Top 5 Sporting Injuries
Treating the injured foot and ankle can be challenging. Although with an accurate diagnosis patient outcomes greatly improve.
Below are the top five common sporting injuries we see.
Tendinitis
Toe injuries e.g Turf toe
Ankle sprains
What is it?
A sprained ankle is an injury that occurs when you roll, twist or turn your ankle in an awkward way. This causes the ligaments to either over-stretch (strain) or tear. The ligaments are tough bands of tissue that help stabilise and secure joints in their correct positions.
Roughly 230,000 Australians will consult a medical professional due to an ankle sprain each year. Around 80% of Ankle sprains involve the lateral (outside) ligaments of the ankle, this happens when the foot points downward and twists inward.
Symptoms
Pain - especially on weight bearing and/or moving the ankle/foot
Tenderness when touching ankle
Swelling
Stiffness
Popping sensation or sound at time of injury
How can it be treated?
Accurate diagnosis through thorough examination and possible imaging (ultrasound or MRI)
RICER protocol (Rest, Ice, compression, Elevation, Rest)
Taping or other immobilisation technique e.g. CAM boot
Manual therapy to reduce swelling and discomfort - Massage
Photobiomodulation therapy (PBMT) i.e. laser therapy
Rehabilitation exercise program
Footwear advice/ changes, orthotic prescription
References
https://www.physio-pedia.com/Lateral_Ligament_Injury_of_the_Ankle
https://www.ncbi.nlm.nih.gov/books/NBK459212/
https://www.mayoclinic.org/diseases-conditions/sprained-ankle/symptoms-causes/syc-20353225
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ankle-sprains
https://www.nps.org.au/consumers/ankle-sprains-10-things-you-should-know
Tendonitis - e.g. Achilles tendinitis, Tib post tendinitis
What are they?
Inflammation of fibrous cord that connects muscle to bone which are known as Tendons. The most common places in the body to suffer a tendonitis injury are the shoulder, ankle, elbow, wrist and knee
How does it happen?
Tendonitis is often caused by repetitive movements especially involving high impact or exertion. Incorrect technique when performing movements further increases the risk of tendinitis.
Your environment can also contribute to the injury e.g. if movements are done on hard surfaces and poor or old equipment e.g. shoes.
What are the symptoms?
Pain at site of injury e.g. back of heel/ ankle
Mild swelling and inflammation
Grating sensation as the tendon moves
Tenderness
Stiffness of joint tendon/ muscle complex mobilises
How can it be treated?
RICER protocol (Rest, Ice, compression, Elevation, Rest)
Reduced exercise levels/ change of exercise type
Avoidance of certain movements
Rehabilitation exercise program - stretching and strengthening
Manual therapy - massage, dry needling
References
https://www.mayoclinic.org/diseases-conditions/tendinitis/symptoms-causes/syc-20378243
https://www.healthdirect.gov.au/tendonitis
https://mydr.com.au/sports-fitness/achilles-tendinitis/
https://my.clevelandclinic.org/health/diseases/10919-tendinitis
Plantar Fasciitis
What is it?
Inflammation of the plantar fascia which is a thick band of tissue that connects your heel to your toes. The plantar fascia is designed to absorb and disperse the shock and pressures applied to our feet during movement.
How does it happen?
Plantar fasciitis is typically a chronic degradation of the plantar fascia from excessive forces due to a multitude of factors. Over time repetitive trauma to the fascia causes micro-tears to happen inside the structure leading to inflammation.
The contributing factors can include:
Poor foot posture
Poor leg biomechanics (how the body moves)
Poor footwear
over use due to sports, work or social lifestyle
Repetitive high impact e.g. repetitive jumping
Obesity
Age
Symptoms
Pain at rising
Pain underneath heel or arch of foot - typically sharp or stabbing feeling
Tenderness when touching heel area
Numbness around heel
Pain after exercise or prolonged activity
How can it be treated?
