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FOOT & ANKLE

Foot & Ankle Anatomy

The tibia, fibula and talus meet to form a complex hinge that does move to a mild degree towards the inside and outside, as well as rotates clockwise and counter-clockwise. view 

Foot & Ankle Sprains

A foot/ankle sprain s an injury which a ligament around the foot/ankle gets stretched or the ligament can be partially or completely torn.  view

Foot and Ankle Fractures/Dislocations

These fractures usually occur from a fall or a twisting injury and may or may not be associated with an ankle dislocation. view 

Foot and Ankle Tendon Disorders

The common tendon disorders about the foot/ankle include bursitis, tendonitis, and tendon tears.   view 

SPRAINS

Pathology

A foot/ankle sprain s an injury which a ligament around the foot/ankle gets stretched or the ligament can be partially or completely torn. These injuries can be caused by one specific injury, such as a fall or while playing sports, or by repetitive microtrauma overtime, often referred to as overuse injuries. When a foot/ankle sprain occurs, there can be pain, weakness, difficulty walking or playing sports, bruising, swelling, and feelings of instability. A physical exam is important to find out which ligament has been injured, whether the injury is partial or complete, and whether any other structures have been injured. X-rays will show any fractures, dislocations, or any evidence of arthritis. An MRI may be necessary to better image the ligaments, tendons, and/or cartilage surfaces to determine the extent of any injury to these structures.

 

Treatment

The initial treatment of foot/ankle sprains will utilize non-operative treatment measures. The most common symptomatic treatment used for all types of soft tissue injuries has three approaches:

  1. R.I.C.E. treatment,
  2. Anti-inflammatory treatment
  3. Controlled early motion and therapy

The acronym RICE stands for Rest, ice, compression and elevation. Rest is usually done for 24-48 hours, and can include the use of slings, splints or other types of immobilizers unless otherwise advised by a physician. Ice is used for no more than 20-30 minutes at a time, three to four times per day. Ice is best applied by using an ice slush which transmits the effects of the cold sensation best and can be made by crushing ice and mixing it with water and then placing it in a zip lock plastic bag. The ice bag should not be placed in direct contact with the skin but instead should have a layer between the skin and ice bag like a towel to prevent the skin from freezing. The ice should be applied for no more than 20-30 minutes to avoid skin freezing as can occur if you fall asleep with an ice pack on your limb. Ice functions by causing the arteries to narrow the size of their lumen which in turn decreases swelling and the pain from swelling.

Compression is the wrapping of a body part to further assist in minimizing swelling and is used in conjunction with elevation. The best way to do a compressive wrapping is by having the compression have multiple layers that provide a cushion effect. The compression should be wrapped without causing the constriction of the blood supply which is recognized by increasing pain to the body part wrapped. Other signs of a tight compressive dressing are the cold sensation of the wrapped limb, blue discoloration of the body part, or change in color from the natural skin color. Elevation of an injured body part is best done by elevating the limb to the level of the heart. If elevation is lower than this, the effects of gravity on the veins, will increase vein pressure and cause the blood in these veins to have difficulty traveling back to the heart and result in limb swelling.

The use of anti-inflammatory medication helps treat the pain, swelling, and inflammation that occurs after injury is imparted on a limb. Examples of anti-inflammatories includes aspirin products, Ibuprofen (Motrin® and Advil®), Naproxen (Aleve® and Naprosyn®), Mobic®, Indocin®, Arthrotec®, and Celebrex® to name a few. All of these medications have side effects and should be taken with this knowledge in mind. Prescriptions should be discussed with your pharmacist and physician.Controlled early motion and therapy to the involved limb decreases the effects of prolonged immobilization which includes stiffness, muscle atrophy, weakness and a longer return to the pre-injury state. The type of therapy recommended will depend on the tissue type injured and the severity of this injury. Consult your surgeon for the best advice. The surgeon may also recommend the use of some sort of foot/ankle brace to be worn for added support while the patient goes through therapy or returns to sports/work.

When more than one of the ligaments in the foot/ankle have been completely torn and the patient is having feelings of foot/ankle instability, surgery may be required if nonoperatve treatment measures have not provided relief. Surgery allows for either the repair or reconstruction of these ligaments to provide the stability required for normal foot/ankle motion and function.