Common Foot and Ankle Injuries in Athletes

Athletes are particularly prone to injuries related to the musculoskeletal systems, especially because they push their bodies beyond normal limits, and therefore can develop either acute or chronic injuries. Foot and ankle injuries are not uncommon and are one of the highest degrees of injuries in sports. This is because whether it be racket sports or sports related with balls, the foot and ankle play a considerable role in manoeuvrability as well as direct impact.

Why Athletes are Prone to Foot and Ankle Injuries

Athletes are prone to foot and ankle injuries either due to individual sports where they are running on uneven surfaces or making quick manoeuvres in different directions, or in contact sports where they make direct contact with either a ball or other personnel playing within their team or other teams.

Common Foot and Ankle Injuries in Athletes

There are many foot and ankle injuries, but the common injuries include conditions such as in the forefoot where you can get turf toe or fractures of the lesser toes, dislocations of the toes at the MTP joints. Metatarsal fractures are also common as well as midfoot injuries such as Lisfranc’s injuries, fracture of the hindfoot, so talus or calcaneus, as well as fracture of the ankle, Achilles tendon ruptures. To a lesser degree, rupture of other tendons in the foot and ankle. Plantar fascia tears and injuries also are not uncommon. On the chronic side, there are repeated injuries of all tendons and ligaments, which can result in problems.

Ankle sprains

Ankle sprains are essentially categorised as either an inversion or eversion sprain, and inversion sprain injures the lateral collateral ligaments, whereas eversion is less likely, but injures the deltoid ligament complex. The sprain could be a mild sprain where it’s just stretching as in grade one. This typically can resolve with rest and rehabilitation. Grade two sprains are partial tears and this may require a longer rehabilitation period, but generally do heal over time, but may take three months. And then there’s grade three sprains where there are torn ligaments and this often requires surgical intervention where the ligaments are repaired. Surgical intervention is required.

Achilles tendonitis

Achilles tendonitis essentially is an overstretch or strain of the Achilles tendon. There it could either be the paratenon which is the outer layer or the tendon itself which can be inflamed and called tendonitis. Sometimes there’s chronic tendinopathy which is where there is enlargement of the tendon with a lump that you feel at the back of the Achilles. This is a more chronic problem with micro tearing and degenerative changes within the Achilles tendon.

Plantar fasciitis

This can be acute or chronic again. The acute is where you get overstepping and overstep and injure your plantar fasciitis, insertion of the mid arch. More chronic is due to repetitive strain, where you get inflammation of the plantar fasciitis at the insertion near the heel, which causes pain particularly worse first thing in the morning and periods of rest. It requires treatment such as shock wave therapy as well as injections and insoles and rehabilitation physiotherapy.

Stress fractures

Stress fractures are overuse fractures in the normal bone, often requiring six weeks of rest in a rigid sole or a boot. You will have to come off sports, you get swelling of the forefoot, pain on mobilisation. They usually heal uneventfully.

Ingrown toenail

Ingrown toenail is typically because certain sports require wearing tight shoes or your toenails may be wider than normal causing impingement. The tighter shoes, especially in ball sports where you want to feel the ball, can cause pressing of the nail within the tissue and inflammation.

Turf toe

This is a hyperextension injury of the big toe. The plantar plate or the ligament that stabilises the big toe at the bottom, the sesamoid complex tears. This results in chronic pain. You have loss of plantar flexion function of the big toe. It often requires surgical intervention in the young patients.

Treatment and recovery

Treatment and recovery essentially with sports injuries affecting foot and ankle always start by investigation. Initially, you may require an X-ray or an MRI to have an accurate diagnosis. You need to grade the injury as to whether it’s just a sprain or whether it’s partial tear that will heal itself or whether it requires surgical intervention and it will affect the long-term function of the athlete or the injury. Then treatment may either be a combination of rest initially, which is required to reduce the inflammation, anti-inflammatory medication, maybe protection in a brace or a post-operative shoe or a sandal or a boot. And then there’s rehabilitation where physiotherapy will need to build strength and rehabilitate range of motion. Often this can take many months. In some cases surgical intervention is required and then rehabilitation.

Conclusion

Sports injuries in foot and ankle are common. They require immediate attention. Most injuries are benign, but sometimes can develop chronic problems. They need urgent attention and investigation to ensure that the athlete returns to full function in the long term.

FAQs

What are the most common foot and ankle injuries in athletes?

The most common being the ankle sprain or the less likely is the Lisfranc’s injuries. Other smaller injuries such as stress fractures, ligament strains, are not uncommon. Turf toe is again an injury that happens less frequently.

How can I tell if my ankle sprain is serious?

If you get swelling that persists more than five days and you can’t put weight on it immediately, then you should seek attention and get X-rays. If you can’t place weight on the ankle straight away, then following Ottawa ankle rules, you should have an X-ray. This could be a fracture. If your swelling or sprain lasts for more than five days, you should see a specialist, you may need an MRI scan to assess whether the ligaments are torn. You may need boot immobilisation. Often if the swelling lasts for more than five days significantly and you can’t put weight on it, you could require surgical intervention.

What causes Achilles tendonitis?

Usually it’s poor mechanics or poor footwear. The overuse of the foot in the wrong position can cause Achilles to overwork and therefore causes Achilles tendonitis.

Can I keep training with plantar fasciitis?

Yes, you can keep training, but I would modify your activity, as in do a lot of stretching before you embark on your running to try to free up the tendon and your Achilles tendon complex and calf muscle loosening before you start exercising so that you reduce the stress on the plantar fascia.

How is stress fracture different from regular fractures?

A stress fracture is an insufficiency fracture or a fracture due to overuse. You do not see a full cortical breach where the bone separates, it happens within the marrow itself, and therefore you will not see on X-rays for the first three to four weeks or until there’s callus formation.