Around thirty million adolescents and children participate in organized sports. It is estimated there are three million sports related injuries that require the athlete to miss playing time. In high school age athletes, football has the highest injury rate followed by wrestling. The lowest injury rates are found in gymnastics, basketball, baseball, softball, track and field and cross-country. Injury rates are similar for sports where both males and females participate.
Foot injuries are more common in sports that involve running and kicking. Ankle injuries are common in gymnasts and tennis players.
Three bones, the tibia, fibula and talus, come together to form the ankle joint, which is termed a mortise joint. The inner aspect of the ankle is termed the medial malleolus and has the feel of a bony knob. The outside is termed the lateral malleolus and it also feels similar to a bony knob. The Achilles tendon can be felt behind the ankle. It connects the calf muscle or gastrocnemius to the heel or calcaneus.
The ankle has ligaments, which are strap like tissues that help to stabilize the joint. The foot consists of twenty-six bones including the tarsals, metatarsals and phalanges. The tarsals lie at the base of the ankle. In the midfoot are the metatarsal bones. The great toe consists of two phalanges and the remainder of the toes consist of three phalanges each.
Muscles that run from the leg to the tarsal or metatarsal bones also stabilize the ankle. A number of muscles control the function and movement of the toes.
Ankle sprain is one of the most common injuries in sports. This injury usually involves the outside or lateral ligaments and typically follows an inversion or twisting inward foot motion. This motion causes tension on the ligament and ligamentous disruption follows. The athlete reports tenderness and swelling over the outside of the ankle joint. Ankle injuries are divided into mild, moderate or severe categories. The initial management includes Rest, Ice, Compression and Elevation. This is the RICE treatment. A clinician should be consulted for anything but the mildest symptoms. X-ray studies may be indicated. Depending on the severity of the symptoms, a clinician may prescribe an air cast or other ankle splint or even casting. Activities may at first be restricted followed by slow introduction to walking, jogging and running.
Some athletes have recurrent ankle sprains that are noted during a preparticipation physical examination. Examination may indicate ligamentous laxity that may contribute to lateral ankle instability and resulting in chronic ankle sprain. The clinician can recommend a strengthening program that should improve lateral ankle stability.
Sever’s disease is an overuse injury that affects the back of the heel or calcaneus at the location where the Achilles tendon is attached. This disease is most commonly seen in younger adolescent boys who participate in gymnastics, basketball or soccer. Some of these teens also have decreased flexibility of the Achilles tendon. The teen will complain of heel pain and tenderness over the heel. Running seems to worsen the pain.
Most of the teens with Sever’s disease continue with their daily activities. Some however need rest from running with a gradual reintroduction to sports over six to eight weeks. A heel pad placed into the shoes may help to reduce the tension on the Achilles tendon; heel cord stretching exercises may also be helpful. Some clinicians order x-rays to rule out bony abnormalities that also produce heel pain.
Metatarsalgia is a condition that gives rise to discomfort in the ball of the foot. It can be aggravated by certain sports especially those that involve running. Long distance running on hard surfaces in poorly made or poorly fitting shoes may contribute to metatarsalgia.
The metatarsal bones are usually tender to pressure if felt near the arch of the foot. Sometimes a callus can also be noted over the bones, which may be visually prominent. Treatment consists of pads or bars placed across the sole of the shoe.
The fascia is a fibrous tissue below the skin overlying the arch of the foot. Seen in long distance runners, especially those running on hills or in athletes who wear poorly fitted shoes; plantar fasciitis may give rise to pain and tenderness in the arch of the foot. This is a condition where the supporting structure of the longitudinal foot arch becomes inflamed usually due to repetitive foot striking. Some adolescents complain of foot pain as soon as they come out of bed in the morning. The treatment includes rest at first, acquisition of appropriate running shoes and possibly the use of orthotics. Stretching exercises including pointing the foot upward and downward may also be helpful as well non-steroidal analgesics.
Turf toe is a hyperextension or upward twisting injury of the great toe. Seen especially in football players who play on artificial turf, the teen will complain of pain, tenderness and swelling of the metatarsophalangeal joint of the great toe. Treatment includes non-steroidal pain relievers, rest and shoe inserts for moderate or severe cases.
The toenails are quite prone to injuries especially for teen athletes who do not wear shoes during athletics. The great toenail is the most vulnerable to injury. After some injuries to the toenail, blood may form underneath it causing a condition known as subungual hematoma. This is especially common in soccer or tennis players. Treatment done by the clinician may include penetrating the nail with a hot paper clip or drill to allow the blood to drain. Some soccer players lose two or three toenails each season due to subungual hematoma. Taping the nail may offer some protection from this injury.
Teens who are involved in prolonged walking, running or dancing activities as well as cross country, long distance running or high impact aerobics programs may develop stress fractures. These are most commonly seen in the second and third metatarsals. The teen may complain of foot pain, and routine x-rays may not demonstrate a stress fracture. A bone scan can be utilized to detect the presence of a fracture. Most individuals with a foot stress fracture will do well with restriction of their activities until the symptoms subside. In some teens, a cast may be necessary to help relieve symptoms.
When training for sports such as running commences, there is increased stress applied to the foot bones. No increased mineral content occurs until after two weeks of training; in fact, there is some resorption of bone during the first two weeks, so the bones are in a slightly weakened state. Muscle strength increases more rapidly. By the third and fourth week of training, there is an increase in bone formation. Stress fracture has been decreased in military recruits where the training intensity has been lessened during the third week of training. Teens should undergo training in a supervised and structured program, and report any persisting foot pain to their clinicians.
Related topics:
Athletic injuries, exercise, footwear, shin splints, sports, stress fractures
