Foot & Ankle Trauma

Achilles Tendon Bursitis :: Achilles Tendon Rupture :: Ankle Sprains :: Stress fracture of the foot :: Ankle Fracture

Achilles Tendon Bursitis

Achilles tendon bursitis or retrocalcaneal bursitis is a condition that commonly occurs in athletes. It is a painful condition caused by swelling of bursa, a fluid-filled sac which is located at the back of the heel under the Achilles tendon. This retrocalcaneal bursa contains a lubricating fluid that acts as a cushion to reduce friction between muscle and bones. Achilles tendon is the large tendon that connects the calf muscles to the heel bone (calcaneous) and is used when you walk, run, and jump.

Achilles tendon bursitis is caused by overuse of the ankle which results in irritation and inflammation of the bursa. The common causes include too much of walking, jumping, or running, Achilles tendon bursitis can also occur in conjunction with Achilles tendinitis, inflammation of the Achilles tendon.

Children who suddenly increase their level of physical activity are at a higher risk of developing Achilles tendon bursitis.

The most common symptom is pain and tenderness at the back of the heel especially while walking or running. Pain increases when standing on tiptoes. In some cases, the skin at the back of the heel may become warm and red.

Your doctor may diagnose the condition based on the symptoms and physical examination of the ankle. Diagnostic tests such as X-ray and MRI may be required later on if the treatment does not improve the symptoms.

Treatment

The initial treatment for Achilles tendon bursitis includes

  • Restrict the activities that cause pain.
  • Apply ice on the injured area which will help to reduce the swelling. Ice should be wrapped on a cloth and applied rather than direct application.
  • Nonsteroidal anti-inflammatory medications may be given to reduce the inflammation and pain.
  • Custom heel wedges can be used to reduce the stress on the heel.
  • Physical therapy may be recommended which will help to restore and improve the flexibility and strength of the muscles, tendons, and joints around the ankle.
  • Corticosteroid injections may be injected into the bursa to reduce swelling and pain. You must ensure that your child does not over stretch the tendon after the injection as it may lead to Achilles tendon rupture.
  • If retrocalcaneal bursitis is associated with Achilles tendonitis, it may be necessary to immobilize the ankle for several weeks until healing takes place. This can be done by applying a cast on the ankle, which limits ankle movement and allows the tendon to rest.

Surgery is considered only when all non-surgical treatment fails to resolve pain and inflammation.
Bursectomy is a surgical procedure done to remove an inflamed or infected bursa.
Achilles tendon bursitis may be prevented by maintaining proper form during exercises. Ensure that your child does some warm up exercises before the start of any sports activity which may help prevent injury of the Achilles tendon.

 

Achilles Tendon Rupture

Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to heel bone. It is used when you walk, run and jump. When the Achilles tendon becomes thin, weak, or if it is not used, it may be susceptible to injury or damage. Achilles tendon rupture occurs most often in middle-aged athlete participating in sports that involve running, pivoting, and jumping. Recreational sports that may cause Achilles rupture include tennis, racquetball, basketball, and badminton.

If Achilles tendon is ruptured you will experience severe pain in the back of your leg, swelling, stiffness, and difficulty to stand on tiptoe and push the leg when walking. A popping or snapping sound is heard when the injury occurs. You may also feel a gap or depression in the tendon, just above heel bone.

Your doctor diagnoses the rupture based on symptoms, history of the injury and physical examination. Your doctor will gently squeeze the calf muscles, if the Achilles tendon is intact, there will be flexion movement of the foot, if it is ruptured, there will be no movement observed.

Achilles tendon rupture is treated using non-surgical method or surgical method. Non-surgical treatment involves wearing a cast or special brace which is changed after some period of time to bring the tendon back to its normal length. Along with cast or brace, physical therapy may be recommended to improve the strength and flexibility of leg muscles and Achilles tendon. Surgical procedure involves opening the skin and suturing the torn tendon together. Surgery helps to decrease the recurrence of the Achilles tendon in comparison to the non-surgical treatment.

To help prevent an Achilles tendon injury, it is a good practice to perform stretching and warm-up exercises before any participating in any activities. Gradually increase the intensity and length of time of activity. Muscle conditioning may help to strengthen the muscles in the body.

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Ankle Sprains

A sprain is stretching or tearing of ligaments, which connect adjacent bones in a joint and provides stability to the joint. An ankle sprain is a common injury and occurs when you fall or suddenly twist the ankle joint or when you land your foot in an awkward position after a jump. It most commonly occurs when you participate in sports or when you jump or run on a surface that is irregular. Ankle sprains can cause pain, swelling, tenderness, bruising, and stiffness, numbness in the toes, and inability to walk or bear weight on the ankle.
The diagnosis of an ankle sprain is usually made by asking the history of injury and physical examination of the ankle. X-ray of your ankle may be needed to confirm if a fracture is present.

The most common treatment recommended for ankle sprains is rest, ice, compression and elevation (RICE).

