Achilles tendonitis is an overuse syndrome that occurs with repetitive microtrauma, or from a larger, sudden stress to the Achilles tendon (Figure 1). The condition usually presents with pain and swelling of the tendon, close to its insertion into the heel bone. It can coexist with a bursitis, or with a protrusion of the heel bone posteriorly called Haglund's deformity or retrocalcaneal exostosis.
Treatment begins with rest, stretching, icing, and oral anti-inflammatory medications like Advil. Add a quarter inch heel lift to the shoes to make it easier for the Achilles to propel the foot forward. Be sure to add the lift to both shoes to maintain hip balance. Specially designed sport orthotics (custom supports) decrease the torque on the Achilles tendon during walking and running. If the condition persists, a sports podiatrist should be consulted.
The most common ankle sprain is the "inversion" sprain, in which the sole of the foot turns inward. In this injury, the ligaments connecting the leg to the foot are stretched, partially torn, or in severe cases, completely ruptured (Figure 2). Ankle sprains most commonly occur in basketball and volleyball players who land improperly from a jump and roll over the outside of the foot. Sprains can occur in any sport when an athlete falls or stumbles while in motion.
Proper treatment necessitates an accurate assessment of the degree of ligament damage. The injury usually consists of a stretch or partial rupture of a single ligament. This can be treated with rest, icing, anti-inflammatory medicines like Advil, and compression with an ankle splint or brace. The doctors of North Shore Foot & Ankle use splints that often allow the athlete to return to their sport.
More severe ankle sprains that involve more than one ligament, or where a ligament has ruptured will need more aggressive treatment. This means immobilization with pneumatic, removable "casts", or surgery to repair the ligaments. Physical therapy plays a role in the rehabilitation of most ankle sprains.
Hallux Rigidus (Traumatic arthritis of the big toe joint)
Jamming of the big toe joint is the most common way Hallux rigidus develops. Initially, the joint will be swollen and tender. As the condition worsens, pain increases and joint motion becomes limited as bone spurs and other arthritic changes develop in the joint.
In the early stages, a cortisone injection is usually effective. Stiff soled shoes should be worn to decrease bending at the big toe joint. Orthotics (custom supports) reduce pressure on the joint and encourage normal joint motion.
In later stages, or if the patient does not respond to conservative care, surgery is indicated to remove the damaged portions of the joint.
Plantar Fasciitis and Heel Pain
In athletic children and adolescents, posterior heel pain may be caused by Calcaneal Apophysitis (posterior heel pain in children and adolescents).
A stress fracture is a subtle crack in the bone, rather than a full break. Stress fractures are most likely to occur when the sport activity is new to the athlete or particularly strenuous, such as running a marathon. The athlete with a stress fracture will have sudden onset of pain and swelling. Metatarsals, the long bones behind the toes, are the foot bones that are most prone to developing stress fractures. Because the fracture is a subtle crack, it is usually not visible on x-ray, initially, and the diagnosis can be missed. After two to three weeks, the body lays down bone around the fracture to splint it, and this can be seen on x-ray (Figure 3, Arrow).
Treatment of stress fractures of the foot requires about four weeks in a removable pneumatic cast. The patient may continue walking in the cast.
Shin splints is an overuse injury of the muscles of the leg that control the foot. Symptoms include pain and soreness in the leg muscles. It is important to treat shin splints, because shin splints are a precursor of tibial stress fracture, an injury that can sideline an athlete for months. Anterior shin splints affect the muscles that lie in the front of the leg near the edge of the shin bone (tibia). These muscles are responsible for bringing the foot and toes upward. Anterior shin splints are common in race walkers and tennis players. Treatment involves exercises to strengthen the anterior leg muscles.
Posterior shin splints affect the muscle group inside and behind the shin bone (tibia). These muscles are responsible for resisting pronation (flattening) of the foot. Treatment begins with arch supports to help the muscles support the foot. If arches do not resolve the condition, custom orthotics are indicated.