Sports medicine foot and ankle problems

Achilles tendonitis

Achilles tendinitis is a painful and often debilitating inflammation of the Achilles tendon, also called the heel cord.  This large tendon is an extension of the two calf muscles; it runs down the back of the lower leg and attaches to the heel bone (calcaneus).

Achilles tendinitis is often an ailment of athletes but women who wear high-heeled shoes and switch to sneakers for exercise also can develop Achilles tendinitis.

The inflammation that characterizes tendinitis reflects tearing of the tendon tissues caused by excessive stress.  The problem may be caused by a single incident of over-stressing the Achilles (such as failing to stretch or “warm up” sufficiently before exercising) or it may result from an accumulation of smaller stresses that produce numerous small tears over time.  The injury may occur at the point where the tendon attaches to the heel or at any point along the length of the tendon.

This condition is common in the “weekend warrior” who exercises infrequently and those who are just starting to exercise.  In these people, the muscles and tendon have little flexibility because of inactivity.  Overdoing exercise in the beginning can cause tendinitis because the muscles are not flexible enough to withstand the new forces being placed upon them.  It is especially important for people who are just starting to exercise to stretch properly, start slowly and increase gradually.

If pain develops even with proper stretching and training techniques, the patient should consult a podiatrist to check for hyperpronation and adequate arch support.  The addition of an orthotic may be enough to maintain good arch and foot alignment and eliminate pain.

Heel spur

Sharp pain, aching or stiffness on the bottom of one or both heels is a very common ailment.  The pain is often at its worst upon awakening in the morning (or after sitting down for an extended period and then resuming activity), causing hobbling or limping for a few minutes before a comfortable stride can be resumed.  As weight continues to be applied during walking or standing, mild or severe pain may persist.

Most cases of heel pain are characterized by inflammation.  First, the ligament begins to pull on the bone and the tissues become irritated, then inflamed.  Inflammation of this ligament is called fasciitis.

A projection or growth of bone is called a spur and can grow where the muscles of the foot attach to bone.  While some heel spurs are painless, others that are determined to be the cause of chronic heel pain may require medical treatment or surgical removal.

Your podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone.

Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices.  Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state.  Physical therapy may be used in conjunction with such treatments.

A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting of the ligaments and tendons attaching to the heel bone.  It will effectively treat the majority of heel and arch pain without the need for surgery.

Extracorporeal Shock Wave Therapy (ESWT) is a new procedure used to treat chronic heel pain (plantar fasciitis/heel spur syndrome). “Extracorporeal” means “outside of the body,” and refers to this non-invasive surgical procedure in which strong sound waves are directed at the area of heel pain.  The device used is similar to that currently used in non-surgical treatment of kidney stones.

Shin splints

A shin-splint is the most common cause of exercise-induced leg pain encountered by athletes of all levels. It is essentially an inflammatory reaction involving the connective tissue of the leg at its insertion into the inside (posterior shin splints) or front (anterior shin splints) aspect of the leg bone. Thus “tibial stress syndrome” is the common medical term used to refer to this condition.

Treatment for shin-splints can vary depending on the location, duration and severity of the problem. In the acute phase RICE (Rest, Ice, Compression, Elevation) is best. The rehab phase responds best to stretching and motion exercises. Training the muscles in the functional phase consists of support (in-shoe orthoses) and exercises. Return to activity phase requires proper foot wear and gradual increasing activity.

Sprained ankle

There’s a good chance that while playing as a child or stepping on an uneven surface as an adult you sprained your ankle – some 25,000 people do it every day.

Sometimes, a sprain is just an awkward moment when you lose your balance with pain that quickly fades away and you go on your way.  But the sprain could be more severe; your ankle might swell and it might hurt too much to stand on it.  If it’s a severe sprain, you might have felt a “pop” when the injury happened.

A sprained ankle means one or more ligaments on the outside of your ankle were stretched or torn.  If it is not treated properly, you could have long-term problems.

You’re most likely to sprain your ankle when you have your toes on the ground and heel up. This position puts your ankle’s ligaments under tension, making them vulnerable.  A sudden force like landing on an uneven surface may turn your ankle inward.  When this happens, one, two or three of your ligaments may be hurt.

Your podiatrist will ask you what you were doing when you sprained your ankle.  He or she will examine it and may want an X-ray to make sure no bones are broken.

Treating your sprained ankle properly may prevent chronic pain and instability.  For a mild sprain, follow the R.I.C.E. guidelines:

  • Rest your ankle by not walking on it
  • Ice it to keep the swelling down
  • Compressive bandages immobilize and support your injury
  • Elevate your ankle above your heart level for 48 hours
  • The swelling usually goes down within a few days.

For a more severe sprain, follow the R.I.C.E. guidelines and allow more time for healing.  Your podiatrist may immobilize or splint your sprained ankle.  For severe ankle sprains your doctor may also consider treating you with a short leg cast for 2-3 weeks or a cast-brace.  People who sprain their ankle repeatedly may also need surgical repair to tighten their ligaments.

Stress fracture

A stress fracture is a break in a bone cause by repetitive stress.  It may occur in any bone, but is quite common in the metatarsal bones of the foot.  There is often no recollection of injury.  You may simply develop a painful foot after some activity, such a walking, sports, or stooping down onto the ball of the foot.  A small crack develops in the outer shell of the bone.  Without proper treatment, this may progress to a “through and through” fracture of the bone.  The second and third metatarsals are the most commonly affected.  Metatarsal stress fracture may not become apparent on x-rays until a few weeks after the injury.

Symptoms include sharp pain in the forefoot, aggravated by walking.  Tenderness to pressure on the top surface of a metatarsal bone.  Diffuse swelling of the skin over the forefoot.

Seek professional help as soon as possible.  Keep weight off the foot and ice the top surface of the forefoot for about 20 minutes every hour.  To reduce swelling, wrap the foot in an ace bandage with moderate compression.  Wear a shoe with a very stiff sole.

Your podiatrist will take x-rays to look for the fracture or order special diagnostic bone scans to establish a questionable diagnosis; Dispense a surgical/ trauma shoe to splint the foot and prescribe medication for pain and inflammation.  Occasionally a plaster cast or walking boot is necessary.