Sports Medicine
helping you on and off the court
What is a Foot or Ankle Sprain or Fracture?
The feet and ankles work together to provide support and mobility to the body. A foot or ankle sprain is a soft tissue injury. Most often, a sprain occurs when an injury pulls, stretches, or tears the ligaments that connect bone to bone. A fracture is actually a break in the bone.
Causes
Injuries are the most common causes of foot and ankle sprains and fractures. Many fractures and sprains occur during sports. Football players are particularly vulnerable to foot and ankle sprains and fractures. Basketball players are prone to ankle sprains, and runners may develop stress fractures of the ankle or foot. Gymnasts and dancers may also develop stress fractures.
Tripping or stumbling on uneven ground is another common cause of foot and ankle sprains and fractures.
Symptoms
Pain, swelling, bruising, and difficulty walking on the affected foot or ankle are the most common symptoms of a sprained or fractured foot or ankle.
Home Care
If you’ve hurt your foot or ankle, it’s best to err on the side of caution. The acronym RICE can help you remember what to do:
Rest—Rest the affected area. Stay off the injured foot or ankle until it can be fully evaluated. Walking, running, or playing sports on an injured foot or ankle may make the injury worse.
Ice—Apply ice to the affected area as soon as possible, and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation.
Compression—Wrap an elastic bandage (such as an Ace® wrap) around the affected foot or ankle. The wrapping should be snug, but not so tight as to cut off circulation.
Elevation—Elevate the affected extremity on a couple of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.
When to Visit a Podiatrist
Podiatrists are doctors who specialize in the care and treatment of the lower extremities. If you’ve injured your foot or ankle, see a podiatrist. He or she can determine the extent of the injury and develop a plan of care to get you back in the game (or back to your everyday life) as soon as possible.
Increased pain, swelling, bruising, redness, or difficulty walking after an injury are definite signs that it’s time to see a podiatrist.
Diagnosis and Treatment
A podiatrist will carefully examine your feet and ankles and take a complete medical history. He or she will also order tests, including an X-ray, ultrasound, or MRI, to determine the extent of your injury. If you have a fracture that’s clearly visible on X-ray, you may not need additional testing. Ultrasounds and MRIs are useful for finding soft issue injuries (including torn ligaments) and stress fractures.
Treatment will depend on your injury. If you have a broken bone, your podiatrist may attempt to “reduce” the fracture, which means lining up the ends of the bones so they can heal properly. (You’ll be given a local anesthetic to numb the area first.) If the fracture is “unstable,” meaning that the ends of the bone do not stay in place after a reduction, surgery may be needed. Podiatrists can use metal plates and screws to fix broken bones.
Stress fractures are treated with rest and immobilization. You will be instructed to stay off the affected area until healing is complete. Crutches and/or a special “boot” or cast may be used to immobilize the area.
Sprains are also treated with a period of immobilization. Depending on the extent of your sprain, you may be able to resume activity fairly quickly, or you may need to wear a soft cast or special “boot” and use crutches for a period of weeks.
Professional athletes may undergo surgery to repair torn ligaments.
Oral anti-inflammatory medication, such as ibuprofen, can be used to decrease pain, swelling, and inflammation.
Prevention
Warming up prior to physical activity can prevent ankle sprains and fractures. So can wearing proper shoes. If you’re an athlete, talk to your podiatrist to determine which shoes are best for your sport, and read APMA’s footwear selection tips on our Tips for Healthy Feet page for more information. Athletic shoes should be replaced yearly; running shoes should be replaced every 300–400 miles or so.
Avoid running or walking on uneven surfaces.
The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.
Causes
Heel pain has many causes. Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear (such as flimsy flip-flops); or being overweight.
Common causes of heel pain include:
Heel Spurs: A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome.” Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.
Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and it can be quite painful.
