The body's foundation originates with the feet, which support the body
weight in a myriad of positions and function over a multitude of
surfaces and contours. Most athletic activity begins with and is
dependent on the feet. As such, the feet continually bear the brunt of
physical stresses and rapidly changing forces thrust on them from all
directions.
Injuries involving an athlete's feet are often magnified
in severity because the feet are weight bearing structures. A
relatively minor injury of the foot can impair an athlete's performance
as dramatically as a major injury to another body area. Proper and
adequate care should be given all injuries and athletic related
conditions of the feet, no matter how minor they appear.
FOOT CONDITIONS
Bunion (Hallux Valgus)
A
bunion is an inflammation and thickening of the bursa of the
metatarsophalangeal joint of the big toe, usually associated with
abnormal enlargement of the joint and lateral displacement of the toe.
The normal cause is chronic irritation and pressure from poorly fitted
shoes or structural anomalies. A bunion-like enlargement of the
metatarsophalangeal joint of the fifth tore is called a bunionette or
tailor's bunion.
Hammertoe
A hammertoe is an
extension deformity of the metatarsophalangeal joint and flexion
deformity of the proximal interphalangeal joint of the lesser toes.
Occasionally this condition involves flexion of the distal
interphalangeal joint as well.
Corns
A hard corn is a localized
hardening and thickening of the skin produced by friction and pressure.
The most common location is over the dorsum of the toes, especially the
dorsal aspect of the proximal interphalangeal joint of the fifth toe. A
corn has a conical shaped core that extends into the dermis, and causes
pain and irritation. A soft corn is a thickening of the epidermis
between the toes caused by pressure between the prominent phalangeal
condyles. This type of corn is kept softened by moisture and maceration,
and often leads to painful inflammation beneath the corn.
Ingrown Toenails
An
ingrown toenail occurs when the skin of the nail fold receives pressure
from the nail edge, causing inflammation and pain. It can be caused by
improperly trimming of the toenail or poor fitting shoes. Ingrown
toenails occur most often in the big toe. In a competitive athlete this
condition can be aggravating and even disabling
Contusions
Contusions
about the foot resulting from various types of direct impacts are
common occurrences in athletics. The skin over the dorsum (top) of the
foot is thin and only loosely attached to the underlying structures.
Further, subcutaneous placement and exposed nature of most structures
near the dorsum of the foot make them susceptible to contusion injuries.
Injuries in this area tend to be painful even if actual tissue damage
is minor. However, all direct trauma to the dorsum of the foot should
be evaluated for the presence of significant damage to underlying
structures such as bones, tendons, or nerves.
Contusions to the
plantar, or weight-bearing, surface of the foot can be particularly
bothersome and handicapping. These injuries, common to the plantar
aspect of the heel and ball of the foot, are normally caused by direct
trauma such as repeated pounding on a hard surface, a faulty spike or
cleat, stepping on an object, or even a wrinkle in the athlete's sock.
The subcutaneous tissue between the bones of the foot and the thick
plantar skin becomes bruised and inflamed. This injury, often called a
stone bruise, or heel bruise, may become quite painful and disabling
during weight bearing and athletic competition. Localized tenderness at
the site of trauma may persist until weight bearing is relieved.
Contusions of this type may develop into a chronic inflammatory process
and reoccur throughout the athletic season.
STRESS FRACTURES
Stress
fractures may involve any bone in the foot, but more commonly involve
the second, third, or fourth metatarsal. These fractures, occasionally
called march fractures, occur with repetitive trauma. Excessive foot
pronation or a high and rigid arched foot may contribute to the
incidence of stress fractures. Symptomatically, stress fractures often
exhibit a gradual increase in forefoot pain that is aggravated by
activity and relieved by rest. X-ray films may be negative initially.
If symptoms persist, the foot should be reexamined by radiography in a
few weeks. At that time callus formation may indicate the presence of a
stress fracture.
Fractures involving the midfoot and hindfoot
during athletic activity are not nearly as common as those in the
forefoot. When fractures do occur in these areas of the foot, they are
usually associated with severe torsion or compression forces and result
in major foot injuries.
STRAINS
Strains involving the foot are
common occurrences in athletics. These injuries may involve the
intrinsic muscles, the tendons, and tendinous attachments of the
extrinsic muscles, and the plantar aponeurosis (plantar fascia).
Strains may occur to any of the intrinsic muscles of the foot as a
result of excessive overuse or violent stresses applied to muscles
during athletic activity. Symptomatically, these injuries usually cause
cramping or fatigue of the involved muscles and are painful during
resistive movements. Symptoms normally subside when activity is reduced
or discontinued. Strains of the extrinsic tendons cause tenderness at
the site of the injury and increased pain on active and resistive
contractions of the muscle or muscles involved.