  • Rest: You should not move or use the injured part to help to reduce pain and prevent further damage. Crutches may be used that help in walking.
  • Ice: An ice-pack should be applied over the injured area up to 3 days after the injury. You can use a cold pack or crushed ice wrapped in a towel. Ice packs helps to reduce swelling and relieve pain. Never place ice directly over the skin.
  • Compression: Compression of the injured area helps to reduce swelling and bruising. This is usually accomplished by using an elastic wrap for few days to weeks after the injury.
  • Elevation: Place the injured part above heart level to reduce swelling. Elevation of an injured leg can be done for about 2 to 3 hours a day.

The doctor may also use a brace or splint to reduce motion of the ankle. Anti-inflammatory pain medications may be prescribed to help reduce the pain and control inflammation.

You may need to use an ankle brace or wrap to support and protect your ankle during sports activities. Avoid pivoting and twisting movements for 2 to 3 weeks.

To prevent further sprains or re-injury you may need to wear a semi-rigid ankle brace during exercise, special wraps, and high-top tennis shoes. A program of ankle exercises will also help to prevent re-injury by making the ankles strong and flexible.

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Stress fracture of the foot

A stress fracture is described as a small crack in the bone which occurs from an overuse injury of a bone. It commonly develops in the weight bearing bones of the lower leg and foot. When the muscles of the foot are overworked or stressed, they are unable to absorb the stress and when this happens the muscles transfer the stress to the bone which results in stress fracture.

Stress fractures are caused by a rapid increase in the intensity of exercise. They can also be caused by impact on a hard surface, improper footwear, and increased physical activity. Athletes participating in certain sports such as basketball, tennis or gymnastics are at a greater risk of developing stress fractures. During these sports the repetitive stress of the foot strike on a hard surface causing trauma and muscle fatigue. An athlete with inadequate rest between workouts can also develop stress fracture.

Females are at a greater risk of developing stress fracture than males, and may be related to a condition referred to as "female athlete triad". It is a combination of eating disorders, amenorrhea (irregular menstrual cycle), and osteoporosis (thinning of the bones). The risk of developing stress fracture increases in females if the bone weight decreases.

The most common symptom is pain in the foot which usually gets worse during exercises and decreases upon resting. Swelling, bruising, and tenderness may also occur at a specific point.

Your doctor will diagnosis the condition after discussing symptoms and risk factors and examines the foot and ankle. Some of the diagnostic tests such as X-ray, MRI scan or bone scan may be required to confirm the fracture.

Treatment

Stress fractures can be treated by non-surgical approach which includes rest and limiting the physical activities that involves foot and ankle. If children return too quickly to the activity that has caused stress fracture, it may lead to chronic problems such as harder-to-heal stress fractures. Re-injury can also occur without allowing the stress fracture to completely heal.

Protective footwear may be recommended which helps to reduce stress on the foot. Your doctor may apply cast to the foot to immobilize the leg which also helps to remove the stress. Crutches may be used to prevent the weight of the foot until the stress fracture is healed completely.

Surgery may be required if the fracture is not healed completely by non-surgical treatment. Your doctor makes an incision on the foot and uses internal fixators such as wires, pins, or plates to attach the broken bones of the foot together until healing happens after which these fixators can be removed or may be permanently left inside the body.

Some of the following measures may help to prevent stress fractures:

  • Ensure to start any new sport activity slowly and progress gradually
  • Cross-training: You may use more than one exercise with the same intention to prevent injury. For example you may run on even days and ride a bike on odd days, instead of running every day to reduce the risk of injury from overuse. This limits the stress occurring on specific muscles as different activities use muscles in different ways.
  • Ensure to maintain a healthy diet and include calcium and vitamin D-rich foods in your diet
  • Ensure that your child uses proper footwear or shoes for any sports activity and avoid using old or worn out shoes

If your child complains of pain and swelling then immediately stop the activities and make sure that your child rests for few days

 

Ankle Fracture

Ankle injuries are the most common sports-related injury. An ankle fracture is a break in one or more bones that make up the ankle joint. Sometimes ligaments may also be damaged. Ankle fractures are most often caused by motor vehicle accident, rolling or twisting of ankle, and by tripping or falling. People participating in sports such as basketball, football, soccer and skiing are at a high risk of developing ankle fractures.

Common symptoms of an ankle fracture include pain and swelling around the ankle, bruising, tender to touch, inability to walk on the leg, and deformity if the ankle is dislocated.

Following an ankle injury it is important to have the ankle evaluated by your doctor for proper diagnosis and treatment. Diagnosis is made based on the history of injury and physical examination of the ankle. In addition, the surgeon may order X-ray of the ankle to determine the extent of the injury.

Treatment varies with the type and severity of the injury. The common method of treatment of ankle fractures is adequate rest, ice application, leg elevation, and medications to reduce swelling and pain. A short leg cast or a brace may be applied over the fractured ankle to provide support. If there is severe injury, excessive swelling or severe pain, you should seek immediate medical treatment.

Some ankle fractures are treated with a splint, which is placed on the ankle for few days until the swelling subsides. Once the swelling decreases a cast may be placed on the ankle to hold the broken bone in a specific place. Surgery may be needed to realign the bones before placing the splint. During surgery, your doctor may place metal screws, plates, or rods to hold the broken bone intact until the healing happens. In some cases, crutches may be used to prevent the ankle from bearing weight.

It is important to use proper fitting shoes for the particular sports activity to reduce the chances of injury.

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