The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly after a night’s sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
Excessive Pronation: Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Achilles Tendinitis: Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
Other possible causes of heel pain include:
- rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint;
- an inflamed bursa (bursitis), a small, irritated sac of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur;
- Haglund’s deformity (“pump bump”), a bone enlargement at the back of the heel bone in the area where the Achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe;
- a bone bruise or contusion, which is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.
When to Visit a Podiatrist
If pain and other symptoms of inflammation—redness, swelling, heat—persist, limit normal daily activities and contact a doctor of podiatric medicine.
Diagnosis and Treatment
The 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 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.
Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.
Prevention
A variety of steps can be taken to avoid heel pain and accompanying afflictions:
- Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, rigid shanks, and supportive heel counters
- Wear the proper shoes for each activity
- Do not wear shoes with excessive wear on heels or soles
- Prepare properly before exercising. Warm up and do stretching exercises before and after running.
- Pace yourself when you participate in athletic activities
- Don’t underestimate your body’s need for rest and good nutrition
- If obese, lose weight
In essence, turf toe is a sprain to the big toe joint. This can happen often in sports when this joint is bent too far or with too much force.
Avoid some serious pain and raise your game by checking out the best shoes for several sports below.
Basketball, Tennis, and Volleyball
Common foot injuries: sprains, stress fractures, tendinitis
The appropriate footwear should:
- Have a thick, stiff sole that provides support for impact.
- Have high ankle construction that supports the ankle during quick changes in direction (for basketball).
- Be lighter, have less midsole support, and contain a sole more responsive to quick starts and stops (for volleyball).
Soccer
Common foot injuries: ankle sprains, turf toe, ingrown toenails, Sever’s disease
The appropriate footwear should:
- Have a good-quality footbed, which can help provide proper support for the arch and user’s foot type.
- Feature the stud type for the ground that will be played on most often: soft, hard, firm, or turf.
- Use molded rubber cleats rather than the screw-on variety.
Football and Lacrosse
Common foot injuries: turf toe, Achilles tendinitis, ankle sprains
The appropriate footwear should:
- Have a good amount of high ankle support. This support is especially important for linemen and other players who make frequent lateral movements during play.
- Allow for proper traction on a grassy field, in both wet and dry conditions.
- Never be hand-me-downs; ill-fitting cleats increase the risk of ankle injuries.
Baseball and Softball
Common foot injuries: sprains, stress fractures, plantar fasciitis, tendinitis
The appropriate footwear should:
- Offer support to prevent arch pain, which frequently affects catchers. Customized shoe inserts called orthoses may help alleviate the pain.
- Not include metal baseball spikes for athletes younger than 13.
- Try multi-cleats for children ages 11–15 to avoid heel pain.
Running
Common foot injuries: plantar fasciitis, shin splints, stress fractures, Morton’s neuroma
The appropriate footwear should:
- Provide shock absorption to help runners avoid injury. Running shoes are made for high-impact forward motion and should not be used for sports with lateral movement.
- Match your foot’s arch type (high, medium, low). A podiatric physician can measure your feet and let you know what type to look for.
- Be replaced after 600–800 miles of running or walking, or every 6–8 months.
- For more info on choosing the right shoe, click here.
Children’s feet are still developing, and they are susceptible to a variety of conditions as they grow. Active kids, especially young athletes, are also prone to overuse and traumatic injuries. The good news is, as a parent, you can take simple steps to ensure your children’s feet and ankles stay healthy.
Parents should keep a watchful eye on kids’ feet. Be sure their footwear fits properly each season, and pay attention if their behavior changes. Little kids can’t always communicate an injury or articulate pain, so they may act more tired than usual or be hesitant to participate in their regular activities when they are in pain. Active preteens can develop conditions such as Sever’s disease, a painful condition of the heel that results from growth spurts in the bone that outstrip the growth of the surrounding soft tissue. And kids may ignore symptoms such as drainage from an ingrown toenail that could signal a serious infection.
The bottom line? Never ignore foot pain. “Growing pains” are not normal, and if your child’s feet aren’t feeling up to par, it’s time to see a podiatrist for diagnosis and treatment.