Foot And Ankle Injuries

The NCH Healthcare System’s orthopedics physicians treat a variety of foot and ankle injuries.

Stress Fractures

A stress fracture is a small crack in a bone or severe bruising within a bone. Most stress fractures are caused by overuse and repetitive activity and are common in runners and athletes who participate in running sports, such as soccer and basketball.

Stress fractures usually occur when people change their activities — such as by trying a new exercise or suddenly increasing the intensity of their workouts. In addition, if osteoporosis or other disease has weakened the bones, just doing everyday activities may result in a stress fracture.

The weight-bearing bones of the foot and lower leg are especially vulnerable to stress fractures because of the repetitive forces they must absorb during activities like walking, running and jumping.

The most common symptom of a stress fracture in the foot or ankle is pain. The pain usually develops gradually and worsens during weight-bearing activity. Other symptoms may include:

• Pain that diminishes during rest
• Pain that occurs and intensifies during normal, daily activities
• Swelling on the top of the foot or on the outside of the ankle
• Tenderness to touch at the site of the fracture
• Possible bruising

See your doctor as soon as possible if you think that you have a stress fracture in your foot or ankle. Ignoring the pain can have serious consequences. Treatment will vary depending on the location of the stress fracture and its severity. The majority of stress fractures are treated nonsurgically.

Sprained Ankle

A sprained ankle is an injury that occurs when you roll, twist or turn your ankle in an awkward way. This can stretch or tear the tough bands of tissue (ligaments) that help hold your ankle bones together.

Ligaments help stabilize joints, preventing excessive movement. A sprained ankle occurs when the ligaments are forced beyond their normal range of motion. Most sprained ankles involve injuries to the ligaments on the outer side of the ankle.

Signs and symptoms of a sprained ankle vary depending on the severity of the injury. They may include:

• Pain, especially when you bear weight on the affected foot
• Tenderness when you touch the ankle
• Swelling
• Bruising
• Restricted range of motion
• Instability in the ankle
• Popping sensation or sound at the time of injury
• When to see a doctor

Call your doctor if you have pain and swelling in your ankle and you suspect a sprain. Self-care measures may be all you need but talk to your doctor to discuss whether you should have your ankle evaluated. If signs and symptoms are severe, you may have significant damage to a ligament or a broken bone in your ankle or lower leg.

For self-care of an ankle sprain, use the R.I.C.E. approach for the first two or three days:

Rest
Avoid activities that cause pain, swelling, or discomfort.

Ice
Use an ice pack or ice slush bath immediately for 15 to 20 minutes and repeat every two to three hours while you’re awake. If you have vascular disease, diabetes, or decreased sensation, talk with your doctor before applying ice.

Compression
To help stop swelling, compress the ankle with an elastic bandage until the swelling stops. Don’t hinder circulation by wrapping too tightly. Begin wrapping at the end farthest from your heart.

Elevation
To reduce swelling, elevate your ankle above the level of your heart, especially at night. Gravity helps reduce swelling by draining excess fluid.

Ankle Replacements

In this procedure, the surgeon removes the ends of the damaged bones and fits a plastic-and-metal replacement joint onto them. The artificial joint helps the ankle retain more-natural movement, so there’s less risk of arthritis developing in nearby joints. However, the loosening of the components can occur.

Artificial ankle joints are generally recommended for healthy people over the age of 60 who have less-active lifestyles. High-impact activities such as running and jumping can damage an artificial ankle joint.

Ankle replacement might not be a good choice if you:

• Are younger than 50
• Have weakened ankle ligaments
• Participate in high-impact sports or work
• Have misaligned ankle bones
• Are significantly overweight
• Have nerve damage from diabetes
• Are a heavy smoker
• Ankle fusion: in this procedure, the surgeon roughens the ends of the damaged bones and then fastens them together with metal plates and screws. During the healing process, the damaged bones fuse together into one combined bone.

Ankle fusion is usually very successful in relieving arthritis pain. But it also reduces the ankle’s motion. To make up for this, nearby joints may move more — which increases the risk of developing arthritis in these joints.

Ankle fusion is usually recommended for younger people with more-active lifestyles. Compared with ankle replacement, ankle fusion:

• Is generally more durable
• Requires fewer restrictions in activity during recovery

Consult with an orthopedic surgeon to determine if ankle replacement or ankle fusion is the right treatment for you.