The most common type of ankle sprain is the inversion sprain. Upwards of 85% of ankle sprains are of the inversion variety. It occurs when the foot is forcefully inverted or rolled inward, while the foot/ankle is in some degree of plantar flexion, affecting the lateral aspect of the ankle. When this injury to the ankle occurs, the lateral ligaments are stretched, sprained and possibly torn. There are three ligaments that are potentially involved. First, the anterior talofibular ligament (ATF). It is the weakest of the 3 and the most commonly involved ligament in the inversion sprain. Next is the calcaneo-fibular ligament (CF). Lastly, and the least frequently injured ligament in the inversion sprain of the ankle, is the posterior talofibular ligament (PTF).
Severity of symptomatology will dictate the area(s) of pain. In the acute inversion sprain there will be generalized pain throughout the medial and lateral aspect of the ankle. There will also be point tenderness along the anterior and distal end of the lateral ankle. All planes of motion, both active and passive, will produce pain and discomfort especially upon inversion and plantar flexion.
Grade 1: This is a mild stretching within the anterior talofibular ligament (ATF) without instability, has little swelling or tenderness, and has some joint laxity.
Grade 2: This is a partial tear of the ligaments, in which they are stretched to the point that they become instable with joint laxity. This grade involves the anterior talofibular ligament (ATF) and the calcaneo-fibular ligament (CF). It will also have moderate swelling and abnormal ranges of motion.
Grade 3: This is a complete tear or rupture of both the ATF and CF. Bruising may also occur around the ankle and foot. Grade 3 will have moderate to severe swelling, joint laxity and instability, loss of function, and abnormal motion.
When an ankle inversion sprain occurs, bony involvement must also be suspected. In any sprain, blood vessels will leak fluid into the tissue that surrounds the joint. White blood cells responsible for inflammation migrate to the area, and blood flow increases. The inflammation and swelling will create pain of a throbbing nature. Warmth and redness are also seen as blood flow increases.
Fractures to the distal end of the fibula as well as avulsion fractures should be ruled out via x-ray and other imaging.
The initial focus will primarily be on the reduction of inflammation utilizing the principles of RICE (Rest, Ice, Compression, and Elevation), or an ice bath. Supportive and palliative foot taping will usually be of value once initial symptomatology begins to reduce. In more severe cases, crutches may be needed so the patient is able to move and keep the foot non-weightbearing
Gradual mobilization and chiropractic adjustments for the foot and lower extremity will be introduced as swelling and pain decrease.
Utilization of flexible functional orthotics that support all arches of the feet and allow for optimal/normal ranges of motion can also be utilized to stabilize the foot when weightbearing.
Rehabilitative foot exercises focusing on eversion, plantar flexion and dorsiflexion will aid in stabilizing and strengthening of the joints involved. Proprioception activities can be initiated utilizing a balance board or trampoline.
Medically, the use of NSAIDs, (non-steroidal anti-inflammatory drugs) is common. In some cases, (usually grade 3 and infrequently grade 2) a surgical consultation may be required as conservative care will not be of the greatest benefit to the patient.
Stress fractures are tiny, hairline breaks that can occur in the bones of the foot. Stress fractures typically occur with activities and sports that involve running and jumping. There is a high tendency of stress fractures to recur. About 60% of people who have a stress fracture have also had one previously exercising, walking or standing.
There are a variety of causes including overtraining/overuse, improper training habits, running on rough or uneven surfaces, improper shoes or improper fitting shoes, a rigid foot, foot deformities, and osteoporosis. Stress fractures of the feet seem to be more common in women, especially in women who do not have regular menstrual cycles. A reduction in estrogen can cause osteoporosis. These tiny breaks in the bones of the feet have the potential to progress to a complete break if left untreated.
Pain to varying degrees, from mild to sharp and severe, swelling, redness, and possibly bruising can be signs of a stress fracture. The fracture can occur almost anywhere in the foot.
Positive diagnosis is via X-ray or MRI. However, many stress fractures will not show on typical X-rays for days or weeks, and sometimes will not be visible on imaging at all.
Common Stress Fractures of the Foot
Metatarsal Stress Fracture
Metatarsal stress fractures are a very common source of foot pain and symptomatology. This fracture is also known as a March Fracture. In adults 25% of fractures are in the metatarsal bones.
This injury was first described in 1902 by Sir Robert Jones. A Jones fracture is a break at the proximal end of the fifth metatarsal on the lateral aspect of the foot. Common symptoms of a Jones fracture are pain when walking plus bruising and swelling over the 5th metatarsal.
Navicular Stress Fracture
Navicular stress fractures are a common foot injury in athletes. Navicular stress fractures tend to occur in athletes who sport requires explosive movements and sudden changes in direction—commonly injured athletes include high jumpers, sprinters, basketball, and soccer players.
Treatment includes rest, elevation, and casting/bracing to immobilize the foot. In some cases crutches or a walking stick may be necessary. In general the patient can begin full weightbearing 2 weeks after the symptoms started. Weightbearing stimulates healing. It is important to begin weightbearing gradually and initially avoid the activity that caused it as the possibility of recurrence of the fracture is high. Non-weightbearing motion is an excellent place to start.
Slow gradual resistance exercises involving all ranges of motion will help to stabilize and strengthen the associated joints and help prevent a recurrence.
The use of functional orthotics will be beneficial to support and stabilize the foot through the weightbearing gait cycle.
Medically, NSAIDs, (non-steroidal anti-inflammatory drugs) may be recommended for pain. In a small percentage of cases surgery may be required to stabilize the fracture especially in the case of a recurrence.