle is an osteochondral lesion of the talus. These are sometimes called osteochondral defects or osteochondral fractures and there are several abbreviations used to describe them- OCL, OCD or OLT. These injuries represent damage to the smooth cartilage covering of the bones that make up the joint and the layer of hard supportive bone underneath known as the subchondral bone. Osteochondral lesions can occur in a variety of joints but are especially common in the ankle usually arising from a severe ankle sprain or fracture.
The lesions are rarely diagnosed immediately but are one possible reason for a failure to recover from an ankle injury. Typically at the time of injury, there is a large amount of swelling and it may not be possible to weight bear on the foot for days or even weeks. Patients with an OCL may complain of persistent swelling and pain inside the ankle beyond six weeks after the injury. OCLs come in different sizes, degrees of severity and locations within the ankle.
CT or MRI scan is usually required both to diagnose a lesion and determine its characteristics.
What are the symptoms?
These injuries are rarely diagnosed immediately and are a common reason for people to fail to recover as quickly as would be expected from what might have been thought to be a simple ankle sprain. Often at the initial time of injury there is significant swelling and it may not be possible to put weight thru the leg. Recovery tends to be protracted and many people notice continued pain and swelling in the ankle beyond six weeks from the injury. Occasionally people may get catching or locking of the ankle- this tends to be a later sign when the injured cartilage becomes loose within the joint and catches the joint surfaces.
What are the causes?
The vast majority are caused by trauma- mainly ankle sprains and fractures. They are surprisingly common and it is estimated that up to two out of three people may sustain damage to the cartilage of the ankle following a severe ankle sprain.
Occasionally cartilage lesions can occur spontaneously with no underlying trauma. This is more common in paediatric and adolescent cases.
How is it diagnosed?
The diagnosis is unfortunately often missed in the acute setting and these injuries are often misdiagnosed as being simple isolated ankle sprain.
Most of the time an MRI is able to detect these cartilage injuries. Occasionally it is necessary to perform a diagnostic ankle arthroscopy (key hole surgery) to confirm the diagnosis in patients with ongoing symptoms and a normal MRI. The cartilage injury is then treated at the same time either arthroscopically or a small separate incision.
Can it become worse?
There are many people with cartilage damage to the ankle who get absolutely no problems from it.
Over time cartilage injuries can progress leading to more pain and damage to the joint.
How are they treated?
As with any soft tissue injury simple supportive treatment is important to speed recovery
- Try the RICE method: Rest, Ice, Compression (Tubigrip or similar support) and Elevation for 48-72 hours. This is followed by a gentle graded return to activity.
- Physiotherapy is often helpful in regaining strength and balance in particular. The majority of ankle sprains, and even some of the severe sprains, do settle with time and Physiotherapy.
Click here to know more about Sports Injuries - Treatment.
Shin Splints
What are shin splints?
Shin splints is a general term used to describe pain in the lower leg brought on by exercise- generally in the midportion at the front of the lower leg. The medical term for shin splints is medial tibial stress syndrome.
What are the symptoms?
The main symptom is pain which is brought on by exertion.
What are the causes?
In general true shin splints are caused by doing too much and too soon. It is important to stretch out before exercise and to build up exercise intensity and duration gradually.
Risk factors for developing shin splints include
- Long distance running.
- Sudden increases in exercise duration, intensity or frequency.
- Running on hard surfaces and uneven terrain.
- Those with flat feet or high arches.
If symptom are prolonged, severe or atypical it is important to seek medical attention. Occasionally there are other causes for the pain including
- Exercise induced compartment syndrome
- Tibial stress fracture
- Muscle hernias particularly of the anterior compartment.
How is it diagnosed?
The diagnosis is generally fairly straightforward and can be made during the consultation. It may be necessary to undergo further investigations in complex cases ranging from a simple X-ray or MRI scan to dynamic pressure monitoring of the muscle compartments themselves or biomechanical analysis.
Can it become worse?
For the majority of people shin splints tends to settle over time with activity modification and Physiotherapy.
How are they treated?
As with any soft tissue injury simple supportive treatment is important to speed recovery
- Try the RICE method: Rest, Ice, Compression (Tubigrip or similar support) and Elevation for 48-72 hours. This is followed by a gentle graded return to activity.
- Physiotherapy is often helpful in regaining strength and balance in particular. The majority of ankle sprains, and even some of the severe sprains, do settle with time and Physiotherapy.
Click here to know more about Sports Injuries - Treatment.
Stress Fractures
What is a stress fracture?
These are small cracks that start as micro fractures generally due to repetitive, cyclic loading and are common around the Foot & Ankle.
What are the symptoms?
The main symptom is pain. It gets worse on walking and particularly with impact sports such as running.
What are the causes?
Stress fractures are often the result of increasing the duration, intensity or frequency of an activity too rapidly. There is almost always an underlying cause. They generally occur in athletes who have recently increased their training times or intensity. Hard surfaces and activities such as running, dancing and jumping all put a lot of strain on the feet. Risk factors are broadly divided into -
- Extrinsic factors inappropriate footwear, training regimens, running surface etc.
- Intrinsic factors such as poor biomechanics (fatigued muscles, abnormal alignment) and rarely metabolic bone problems.
How are they diagnosed?
Stress fractures are often misdiagnosed initially and X-rays are frequently normal early on. The mainstay of diagnosis is a high index of suspicion for the condition and an MRI scan.
Can they become worse?
Stress fractures that are not appropriately treated can become worse and cause problems for longer.
How can they be treated?
As with any soft tissue injury simple supportive treatment is important to speed recovery
- Try the RICE method: Rest, Ice, Compression (Tubigrip or similar support) and Elevation for 48-72 hours. This is followed by a gentle graded return to activity.
- Physiotherapy is often helpful in regaining strength and balance in particular. The majority of ankle sprains, and even some of the severe sprains, do settle with time and Physiotherapy.
Click here to know more about Sports Injuries - Treatment.