Common Sports Injuries of the Foot And Ankle

with Eric Malicky, M.D., Advanced Healthcare

Posted: May 1, 2005

Dr. Eric Malicky doesn’t need to look out a window to know that spring is in the air. He can just check out the waiting room of his office. A fellowship-trained orthopaedic foot and ankle surgeon at Advanced Healthcare, Dr. Malicky sees a spike in sports-related injuries when the weather starts to warm up.

“These are common injuries of the foot and ankle,” he said, “and it’s important for people to know when they should see a doctor, and when they can take care of the problem on their own.”

Injuries to the Achilles tendon, sprains to the ankle or mid-foot, and stress fractures are all associated with athletic activity, although they can be caused by other factors as well.

Eric Malicky, M.D., Fellowship-Trained Orthopaedic Foot and Ankle Surgeon, Advanced Healthcare "If mid-foot sprains aren’t properly treated, the result can be chronic instability in the arch of the foot, chronic pain, arthritis and permanent disability."

Achilles tendon injuries
The Achilles tendon, the strongest and largest tendon in the body, connects the muscles of the calf to the heel.

“Both recreational and elite athletes can develop overuse injuries or a tear to the Achilles tendon,” Dr. Malicky said.

Changes in the intensity level of exercise or an increase in activity can cause an Achilles injury, as can sudden trauma to the calf muscle, overuse or over-training. Basketball and tennis players are particularly prone to this type of injury.

“It’s more associated with sports where an athlete lands on the foot and the sudden force goes through the Achilles tendon, extending beyond its ability to absorb that force,” he said, adding that there are warning signs that may occur before the injury occurs.

Those may include mild pain in the Achilles tendon after training, stiffness when they first wake up that subsides with activity or warm-up exercise, swelling in the area, and pain during activity or exercise.

It’s believed that as people age, the blood supply to the area changes, weakening the tendon. Injuries to the Achilles run on a spectrum from mild to severe. Achilles tendonitis is a mild inflammation of the tendon. Chronic aches and pains to the area may be due to scar tissue forming on the tendon.

Both are treated with rest, laying off the exercise or activity for a week or two, or cross-training by exchanging the irritating activity for something that doesn’t put pressure on the tendon, such as bicycling or swimming.

Other treatments for mild to medium-level Achilles injuries include a heel lift, physical therapy, non-steroidal anti-inflammatory medication and orthotics, which are shoe inserts. In some cases, Dr. Malicky said, ice can be helpful.

Tears or ruptures of the Achilles tendon are treated either with surgery to reconnect the two ends of the tendon, or by casting the area for six to eight weeks. The treatment modality depends on the surgeon and patient preference.

“The advantage in my practice in terms of surgically reconnecting the tendon is that it allows for immediate, early rehab,” Dr. Malicky said, adding that it’s believed that the re-injury rate for surgically repaired ruptures is lower and the strength of the tendon after recovery is stronger.

Ankle sprains
It’s rare to find a weekend athlete who doesn’t have some experience with a sprained ankle, either firsthand or through helping a friend or teammate off a playing field or running track.

But, said Dr. Malicky, few realize that a sprain of the mid-foot, the area around the arch, can be just as problematic.

“It can either occur from a twisting of a foot in a hole, or if an object drops on top of the foot, or if an athlete’s foot gets stepped on,” he said.

Sprains occur when a joint is forced out of its normal position, resulting in an overstretch or tear of the ligament supporting that joint. Signs and symptoms include swelling, bruising, pain, and the inability to use the joint. Symptoms can range from mild to severe. Mild sprains can be treated at home, using R.I.C.E. (rest, ice, compression, and elevation).

If the sprain is severe enough that it can’t support weight or be moved, is tender to the touch, swollen, has lumps and bumps in addition to swelling, is numb, has red streaks emanating from the area or has been injured in the past, it’s best to get it checked out by a doctor. It’s also a good idea if you’re unsure as to the severity of the injury.

Mid-foot sprains
The middle part of the foot contains a group of bones that form the arch of the foot, which are connected by various ligaments.

“Unfortunately, there are cases where the ligaments are torn and there’s not necessarily a fracture identified on an X-ray, but the ligament tear can leave the mid-foot unstable, causing those small bones in the arch to shift,” Dr. Malicky said.

If left untreated, those bones will shift, and the consequences can be drastic.

“There can be chronic instability in the arch of the foot, chronic pain, arthritis and permanent disability,” Dr. Malicky said.

As with an ankle sprain, a mid-foot sprain can be treated with R.I.C.E. If, in a few days, the pain and swelling have not diminished, Dr. Malicky recommends consulting a doctor.

“There are ways of making the diagnosis of a mid-foot injury based on a physical exam, comparison X-rays between the injured and uninjured foot, or a CAT scan or MRI,” Dr. Malicky said.

Mid-foot sprains can be treated either by casting the area, surgically realigning the bones or, if the injury was left untreated and permanent instability developed, by fusing the bones in order to restore stability.

Dr. Malicky described his experience with two patients who had mid-foot sprains. One, an adult man, arrived in his office six months after a 200-pound object had fallen on his foot. He’d been treated at the time for a bruise, but the foot was still painful. That patient ended up with a bone fusion for post-traumatic arthritis.

The other patient, a 17-year-old football player, was seen within a month of the injury, which occurred during a football game. Two years after surgery to re-align the bones of the foot, he is in college and playing Division II football.

Stress fractures
Stress fractures occur when a bone is being worked beyond the limits of its strength, and is happening repetitively.

“This is most common in a recreational athlete who’s just starting up a running program, a high school athlete beginning a new sport or a military recruit going to boot camp,” Dr. Malicky said. “The physical stress on the bone causes a small weakness in that bone. It’s not enough to break it in two, but the bone reacts by alerting the patient with signs of pain, swelling or redness.”

The smart thing to do at that point, Dr. Malicky said, is to stop the activity and give the bone a chance to recover. In cases where the signals are disregarded, the bone can actually break, although Dr. Malicky emphasized that is an extremely rare occurrence.

Stress fractures are small and generally don’t show up on an X-ray at the time they’ve occurred, but if an X-ray is taken a month later, it will show healing in the area. Rest is the most effective treatment for a stress fracture.

Other interventions may include immobilizing the affected area, cross-training, orthotics and gradual resumption of the original activity once the pain has completely subsided. Some modifications may be made, such as ensuring that shoes are properly fitted and that the terrain on which they’re working on isn’t contributing to the problem.

Dr. Eric Malicky:
Good Hope Clinic
3003 W. Good Hope Rd.
Milwaukee, WI 53209
414-352-3100

East Mequon Clinic
12203 N. Corporate Pkwy.
Mequon WI 53092
262-387-8300

For more information related to common sports injuries of the foot and ankle, visit ortho.ah.com.

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