Free Facebook Likes, Youtube Subscribers,  Twitter Followers

Ads 468x60px

Blogger Tricks

Blogger Themes

7. 4. 2012.

Foot and ankle injuries

Turf toe syndrome

Turf toe syndrome is a sprain of the plantar capsule of the base joint of the big toe(metatarsophalangeal joint). It is common in playing football on an artificial surface and is caused by a forceful dorsiflexion of the big toe due to increased friction between the shoe and the surface.

Symptoms and diagnosis

The symptoms are pain, tenderness, and swelling in the base joint of the big toe. It is particularly painful during push-off in running and passive dorsiflexion of the joint causes pain.


Initial treatment includes RICE treatment, anti-inflammatory agents, and relief of weight bearing. After 2-4 days, weight-bearing can be resumed, but 2-4 weeks of rest is recommended before return to football. During the rehabilitation phase, the great toe can be taped to limit dorsiflexion.

Football toe

Subungual hematoma is often called “football toe” because it is more common in football than in other sports. The injury is usually caused either by jamming of the longest toe against the toe-box or on an opponent’s stepping on the shoe.

Symptoms, diagnosis and treatment

Subungual hematoma produces severe pain which can be eliminated by making a hole through the nail with a red-hot needle or straightened paper clip.

Morton’s syndrome

Morton’s syndrome is a local swelling of a plantar digital nerve, caused by compression of the nerve between the metatarsal heads. A player with hypermobile foot with excessive pronation or a depressed anterior arch is predisposed to this entity.

Symptoms and diagnosis

The most common symptom is pain on the plantar aspect of the foot. The pain may radiate into the adjacent toes and is relieved by rest.


Conservative treatment consists of wide-fitting shoes and arch support with a pad which can spread the metatarsal bones. Surgical excision through a dorsal incision is very effective.

Ankle sprain

Ankle sprains are the most common injuries in soccer. They constitute about 20% of all football injuries and the incidence in senior players is reported to be between 1.7 and 2x1000h-1 of exposure to soccer.
Most ankle sprains affect the lateral ligamentous complex and these injuries are caused by inversion and plantar flexion of the ankle. The anterior talofibular ligament(TFA) is injured first(70%). In about 20% of cases, there is a combination injury with tear of the TFA as well as calcaleofibular ligament. In young growing athletes with strong ligaments and in elderly patients with brittle bones, an inversion/plantar flexion trauma could cause a bony avulsion at the tip of the lateral malleolus, whilst the ligaments remain intact. Injuries to the deltoid ligament on the medial side are uncommon, accounting for less than 10% of all ankle sprains. The mechanism behind these injuries is pronation and outward rotation of the foot.

Symptoms and diagnosis

The diagnostic of an ankle sprain is made by the presence of swelling and tenderness over the injured ligament. The clinical anterior drawer test is positive in case of rupture of the TFA, but this test can be difficult to evaluate in acute injuries with pain and swelling. An X-ray examination is suggested to exclude fractures and bony avulsions and X-ray with an anterior drawer test confirms the diagnosis of lateral ligament injury.
Concerning differential diagnosis, a syndesmosis injury should be suspected in cases with tenderness over the junction of the tibia na fibula and a widening of the ankle mortise at X-ray. If left untreated, a syndesmosis injury could later cause lateral subluxation of the talus which impairs performance in soccer.


The initial treatment of ankle sprains consists of limiting bleeding and swelling by the use of RICE therapy. The treatment should be immediate and intensive. A compression bandage suitable for ankle sprains is a horseshoe-shaped pad around the lateral malleolus(over the three ligaments) combined with overlaying elastic bandage. The compression bandage should be used for 3-7 days or until the swelling has disappeared. The bandage should be kept on over night. The use of crutches is recommended during this period to minimize loading. As soon as pain subsides, mobility training including flexion and extension of the ankle joint is started.
When swelling subsides, the elastic bandage should be replaced by a supportive tape bandage. The ankle joint should be taped continuously for 5-6 weeks. To avoid skin problems and loosening of the tape, retaping each week is recommended. Healing of the ligament takes 6-8 weeks, but with proper taping and rehabilitation, return to soccer can take place earlier.
If a ligament injury still causes instability problems 4-6 months after conservative treatment, surgery is indicated. The results after suture or reconstruction of a ligament injury are favorable. An ankle sprain may also cause cartilage injuries or osteochondral fractures on the talus. The symptoms are pain and tenderness(common on the medial side), swelling and locking. Arthroscopy or arthrotomy are valuable for diagnosis and treatment.

