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

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