Sprains, Strains and Other Foot Problems
with Anthony Ferguson M.D.
Dr. Anthony Ferguson, an orthopaedic surgeon and foot and ankle specialist with Columbia St. Mary's, sees patients of all ages and fitness levels, from athletes to couch potatoes. Usual problems include the fairly benign sprains and strains, tears to cartilage and ligaments that may require arthroscopic surgery, growth plate injuries in young athletes, which are almost always serious, and fractures.
Annoying injuries
They can happen to anyone…a wrong step or even a light fall with a bad landing and suddenly the ankle starts to throb and swell. It may be a sprain (an injury to the ligament), a strain (an overstretch of the muscle or tendon) or a break. In those few hours after the injury, it's often hard to tell the difference.
"If you can walk on the ankle, if it feels stable, you can rest and ice it and give it some time to heal. If you can't walk or if the pain continues to be unbearable that's the injury that needs to be seen by the doctor," said Dr. Ferguson.
"I also see patients who have ankle sprains and tried to rest them but their ankles keep giving out on them. These are the ones who also need to be treated," the doctor said.
Treatment does not always require surgery. Sometime bracing and therapy can help. However, the doctor stressed the need for a close evaluation of the injury. This will include diagnostic tools such as X-rays and MRIs. However, these may miss significant problems in the ankle joints.
"As a treating surgeon, I put together the whole history of the injury and follow up with a physical exam. Your physical exam is more important than an MRI in many situations," Dr. Ferguson said.
Dr. Ferguson may order physical therapy or order custom insoles to realign the foot. He may also suggest lifestyle changes to prevent further injuries. "A lot depends on what a person is willing to give up. A person who has problems playing basketball but who is fine with daily living may just want to give up the sport," he said. "If not, then more aggressive intervention may be necessary to return to one's prior level of activity."
Dr. Anthony Ferguson, Orthopaedic Surgeon
Columbia St. Mary's
"The thing I see that is most frustrating is people who ignore a lot of foot problems that can be treated fairly simply with inserts or proper shoes or therapy; and when they do come in it has gone so far that they need surgery."
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Growth plate problems
The growth plate is the area of developing tissue at the end of the long bones of the body, such as the major bones of the leg and the foot. Once a child's growth is complete, the plate is replaced with bone. If a growing athlete injures a growth plate, it may interfere with future growth of that limb.
Dr. Ferguson said he sees a lot of growth plate injuries, especially around the ankles and that the symptoms can mimic a strain. "As a general rule, if a child has pain on one of the bones around the ankle, or who gets an injury that causes a severe limp or can't bear any weight at all, he should be evaluated," the doctor said.
He stressed that growth plate injuries must be treated very conservatively, usually with a cast or a boot to assure the plate heals with proper alignment.
Avoiding injury in children's sports
While any child active in sports can suffer a growth plate injury, proper conditioning can help avoid them, as well as other problems. "We see a lot of kids sent out on the soccer field without adequate warm-ups. Quite often these kids are also on two or three different teams. Improper warm-ups and overusing muscles can cause muscle fatigue, predisposing kids to injury," Dr. Ferguson said.
Foot surgery
Foot and ankle surgery is almost always outpatient surgery. Often it is arthroscopic surgery, which requires little cutting of the soft tissue around the joint. "We do everything we can to allow early motion and early weight bearing. For ligament reconstruction or serious injuries, we may immobilize the joint, but the whole goal is to make the recovery as rapid as possible and still allow healing," the doctor said.
Follow-up physical therapy will depend on the type of injury to help the patient restore proper foot balance.