Plantar Fascittis
Is
a common strain of the foot involving the plantar aponeurosis or
fascia. These strong bands of fibrous connective tissue originate on
the calcaneal tuberosities and inserts into the sides of the metatarsal
heads and into the flexor digital tendon sheaths. This tough fascia
surrounds the soft tissue structures of the sole of the foot and acts as
one of the primary supports for the longitudinal arch. It is often
described as a "tie rod" for the longitudinal arch because it serves to
connect its end and prevent their spread. The plantar fascia is
subjected to many stresses and forces during athletic activity, which
may result in a strain injury that often becomes chronic. The pain
associated with this type of an injury can be acute and handicapping.
In many cases is most severe when the athlete first puts weight on the
foot, for example, when getting out of bed in the morning or at the
beginning of activity. The pain generally diminishes during activity,
only to increase when activity stops or when the athlete is "cooling
down." Point tenderness is usually located toward the calcaneal end of
the aponeurosis and very often over the anterior medial tuberosity of
the calcaneus. Occasionally the pain can be reproduced by having the
athlete stand on the toes. Plantar fasciitis is often aggravated by
excessive pronation of the foot, obesity, or an abnormally high arch
(pes cavus).
SPRAINS
Injuries involving the ligaments or
ligamentous capsules surrounding the various joints of the foot are
common in athletic activity. Sprains frequently result from forced
motion at the joint, especially torsion movements, which can stress any
of the supporting ligaments and cause various degrees of damage.
Although it must be remembered that the human body is a chain-linkage
system, sprains will be discussed in three segments that correspond to
divisions of the foot: (1) Fore-foot, (2) Mid-foot, and (3) Hind-foot,
which also includes the ankle joint. An injury in any one of these
segments can cause problems or affect the others.
Fore-foot
The
forefoot is composed of the metatarsals and phalanges. This part of
the foot is used in the pushing off of the foot and is subjected to
stresses that may result in various types of sprains. The
interphalangeal and metatarsophalangeal joints are most often injured by
extreme dorsiflexion or plantar flexion forces.
Great Toe Sprain --
the metatarsophalangeal joint of the great toe is a common site for a
sprain type of an injury, which is often referred to as a turf toe. A
sprain of this joint can be debilitating n that the great toe is very
important in weight bearing and must bear the brunt of every step.
Symptomatically, sprains about the toes will be tender at the site of
injury with an increase in pain on reproduction of the stress that
caused the injury. In addition, there are normally varying amounts of
swelling, stiffness, and soreness surrounding the articulations.
Depending on the amount ligamentous damage, there may be varying amounts
of instability associated with the injury. If instability is
recognized, the athlete should be referred for medical assistance.
Transverse
Arch Sprain -- the metatarsal bones are joined by a complex mechanism
of ligaments. Occasionally the ligaments and supporting tissues of the
metatarsal head will be injured. The mechanism is varied but usually
is associated with prolonged activity on hard surfaces or with overuse.
Physical findings normally include tenderness and swelling under the
heads of the metatarsals and pain upon weight bearing. Sprains
involving the tarsometatarsal joints sometimes occur as a result of a
twisting mechanism or direct stress, such as the athlete stepping on
someone or something. This type of forefoot sprain can be very
disabling because of the increased tenderness and pain upon weight
bearing. Return to full activity may take up to 4 weeks or longer with
this type of injury.
Fractures -- are by the most common area for
fractures in the foot. These fractures can result from a direct blow to
the area or by indirect trauma produced when harmful forces are
transmitted along the shaft of the bones. Symptomatically these
fractures demonstrate point tenderness over the injured site and
increased pain during longitudinal stress. Swelling, discoloration,
crepitation, and deformity may also be present.
Mid-foot
The
midfoot is composed of the navicular, cuboid, and three cuneiform bones.
The mid-tarsal and tarsometatarsal joints are supported by a strong
ligamentous system that is not injured often. Midfoot sprains can
result from severe twisting mechanisms or forceful direct trauma that
causes a subluxation of the involved tarsals or metatarsals. These
sprains produce tenderness at the site of the injury, and often weight
bearing is extremely painful. Tenderness may be elicited at the
involved joint by gentle passive pronation and abduction of the
forefoot. Midfoot sprains can prevent an athlete from normal activity
for a considerable length of time. If recovery is slow, it is often
beneficial to place the foot in a firm-soled shoe or firm orthotic to
decrease the stress across the midfoot and promote healing.
Longitudinal
Arch Sprains -- the ligaments that support the longitudinal arch are
also subjected to many stresses during athletic activity and can become
inflamed, stretched, or torn. The mechanism of injury and symptoms are
very similar to plantar fasciitis that was previously discussed.
Hindfoot
The
hindfoot is composed of the calcaneus and talus. These bones serve as
attachments for the medial and lateral ligaments that support the ankle
joint; therefore injuries to the hindfoot are included in the segment
with injuries to the ankle.
Information obtained from Booher & Thibodeau, Athletic Injury Assessment, 3rd Ed., Chapter 17
No comments:
Post a Comment