Orthopaedic Associates-Injury Facts-Foot and Ankle

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Orthopaedic Associates has experts on staff who specialize in foot and ankle problems. If you have any questions regarding this or any other topic, please call us at 410-337-7900 or 1-800-678-4671.
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Ankle Sprains

Ankle sprains occur frequently. The ankle is a hinge joint and the bones and ligaments (attach bone to bone) determine its stability. A sprain is an injury to one or more ligaments. A sprain results from the joint being forced beyond its normal anatomical constraints. Inversion ankle sprains (lateral ligaments) are the most common. They occur when the ankle rolls outward when falling off a curb, sidewalk, or uneven terrain. Eversion sprains (medial ligaments) occur commonly after landing on another player's foot. Return to activity depends on the number of ligaments injured, amount of swelling and degree of instability.

Signs and Symptoms:

Point tenderness
Ecchymosis (discoloration)
Pain on movement and ambulation
Swelling
Loss of motion

Immediate treatment:

Protection. Stabilize the ankle to prevent further injury.
Rest as advised by physician or certified athletic trainer. Avoid unnecessary irritation.
Ice the area for 20 minutes several times a day for the first 72 hours.
Compression sleeve should be used to reduce swelling/bleeding in the ankle. (compression wrap should be removed at night)
Elevate the ankle above the level of the heart to reduce swelling.
Crutches can be used to assist with walking.
Temporary use of anti-inflammatory. (Aleve or ibuprofen). Consult your physician for proper dosage.

Rehabilitation:

Rehabilitation program. Consult your physical therapist or certified athletic trainer. Begin with exercises 1-5 and progress as tolerated to 6-12.
Obtain full range of motion.
Proprioception/balance exercises (awareness of body position).
Strengthening exercises. Strengthening of the muscles surrounding the ankle will help provide stabilization.

Return to play criteria:

Fully rehabilitate ankle. Athlete should pass functional testing prior to return. These tests should include: jog, run, run with cutting, karaoke, hop on involved foot 10 times without pain, run in a figure 8, sport specific tests.
Regain appropriate proprioception/balance. (Athlete should be able to balance on one leg for one minute.)
Bracing/taping may be used for support and to facilitate a quicker return to sport.
Continue strengthening activities following return to play.
Wear shoes that are appropriate for the specific sport/activity.

CLICK HERE FOR EXERCISES (PDF)
The exercises are in PDF format. To view this file, you need Adobe Acrobat reader. If you don't have access to Adobe acrobat reader, you can go the adobe website and download it for free HERE.

Flat Feet

Falling Arches: Prevention and Treatment

One in four Americans has flat feet - or 60 million people, according to the American Orthopaedic Foot and Ankle Society. Though flat foot is the most common foot deformity, most people can live very well with it - participating in sports and even running marathons. "It's pain that brings people with flat feet into the doctor's office," explains Dr. Jeffrey Brodie, a foot and ankle specialist at Orthopaedic Associates. Most cases of flat feet, especially in children, are due to the way a person's foot develops from birth, says Brodie. Congenital flat feet are "generally asymptomatic," says Brodie. "We don't treat painless flat feet in kids. It's a benign condition." But other cases of flat feet can develop over years as the posterior tibial tendon that supports the arch weakens, stretches and even tears. As a result, the arch starts to collapse. This is known as progressive flat foot.

The Importance of Support

"Bad shoes can contribute to it, for example if you wear shoes without arch support or a high heel and you already have problems with flat feet. If you're in a heel, your foot is working harder to balance itself," he says. "Also, as patients gain weight and get more sedentary, the potential for injury to the tendon increases. The tendon can tear and become painful." Brodie explains that many patients who seek care for painful flat feet are women in their 50s and 60s, who are also overweight. The arch can begin to collapse under additional weight. "A lot of times, someone will have twisted her ankle and it doesn't get better in four to six weeks. She comes in and we discover the pain is connected to the tendon that supports the arch. Folks who have an ankle sprain that's not getting better should seek treatment."

When Pain Begins

Although flat feet in young children are usually painless, the condition can become painful in adolescence or older. Sometimes, pain occurs during or after sports or other physical activity. Other times, there's aching pain at night or a tired feeling in the foot, ankle or leg. The heel can become red and painful if the Achilles tendon at the back of the ankle is involved. Calluses may form under sagging arches. All these symptoms are reasons to consult a doctor.

Prevention

Prevention is the first approach to care, explains Brodie. "One thing that's helpful is daily stretching to keep the tendon supple and mobile. This can prevent flat feet from becoming a fixed deformity. The other thing is shoes with good off-the-shelf support or even custom orthotics," he says. Once an injury occurs, the initial treatment is rest, activity moderation and anti-inflammatory medications. "If it's really painful, there are a variety of bracing techniques or large removable walking casts," says Brodie. Surgery is only considered when the tendon is torn or conservative treatment hasn't worked. In some cases, Brodie explains that surgery may involve cutting the heel bone and realigning it, or doing a tendon transfer from the arch of the foot. In extreme instances, if the foot no longer moves, the surgeon may need to reconstruct the arch. Despite the fact that flat feet are usually an inherited condition, doctors are seeing more adult cases of fallen arches. "It's a dynamic process of wear and tear that occurs over years," says Brodie. He advises that if you begin noticing that your arch is falling and your feet feel painful, consult a doctor. Fallen arches can be a serious injury that can even lead to back, hip and knee problems.

