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