RN

Common Injuries in the Foot

  • Fractures
    • Mechanism of Injury (MOI): caused by direct trauma from contact with the ground or an opponent
    • Fractures in specific areas of the foot that occur frequently are given particular names to designate the location of the injury
    • Example- Jones Fracture: most common acute injury to the foot, occurs at the proximal base of the fifth metatarsal
    • Signs and Symptoms (S&S)
    • Pain and swelling at injury site
    • Possible deformity of the bone
    • Discoloration or redness
    • Athlete heard a pop or snap
    • Athlete unable to bear weight
    • Hesitation to ambulate
    • Treatment
    • Depend on the location of injury
      • Phalanx Fracture vs Metatarsal or Tarsal bone
    • Immobilization: walking boot, crutches (NWB)
    • Rehabilitation
  • Stress Fracture
    • MOI: overuse
    • Can occur in any bone in the foot but most common in the metatarsals (2nd and 5th)
    • March Fracture: stress fx to the 2nd metatarsal (high occurrence rate in the military during basic training
    • S&S:
    • Gradual onset of pain (achy)
    • Sensation similar to a rock in their shoe while running or walking
    • Can lead to Stress Reactions: bone attempts to repair healthy bone tissue to protect itself.
    • This increases the stress fx stage as bone becomes weaker and eventually breaks down
    • Treatment
    • Immobilization
    • Rest to bone stimulation
    • Surgical intervention
    • Orthotics to long term reduce forces or correct mechanics
    • Rehabilitation
  • Arch Strain/Sprain
    • MOI: Hyperextension of the midfoot, often resulting from contact with an uneven surface or twisting motion during running
    • Longitudinal arch most common one sprained/strained
    • Damage to the muscles, ligaments and/or fascia that assist in the formation of the arch
    • Because multiple structures are damaged we use sprain and strain
    • S&S:
    • Pain and tenderness over injury site
    • Swelling (usually seen on medial aspect of arch)
    • Pain with running and cutting
    • Treatment:
    • RICE
    • Arch tape, orthotics
    • Return to Play (RTP)
  • Spring Ligament Sprain
    • Plantar Calcaneonavicular Ligament (Spring Ligament)
    • Important component of the longitudinal arch and assists in the shock absorption and maintaining the integrity of the arch
    • MOI: running on uneven surfaces and stepping in holes or divots
    • S&S
    • Pain and tenderness distal to the heel of the foot on the medial aspect of the arch
    • Pain with weight bearing
    • Slight swelling over injury site
    • Treatment:
    • RICE
    • Orthotics or padding to provide support
    • RTP as tolerated
  • Plantar Fasciitis
    • Plantar Fascia: fibrous tissue on the bottom of the foot that runs the length of the foot to help strengthen the arch complex
    • The fascia can become inflamed as a result to chronic stress.
    • The initial stress causing the fascia to tighten, which decreases range of motion (ROM) and increases the stress on the tissue.
    • As the stress increases, the tightness and inflammation increases causing more damage to the fascia.
    • MOI: overuse/chronic, anatomy
    • S&S
    • Pain most often at the distal aspect of the heel on the lateral side
    • Pain that is most severe with the first steps out of bed in the morning
    • Tightness and decreased ROM at the midfoot
    • Slight swelling at injury site
    • Treatment:
    • Ultrasound therapy
    • Ice massage
    • Friction massage (tennis or lacrosse ball) -> break down scar tissue
    • Stretching
    • Medication
    • Night Splint (keep dorsiflexed position)
  • Heel Contusion
    • MOI: stepping on a hard object or jumping from a high height
    • Injury may also develop chronically from repetitive compression (worn down shoes without proper cushioning)
    • S&S
    • Point tender on heel
    • Slight discoloration
    • Pain with ground contact
    • Treatment
    • RICE
    • Heel cup or heel taping when playing sports
    • X-ray to rule out fx
  • Turf Toe
    • Sprain of the first metatarsophalangeal (MTP) joint
    • MOI: hyperextension or hyperflexion motion of the joint
    • S&S
    • Pain at 1st MTP joint
    • Pain with flexion or extension of 1st MTP
    • Pain and discomfort with running, especially push off
    • Slight swelling and discoloration
    • Treatment
    • RICE
    • Referral to physician to rule out fx
    • Turf toe tape or steel insole to decrease motion
  • Bunion and Bunionette
    • Bunion: protrusion medially from 1st metatarsal head, inflammation of the synovial bursa resulting in the enlargement of the joint and lateral displacement of the toe
    • Bunionette: similar injury expect it occurs at the 5th metatarsal
    • MOI: chronic and increases in size over time, 1st metatarsal head moving medially causing inflammation in surrounding tissue and forcing the first toe in the opposite direction
    • S&S
    • Pain, especially with shoes on
    • Redness and swelling
    • Obvious protrusion of the 1st or 5th metatarsal with opposite movement of the associated toes
  • Treatment of Bunions/Bunionettes
    • Ice
    • Shoe change
    • Surgical intervention
    • Padding