For more information or a referral call 410-337-7900 and ask to speak to Dr. Brodie's secretary.

Plantar Fasciitis

The plantar fascia is a dense fibrous tissue that runs along the bottom of the foot. It is attached at the heel (calcaneus) bone and spreads upward toward the base of the toes. Overuse causes inflammation at the point of the fascia attachment to the heel bone, resulting in pain. Pain can also spread along the plantar fascia. This condition is known as plantar fasciitis or inflammation of the plantar fascia.

Signs and Symptoms:

Pain on the plantar (bottom) surface of the foot.
Pain is generally worse with the first few steps in the morning and following prolonged sitting.
Tenderness over the attachment of the plantar fascia at the heel.
Increased pain with dorsiflexion of the ankle.
Pain may decrease during activity but return at rest.
Ecchymosis (bruising or discoloration).

Causes:

Chronic overuse such as running or jumping.
Acute injury.
Foot mechanics (flat feet, high arches).
Excessive tightness of the gastrocnemius-soleus (calf muscles) causing overload to the plantar fascia at the heel attachment.
Increase in weight.
Sudden increase in activity.
Lack of proper stretching prior to activity.
Other factors may include poor shoe support, running on toes (hills), running on soft surfaces (sand), and increasing age of patient.

Treatment:

Stretching achilles tendon and plantar fascia.
Temporary use of anti-inflammatories (ibuprofen or Aleve). Consult your doctor for proper dosage.
Ice therapy daily especially following activity (apply an ice bag or roll a cold can under the foot).
Use of shock absorbing heel pad or arch supports.
Modification of activities until symptoms subside followed by gradual return to activity.
Wear shoes with adequate support.
Avoid walking barefoot.

Posterior Tibialis Tendinitis

Posterior Tibialis tendinitis is a common overuse condition characterized by medial ankle pain. It is often caused by forceful eversion of the ankle/foot as seen in repetitive kicking in soccer or in runners with hypermobility of the ankle or overpronation of the foot. It is necessary to decrease the inflammation of the tendon to allow pain free return to activity.

Signs and Symptoms:

Medial ankle pain generally surrounding the medial malleolus
Swelling of medial ankle
Pain with passive pronation and active and resisted supination.
Pain to palpation of posterior tibialis tendon
Discomfort when raising up on toes

Causes:

Forceful supination of the foot/ankle as seen in repetitive kicking.
Activities requiring sudden starting and stopping with push-off action.
Hypermobility or overpronation of feet.
Improper footwear.
Poor training techniques.
Running on banked surfaces.

Treatment:

Rest or modification of activity as prescribed by your physician or certified athletic trainer.
Ice therapy to reduce inflammation and pain.
Temporary use of anti-inflammatory (Aleve or ibuprofen) as prescribed by your physician.
Following the acute stage, heat therapy may be used in conjunction with stretching exercise.
Rehabilitation program. Consult your physical therapist or certified athletic trainer. Begin with exercises 1-4 and progress as tolerated to 5-12.
Flexibility exercises with focus on the heel cord.
Strengthening exercises for the ankle with focus on plantarflexion and inversion musculature.
Medial heel wedge or orthotics to correct improper biomechanics.
Arch support taping.
Proper footwear for sport or activity.

Sever's Disease

Heel pain occurring during periods of rapid skeletal growth (girls 8-11, boys 10-13). Pain results from traction on the secondary ossification center of the heel.

Risk Factors:

Biomechanical abnormalities of the foot (flat feet, high-arched feet, overpronation).
Overuse.
Poor flexibility of the heelcord or plantar fascia of the foot.
Participation in high impact sports (track, cross-country, soccer, gymnastics, ballet, or tennis).

Signs and Symptoms:

Intermittent or continuous heel pain with weight bearing.
Absence of pain in the morning or without activity.
Pain with toe raises or toe-walking.
Walking with limp.
Pain with squeezing the heel.

Treatment:

Rest (decrease activities that worsen the pain).
Ice (15-20 minutes) two or three times a day.
Heel lifts (viscoelastic 1/4"-1/2" to decrease impact forces).
Proper shoe wear with good arch supports and solid heel counter.
Physical therapy program emphasizing heelcord flexibility and dorsiflexor strengthening program.
Avoid walking barefoot.
Symptomatic improvement is usually attained from 2 weeks to 2 months. Occasionally, temporary immobilization is needed to relieve symptoms.
Cortisone injections are not recommended.

Prevention:

Take occasional breaks from high impact activities.
Maintain a good heelcord stretching program.
Avoid jumping onto hard surfaces without shoes.

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