Rest
Footwear education and correction
Rehabilitation exercise program - stretching, strengthening, self massage
Manual therapy - massage, dry needling
Photobiomodulation therapy (PBMT)
Shockwave - depending on duration of symptoms/ condition
Corticosteroid injection - Extremely painful and can cause scarring.
References
https://www.ncbi.nlm.nih.gov/books/NBK431073/
https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs/
https://www.healthdirect.gov.au/plantar-fasciitis
https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846
Stress fracture
What is it?
A stress fracture is a small crack in a bone due to overuse or repetitive trauma to the affected area. They are most common in the weight bearing bones of the lower leg and foot. They can often be alternatively called a “stress reaction”. You are at more risk of developing a stress fracture if you have an underlying condition e.g. Osteoporosis.
The most common bone to experience is your Tibia (shin bone) where between 20 to 75% of all stress fractures occur.
What is the most common cause?
Repetitive movements involving high load or impact e.g. running, high intensity sports.
Overdoing a new exercise or activity in terms of intensity, duration or frequency.
Changing of workout/ exercise surfaces e.g. from park running to road running.
Incorrect movement during exercises
Poor equipment when performing activity e.g. footwear
Symptoms
Pain on weight bearing and touch
Ache at night
Swelling around painful area
How can it be treated?
Accurate diagnosis through physical examination and imaging referrals. Type of imaging depends on the duration of symptoms. MRI and/ or CT scan is preferred imaging especially when an acute injury. If pain is present for over 2 months, X-ray can often diagnose injury.
Offloading injured site or limb through the use of a CAM walking boot or proper supportive footwear and orthotics if CAM boot is not appropriate.
Rest from excessive weight bearing and rest from exercise advised.
Surgery to provide internal support to injured bone is explored if conservative options are unsuccessful or severity of injury is too great for conservative management.
References
https://www.mayoclinic.org/diseases-conditions/stress-fractures/symptoms-causes/syc-20354057
https://orthoinfo.aaos.org/en/diseases--conditions/stress-fractures-of-the-foot-and-ankle/
https://my.clevelandclinic.org/health/diseases/15841-stress-fractures
https://www.hss.edu/conditions_stress-fractures-foot-ankle.asp
Toe injuries e.g. Turf toe
What is it?
Turf toe refers to the spraining of the ligaments surrounding typically the First metatarsal phalangeal joint (big toe joint). The common term for the ligaments and other soft tissues is the Plantar complex. Similar to other strains there are different grades of injury depending on the severity of the strain;
Grade 1. The plantar complex has been stretched, causing pinpoint tenderness and slight swelling.
Grade 2. A partial tearing of the plantar complex causes more widespread tenderness, moderate swelling, and bruising. Movement of the toe is limited and painful.
Grade 3. The plantar complex is completely torn, causing severe tenderness, severe swelling, and bruising. It is difficult and painful to move the big toe.
How does it happen?
Turf toe is caused by over extension of the big toe, causing it to bend “upwards” too far resulting in the plantar complex over stretching. This movement typically happens in sports that involve short explosive movements when athletes are on the balls of their feet e.g. Football, Basketball, Hockey.
The injury is more common for athletes competing on hard surfaces e.g. wooden courts, artificial grass (Turf) or outdoor courts.
Symptoms
Pain when bending toe upward both non-weight bearing and weight bearing.
Pain when touching the bottom surface of the toe and joint.
Swelling to joint area
Treatment
RICER protocol (Rest, Ice, compression, Elevation, Rest) at time of injury
Rest from exercise
CAM walking boot to offload pressure and stabilise joint (Grade 2 and above)
Joint immobilising e.g. splint
Physical rehabilitation exercises
Surgical repair of ligaments if complete tear (grade 3)
References
https://orthoinfo.aaos.org/en/diseases--conditions/turf-toe
https://www.sydneyorthopaedic.com.au/turf-toe.html
https://my.clevelandclinic.org/health/diseases/17590-turf-toe