Achilles tendon injuries

Usually caused by trauma(total or partial rupture) or by overuse(Achilles tendinitis or Achilles bursitis). Two factors predispose to Achilles tendon injuries: a) the great load that is put on the tendon in athletic activities; and b) the poor circulation of the tendon. Concerning the load, the critical limit for tendons is estimated to be about 5000 Nxcm-2.The cross section area of the Achilles tendon is about 2cm2 and since the forces put on the tendon is about 5000- 10000N in sprinting activities, it is clear that many activities in soccer put a stress on the Achilles tendon which is close to its critical limit.
Injuries of the Achilles tendon usually occur at the  zone of poor circulation, which is located 2-6 cm above it’s insertion at calcaneus.

Total rupture of Achilles tendon

Total ruptures usually occur in degenerated tendons and are therefore more common in elderly players or in players previously affected by Achilles tendinitis.

Symptoms and diagnosis

Typically, the player feels like he has been kicked on the tendon. The player can usually walk normally, but is unable to stand on tiptoe. There is a distinct tenderness over the ruptured area and a gap in the tendon can be felt. Definite diagnosis is made with the Thompson test. In this test, the calf is squeezed, and if the ankle fails to flex, the Achilles tendon is ruptured.


Treatment of a complete rupture of the Achilles tendon in an active soccer player should be surgical.

Partial rupture of the Achilles tendon

Partial ruptures of the Achilles tendon are common in soccer players and they often become chronic and cause prolonged problems.

Symptoms and diagnosis

Usually the player experiences a sharp pain in the tendon on jumping, sprinting, and other explosive movements. A nodule is palpable in the tendon, usually 2-6 cm above the os calcis.


Conservative treatment consists of rest, a heel lift, and anti-inflammatory medication. If conservative treatment fails, the nodules should be exposed and degenerative areas of the tendon restricted. If conservative treatment fails, the nodules should be exposed and degenerative areas of the tendon resected. The rehabilitation period after surgery is usually 4-6 months before soccer can be resumed.

Achilles tendinitis is the most common tendonitis seen in soccer players. It is an overuse injury resulting  from prolonged repeated loading. Anatomical malalignments such as flat feet, pes cavus, or muscle tightness of the calf muscles predispose to this injury.

Symptoms and diagnosis

The major symptom is pain, which is aggravated by activity and relieved by rest. The player usually complains of stiffness in the morning and before and after activity.


The treatment consists of rest, heel lift, ice massage, and anti-inflammatory medication for a couple of weeks. If the player does not rest, the acute inflammation may turn into a chronic condition where the pseudosheath of the Achilles tendon becomes fibrotic and stenotic and may require surgical decompression consisting of removal of the entire pseudosheath.

The retrocalcaneal bursa is located between the Achilles tendon and os calcaneus. Inflammation and hypertrophy of this bursa is common in soccer players due to either kicking in the area of pressure from the football shoes. A prominent posterior tubercle of the os calcis may be an additional cause of the bursitis.

Symptoms and diagnosis

The pain and tenderness at palpation are located at the insertion of the tendon, more distal then the location of an Achilles tendonitis or a partial rupture.


Conservative treatment with ice or injection of cortisone in the bursa is usually favorable. In chronic cases, surgery is indicated. During the exploration, the bursa and the bony prominence are removed.

“Handbook of Sports Medicine and Science - Football(Soccer)”, Björn Eklbom

0 коментара:

Постави коментар

Search this blog