Fall is officially here which means football season is underway! Football players can experience a wide range of foot and ankle injuries, ranging from turf toe to Lisfranc injuries, high ankle sprains to Achilles tendon ruptures. Let’s delve a little deeper into each of these injuries, including a look at their mechanism of injury and possible treatment options.
Turf toe refers to an injury to the ligaments surrounding the big toe joint. It often occurs from overextending the big toe during a “push off”
type motion, causing the ligaments to elongate or tear. This injury is especially common in football or soccer players due to the artificial turf
surface. Athletes may experience a popping sensation when the injury occurs or may feel stiffness and limited motion around the big toe. It is important to see a podiatrist if you experience any of these symptoms, and an x-ray will be performed to rule out any fractures or dislocations. Milder injuries to the joint can be treated with immobilization, compression, ice, and elevation. Athletic tape can also be utilized to stabilize the toe and minimize motion at the joint during the healing process. For more advanced injuries, a walking boot or cast may be necessary to eliminate all motion and allow the ligaments and damaged tissues to heal properly.
A Lisfranc injury refers to a strain in the midfoot, an area which is highly important in stabilizing the arch and the entirety of the foot. Lisfranc injuries range from purely ligamentous injuries to fractures in the midfoot bones. One common mechanism of injury in football players is a downwards force on a foot with toes flexed towards the ground. In essence, the toes buckle underneath the foot and there is strain or collapse at the midfoot level. It is not uncommon for players to experience immediate pain and swelling, with the inability to bear weight. Imaging is highly important in these injuries and may include x-rays, MRI, or CT scans. Treatment ranges from a walking boot or cast to surgical intervention. Recovery times can range from 4-6 weeks to several months for more complex fracture-dislocation injuries. Untreated injuries can lead to further instability and chronic pain.
High ankle sprains generally refer to an injury to the ligament complex above the ankle joint. This complex, referred to as the syndesmosis, is responsible for stabilizing the joint between the two long bones of the leg, the tibia, and the fibula. The mechanism of injury usually occurs from an external or outward rotation of the leg on a planted foot, especially when the foot and toes are pointing up (dorsiflexed) in relation to the ankle joint. Podiatrists can diagnose this injury by squeezing the two bones together at the lower leg, which will elicit pain. X-rays and MRIs can also aid in making this diagnosis. Conservative treatment options include immobilization in a walking boot, ice, compression, and elevation. In cases where the gapping between the two bones (referred to as the “diastasis”) is excessively wide, surgical treatment is indicated to stabilize the ankle joint. This can involve either screws or surgical anchors to support the two bones and decrease the gapping.
Achilles tendon ruptures are among the most common injuries to affect football players. A rupture refers to a complete tear of the calf tendon, either within the midsubstance of the tendon or, less commonly, when the tendon tears off the back of the heel bone. One possible mechanism of injury includes the forced planting of the foot on the ground with the majority of the player’s body weight pushing down. Any type of aggressive dorsiflexion of the ankle (when the foot and the toes pointing upwards at the ankle joint) can cause a “popping” sensation in the Achilles, which may be indicative of a partial or complete rupture of the Achilles tendon. If the tendon is torn, the patient will be unable to plantarflex (point their foot and their toes in a downward direction), and will likely be unable to bear weight on the affected extremity. Podiatrists will often feel a noticeable gap in the area of the tendon rupture on the back of the patient’s calf. Though clinical evaluation is often all that is needed to make the diagnosis, ultrasound or MRI imaging can be helpful in confirming a tendon rupture and informing the doctor of the gap that exists between the two torn tendon ends. TIn milder injuries, tendon ruptures can be treated conservatively with complete immobilization in a boot or cast. More often in the athletic population, surgical treatment and open repair of the tendon rupture is indicated, as this leads to a lesser chance of re-rupture. Surgical intervention includes an open end-to-end repair of the torn Achilles tendon, often using a heavy stitch (suture) material to reapproximate the tendon ends. It is important to note that these injuries have a long recovery period of rehabilitation and physical therapy, generally ranging from 9-12 months.
Recognizing any of the above conditions and seeing a podiatrist quickly after an injury can minimize the risk of complications or delayed diagnoses. Ultimately, it is both the patient and the physician’s goal to return to the sport in an efficient but safe manner!