Sports injuries

• Ankle sprains – these can range from mild to severe. They are the result of twisting the foot, causing damage to the ankle ligaments. Inversion sprains are due to twisting the foot inwards while eversion sprains result from twisting the foot outwards. The former are more common and cause damage to the outer ligaments. Eversion sprains damage the inside ligaments and tend to be more severe. it is important to get a prompt diagnosis as, left untreated, sprains can cause chronic ankle instability.
• Achilles tendonitis – this is inflammation of the tendon that runs down the back of the leg, which is the largest tendon in the body. Tendonitis is normally due to overuse or wear and tear linked to ageing. Left untreated it can cause tears or ruptures of the tendon.
• Plantar fasciitis – this is pain in the heel, caused by the band of tissues that support the arch of the foot being placed under too much stress. It is a common injury among runners. It can also be the result of problems with the structure of the foot or due to wearing inappropriate footwear during sport.
• Stress fractures – repeated impact can lead to the development of stress fractures in the foot or ankle. Unlike fractures, which are breaks in the bone, stress fractures are small cracks in the bone due to the bones being unable to absorb the stress of repeated impact. The second and third toe are particularly susceptible.
• Neuroma – this is a pinched nerve in the foot which may be the result of overuse, trauma to the foot, flat feet or wearing the wrong type of footwear. The condition causes pain, tingling or numbness in the ball of the foot and between the toes while walking.
• Heel spur – this is a bony protrusion on the heel bone, caused by a calcium deposit. It can be the result of flat feet or high arches and may exacerbated by running on hard surfaces, wearing inappropriate footwear, age, weight or gait. It can cause severe pain in the heel.
• Fractures – a fracture is a partial or complete break in the bone. Foot and ankle fractures can range from avulsion injuries (where small pieces of bone are pulled off) through to bones shattering due to severe trauma. Open fractures are those that pierce the skin. These require immediate treatment as there is a significant risk of infection and this type of fracture often requires a prolonged recovery period.

Depending on the nature and severity of the injury, you may experience mild to severe pain. Other common symptoms include inflammation, tenderness, stiffness, loss of movement, weakness and bruising. If you have an open fracture, you may also experience blood loss and a high risk of infection.

Depending on your symptoms, a range of diagnostic approaches might be used. A physical examination is the normal starting point to ascertain what is causing any pain, as well as assessing for loss of movement, weakness and swelling in the affected area. You may also be referred for diagnostic testing, such as:

• X-rays – these are used to diagnose (or rule out) fractures as well as conditions like arthritis which can cause bony spurs to develop. For some conditions a contrast dye might be injected into your joint in a procedure called an arthrogam. This helps to show up the soft tissue structures in the joint.
• MRI scans – these provide a detailed picture of soft tissues (tendons, ligaments and muscles) and can show if there is tearing or a rupture.
• CT scans – these combine X-rays with computer technology to create a detailed cross-sectional image of your body. This type of scan shows the shape, position and structure of tissues and organs.
• Ultrasound scans – these use high-frequency sound waves that echo off structures in the body.
• Bone scans – these involve injecting a small amount of radioactive material into the vein. Areas that are forming new bone – such as fractures that are healing or bone infections or tumours – show up as increased bone activity.

The treatment you receive will depend on the type and extent of your injury. If possible, non-surgical treatments will normally be tried first, however severe injuries may require immediate surgery. Treatment options for foot and ankle injuries might include:

• Using the RICE method – rest, ice to reduce inflammation, compression and elevation above the level of the heart.
• Painkillers or anti-inflammatory medication to control pain.
• Low-impact exercises such as stretches to strengthen the muscles and improve flexibility. These can also be used effectively to prevent certain types of injury, too. A physiotherapist may be able to recommend exercises for the treatment and prevention of injuries.
• Injections of corticosteroids into the joint to relieve pain and improve movement.
• Shockwave therapy may be recommended for certain types of tendon injury. Impulses of energy are targeted at damaged tissues to increase blood circulation to the affected area and encourage healing.
• Wearing correct footwear is important during sport to support the feet and ankles and prevent injury. In the case of plantar fasciitis, walking barefoot or without proper support will place more stress on the plantar fascia and could aggravate the condition.
• Orthotics may help to reduce stress on the arch of the foot or heel.
• Night splints can help to relax and stretch the plantar fascia while you sleep, helping to reduce pain. For some conditions a brace or walking cast can also help by immobilising the foot or ankle while you heal.
• Surgery may be needed to repair fractures using metal plates, screws or pins.
• Surgical reconstruction of the joint may be required for chronic ankle instability.