From the repeated pounding on paved surfaces to the side-to-side motion experienced during court sports, athletes’ feet and ankles are prime candidates for injuries. Whether you participate in sports regularly or are just a “weekend warrior,” you need to be in the know about some of these common problems.
Ankle injuries are defined by the kind of tissue — bone, ligament or tendon — that’s damaged. The ankle is where three bones meet: the tibia and fibula of your lower leg with the talus of your foot. These bones are held together at the ankle joint by ligaments, which are strong elastic bands of connective tissue that keep the bones in place while allowing normal ankle motion. In addition to helping keep the joints stable, tendons attach muscles to the bones to do the work of making the ankle and foot move by translating muscle contraction into bone and joint movements.
A fracture describes a break in one or more of the bones. A sprain is the term that describes damage to ligaments when they are stretched beyond their normal range of motion. A ligament sprain can range from many microscopic tears in the fibers that comprise the ligament to a complete tear or rupture. A strain refers to damage to muscles and tendons as a result of being pulled or stretched too far.
Muscle and tendon strains are most common in the legs and lower back. In the ankle, there are two tendons that are often strained. These are the peroneal tendons, and they stabilize and protect the ankle. They can become inflamed as a result of overuse or trauma. Acute tendon tears result from a sudden trauma or force. The inflammation of a tendon is called tendinitis. Microscopic tendon tears that accumulate over time, because of being repeatedly overstretched, and don’t heal properly lead to a condition called tendinosis. Tendons can also rupture or tear. Subluxation refers to a tendon that slips out of place.
The following are a few of the more common foot and ankle problems:
Ankle Fractures (Broken Ankle)
A broken ankle is also known as an ankle “fracture.” This means that one or more of the bones that make up the ankle joint are broken.
A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which force your ankle out of place and may require that you not put weight on it for a few months.
Simply put, the more bones that are broken, the more unstable the ankle becomes. There may be ligament damage as well. (Ankle ligaments hold the ankle bones and joint in the proper position.)
Broken ankles affect people of all ages. During the past 30 to 40 years, doctors have noted an increase in the number and severity of broken ankles, due in part to an active, older population of “baby boomers.”
Achilles Tendonitis or Injury
The long thick tendon on the back of the leg that attaches to the heel, the Achilles tendon, takes repeated abuse in many sports. Eventually, it may become inflamed, inflexible and cause nagging pain in the heel and lower calf. Running “through the pain” may subject the tendon to repeated small partial tears, which makes it vulnerable to a complete rupture. When it ruptures, the pain is so sharp in the back of the leg that it feels like you’re being kicked. Athletes are at high risk for developing disorders of the Achilles tendon. A sudden increase of a repetitive activity, leading to micro-injury of the tendon fibers, can cause these conditions. In addition to repetitive trauma, high-impact sports, such as basketball, can lead to tears and even ruptures of a healthy Achilles tendon. A foot and ankle specialist should manage these conditions.
Prompt evaluation and treatment by a physician is important because sometimes a suspected “sprain” is actually an ankle fracture, and treatment for these two conditions is very different. An x-ray is essential to make the proper diagnosis. Proper rehabilitation is a critical component to recovery. An ankle that has not been properly healed and strengthened is more likely to suffer repeated sprains, leading to chronic ankle instability. “It’s not broken” gives little solace to the athlete who suffers “only a sprain” because the pain keeps the athlete grounded until it heals. Early diagnosis, proper treatment and rehab will allow for a rapid and safe return to play.
Pain in the forefoot and numbness in the toes can indicate a neuroma, which is a condition of the nerves. One or more nerves are pinched, and burning pain and inflammation follow. Untreated, it can lead to even more pain. It often feels as if the socks are balled up under the toes. Treatment temporarily sidelines the athlete but stops the pain from creating bigger problems. Causes include activities that involve repetitive irritation to the ball of the foot, such as running or court sports. Symptoms start gradually and may come and go when the nerve is irritated due to activity. Early treatment is important to prevent more severe damage.
The athlete who overuses the foot can stress the fascia, which connects the heel to the toes. It triggers pain on the bottom of the foot. Running long distances or exercising on hard surfaces can worsen the condition. The key is to identify it before nerve pain develops because nerve pain requires more aggressive treatment.
While faulty foot structure is the most common cause of plantar fasciitis, it can also result from wearing shoes that are worn out or are not designed for the sport in which you’re participating. Proper stretching of the Achilles tendon can help get rid of this pain, but continued pain should be checked out to rule out a fracture or other cause.
Turf Toe Injuries
Explosive athletes, such as sprinters, football and basketball players, may injure these bones or the ligaments and tendons that run under the big toe. This is referred to as a turf toe injury, so called because it is much more common on artificial turf. This requires early and aggressive treatment, but most likely without surgery.
Pain and swelling in the front or inside of the shin can mean a shin splint, resulting when the covering of the bone known as the periosteum becomes inflamed and possibly tears away from the bone. The forward on a basketball team and the triathlete consider the shin splint familiar territory, but it heals with time. Either way, the athlete must take it easy and follow the physician’s advice while the shin heals. Chronic shin splints that do not improve with rest and time may be a sign of a stress fracture or a condition where pressure builds inside the muscles called chronic exertional compartment syndrome. Get evaluated if you’re not improving.
Repeated use of the foot and leg can cause a stress fracture, which is a tiny break of the bone. This is an incomplete break in a bone often due to repetitive activity on a bone. Stress fractures tend to occur when you start a new exercise regimen or get back to an old one after taking time off. Basically, the cause is doing too much, too quickly. Many factors such as the frequency and duration of activity, faulty foot structure, poor footwear and type of surface can contribute to the development of a stress fracture. The stress fracture in the foot or lower leg is a common injury for athletes who run or jump.
Dr. Michael Gross, the founder and director of Active Orthopedic and Sports Medicine, is the section chief of sports medicine and the orthopedic director of the Center for Sports Medicine at Hackensack University Medical Center, as well as medical director of Active Center for Health and Wellness.