Foot Problems in Athletes

If you're athletic, eventually you'll have a problem with your foot or ankle.

These are some of the most common foot and ankle problems in athletes.

Turf Toe

Turf toe is a sprain of your big toe joint resulting from injury during sports activities. The injury is usually caused by excessive upward bending of your big toe joint. Jamming the toe, and repeatedly pushing off when running or jumping are common causes. Although most common in football players, those who play soccer, basketball, wrestling, gymnastics and dance also are at risk.

The injury is called “turf toe” because it’s especially common in athletes who play on artificial turf. The less-supportive, flexible shoes worn on this surface and the foot’s tendency to “stick” to turf are some reasons why artificial turf may be partly to blame.

The signs and symptoms of turf toe can include pain, swelling and limited joint movement. If turf toe iscaused by repetitive actions that cause injury, the signs and symptoms will usually begin slowly and can gradually worsen. Turf toe can also be caused by a direct injury leading to damage of the bone beneath the cartilage. If direct injury is the cause, the signs and symptoms may begin suddenly and get worse over a 24-hour period.

Diagnosis Typically Includes:

  • Medical history
  • Physical exam of the foot
  • X-ray to rule out any broken bones.

Treatment Typically Includes:

  • R.I.C.E. (rest, ice, compression and elevation)
  • Switching to less flexible footwear
  • Surgery, in severe cases

Stress Fracture

A stress fracture is a common overuse injury. Usually, a fracture, or broken bone, is caused by an acute event, such as a car crash or a fall. When this is the case, the bone experiences a very high force that causes the fracture. A stress fracture occurs when the forces are much lower, but happen repetitively for a long period of time; these injuries are also known as "fatigue fractures."

Stress fractures are commonly seen in athletes who run and jump on hard surfaces, such as distance runners, basketball players and ballet dancers. A stress fracture can occur in any bone, but most common in the foot and shin bones.

If you increase your level of activity over a short period of time, a stress fracture is more likely. The increased demand placed on these bones causes them to remodel and become stronger in the areas of higher stress. However, if the response of your bones can’t keep up with the repetitive demands, a stress fracture may result.

Dietary and menstrual irregularities can also contribute to stress fractures, as both contribute to overall bone health. Poor nutrition, anorexia, bulimia or unusual menstruation may place you at a higher risk for these injuries.

Diagnosis Typically Includes:

  • Physical examination and medical history
  • X-ray, which may show a bone attempting to heal around a stress fracture
  • MRI or bone scan, if the initial diagnosis is unclear.

Treatment Typically Includes:

  • Resting the injured leg
  • Icing the injured area
  • Wearing proper equipment, especially footwear
  • Increasing activity gradually

One rule of thumb (but not an absolute rule) is: if there is pain, don't do it. If jogging causes pain where you have a stress fracture, don't jog. If walking causes pain in that location, use crutches. If pain develops and persists, see you doctor.

Tarsal Tunnel Syndrome

The tarsal tunnel is a space in your foot formed between bones and overlying fibrous tissue. Within the tarsal tunnel lies a nerve called the posterior tibial nerve. The tarsal tunnel is walled on one side by sturdy bones, and on the other by tough fibrous tissue.

When the posterior tibial nerve is pinched in the tarsal tunnel, numbness over the bottom of the foot is common, as is pain, burning and tingling over the base of the foot and heel. Occasionally, tarsal tunnel syndrome is confused with plantar fasciitis, or heel spurs.

It isn’t always possible to pinpoint the cause of tarsal tunnel syndrome, though fractures, bone spurs, ganglions and other benign tumors, muscle impingement, and foot deformities can lead to the condition.

Treatment Typically Includes:

  • Anti-inflammatory medications
  • Possible injection of cortisone around the nerve
  • Using different footwear, possible including orthotics.

If none of these measures helps, then a procedure called a tarsal tunnel release may be necessary. During this procedure, an incision is made to open up the tarsal tunnel and decrease pressure on your posterior tibial nerve. This surgery is very similar to a carpal tunnel release in the wrist.

Achilles Tendonitis or Tendon Tear

Achilles tendonitis is irritation and inflammation of the large tendon in the back of your ankle. It’s a common overuse injury in recreational athletes that causes pain and swelling. This is different from Achilles tendinosis, which is caused by degenerative, microscopic tears within the tendon, and also results in swelling and pain.

Achilles tendonitis is typically caused by a lack of flexibility, over-pronation, recent changes in footwear and recent changes in exercise training schedules. Middle-aged recreational athletes are most susceptible to Achilles tendonitis, due to a loss of flexibility in the tendons as you age.

The main symptom is pain behind the heel, usually in an area two - four centimeters above the location where your tendon attaches to your heel. The most significant pain usually occurs after you’ve been inactive – such as when you first walk in the morning, or when you get up after sitting for a long period of time. Running, jumping and other similar activities may also be painful. Achilles tendonitis pain associated with exercise is most significant when you’re pushing off or jumping.

Treatment Typically Includes:

  • Icing the affected area
  • Resting the tendon
  • Crutches or immobilization of the ankle may be required
  • Medication, injections or surgery may be needed for more serious cases.

An Achilles tendon tear occurs when the tendon attaching your calf muscle to your heel is completely torn. This injury is common, especially in middle-aged, male, “weekend warriors.”

This injury causes sudden pain behind your ankle. You may hear a 'pop' or a 'snap,' and will almost always feel as though you’ve been kicked in the heel. If you experience this injury you’ll have difficulty pointing your toes downward, and may have swelling and bruising around the tendon.

About 15 to 20 percent of patients have symptoms of Achilles tendonitis before they experience an Achilles tendon tear, but most patients have no prior history of Achilles problems. More than 75 percent of Achilles tendon tears are associated with playing ball sports, especially basketball or tennis. Other risk factors that are associated with Achilles tendon rupture include cortisone injections into the Achilles tendon, gout and fluoroquinolone antibiotic use.

Your doctor will examine your ankle for continuity of the tendon. A defect in the Achilles tendon can often be felt after a tear. In addition, flexing your calf muscle should cause your foot to point downwards, but if you have a torn Achilles tendon, your foot won’t move. Your doctor may also order an X-ray to check for other potential conditions including ankle fracture or ankle arthritis.

There are surgical and non-surgical treatment options. If you opt for surgery, it’s likely you’ll be able to get back to the sports you love more quickly, and there is probably a smaller chance that you’ll re-tear the tendon. If you opt for a non-surgical approach, you’ll avoid any potential risks associated with surgery, and your long-term results should be similar to patients who do have a surgical procedure. Discuss the pros and cons of each approach with your physician.