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Foot and Ankle Injuries: An Overview of Types, Causes and Treatments

Posted by David N. Garras, MD on September 11, 2017

foot-and-ankle-injuries-an-overview-of-types-causes-and-treatments.jpgFoot and ankle injuries are common. They can be caused by a serious accident, sports, work, or something that occurs in daily life. If not diagnosed in a timely fashion or thoroughly treated, they can be debilitating, inconvenient and costly. Serious injuries can result in time off of work and the need for significant rehabilitation. 

If you've experienced one or more foot or ankle injuries, learning the causes, most common types, and how to effectively treat these injuries can help you get back to work, sports, and everyday activities.

Costs and Risk Factors

Foot and ankle injuries can be expensive. According to data from the National Safety Council, the average total costs incurred per claim by each body part in 2008 were:

  • Ankle: $23,262
  • Foot/Toe: $21,585
  • Leg: $43,131

Those figures are a combination of medical and indemnity cost.

What makes people more susceptible to a foot or ankle injury? Human risk factors include:

  • More prevalent among African-Americans
  • More common among younger people
  • Having only been in your job for a short time
  • Having pre-existing arthritis
  • Having peripheral vascular disease, a circulatory condition
  • Having diabetes mellitus, a pancreatic condition that affects the body's ability to produce insulin

What you do for a living can also affect your likelihood of having an injury that affects your foot or ankle. These occupational risk factors may come into play:

  1. Your job involves manual material handling, such as a laborer, freight handler or warehouse worker.
  2. You are exposed to falling objects. Sixty percent of injuries occur when a falling object strikes the foot.
  3. You operate or work around forklifts. Just over 30 percent of forklift injuries affect the toe or foot.

Anatomy Lesson: Parts of the Foot

The foot is comprised of 30 bones — including the tibia and fibula — and numerous joints, ligaments, muscles and tendons. The foot has relatively little soft tissue coverage, especially the dorsum, making it susceptible to crush injuries. The skin and soft tissue make it harder to recover from injury.

Sometimes the first assessment of an ankle sprain or another type of foot injury is difficult due to pain and swelling. If the injury doesn't require immediate treatment, your doctor might require you return in one to two weeks for a follow-up evaluation after some of effects of the acute injury have subsided.

Some tools that a doctor may use to evaluate your injury in addition to a physical exam include:

  • Radiographs
  • Bone Scan
  • CT Scan
  • MRI

Types of Injuries: Ankle Sprains

The term "ankle sprain" is a common, catch-all phrase that people often use to describe any kind of pain or injury to the foot or ankle. It's often overused and doesn't accurately describe what's going on with ankle or foot injuries. In order to determine the nature of the injury, your doctor will take a comprehensive physical exam, and ask questions to determine how the injury occurred, what symptoms are present and any other specific, relevant information is needed to make a diagnosis.

Ankle sprains do legitimately affect one in 10,000 people each day. That accounts for more than 23,000 sprains per day. The majority of people resume normal activity within four to six weeks. However, 20 to 40 percent of those with severe sprains do experience residual pain, with the poor rehabilitation being the most common cause of lingering problems.

Ankle sprains most commonly affect the following ligaments:

  • Anterior talofibular ligament (ATFL)
  • Calcaneofibular ligament (CFL)

Your doctor may rate your injury on the following scale:

I — Stretch

II — Partial Tear

III — Complete Tear

IV — High Ankle Injury

Treating an Ankle Sprain

Treatment of ankle sprain will generally follow the following stages:

  1. Decrease pain and swelling
  2. Strengthen and stretch
  3. Return to normal activity

The grade of ankle sprain will determine when you can return to normal activity. This is the scale:

  • Grade 1: 1-2 weeks
  • Grade 2: 2-4 weeks
  • Grade 3: 8-10 weeks
  • Grade 4: 12-16 weeks

If pain persists for more than eight to 12 weeks, you continue to experience functional limitations or you have continued swelling, contact your doctor. You may require additional treatment.

There are many injuries that can masquerade as ankle sprains, including an undetected fracture, a cartilage injury, nerve damage and more. Again, talk to your doctor if pain persists.

Types of Injuries: Fractures and Tendon Issues

Stress fractures, which are breaks caused by overuse, can affect the following bones:

  • Metatarsals
  • Navicular
  • Calcaneus
  • Distal tibia/fibula

Traumatic fractures are caused by an accident, fall, event or some other type of injury. Some commonly missed fractures affect the following bones:

  • Anterior process calcaneus
  • Lateral talar process
  • Posterior talar process
  • Fifth metatarsal (base)
  • Distal fibula
  • Talus (osteochondral lesion)

Other foot and ankle injuries include: Tendon issues may affect Achilles tendons, peroneal tendons and posterior tibial tendons. Lisfranc injuries affect the joints or tendons of the middle foot, and are often caused by accidents or falls. They can also be mistaken for an ankle sprain.

Treatments for Injuries

In general, early detection of foot and ankle injuries is key to treatment and recovery. If nothing is displaced or grossly unstable, orthopedic surgery will likely not be needed. Treatment in that case may include:

  • A non-weight-bearing cast for six to eight weeks
  • Frequent check-ups until the injury is no longer tender
  • Weight-bearing or controlled ankle movement (CAM) boot for six weeks
  • Physical therapy

Total healing and improvement should occur in six to nine months.

In cases where displacement occurs and surgery is needed, hardware like screws may be implanted. In some case, hardware will be removed after four to six months. If the hardware doesn't cause any problems, you may decide to go without an additional surgery. Followup to initial surgery may include:

  • Splint immobilization for two weeks
  • A non-weight-bearing cast for four weeks
  • Weight-bearing or controlled ankle movement (CAM) boot for six weeks
  • Physical therapy
  • Three to six months with arch support in shoe

Total healing and improvement should occur in six to nine months. The time it takes to get back to full capacity at work may be difficult, especially for those with jobs requiring physical labor. Some patients may experience pain up to more than a year after the injury and others may experience traumatic arthritis.

Crush injuries and Calcaneus Fractures

Crush injuries can be difficult to treat due to the injury affecting soft tissue, muscle and bone. Not surprisingly, these types of injuries are more likely to affect people who are material handlers, forklift operators and other vehicle operators. Data shows people who are at higher risk include African American men, those with a high school education and those who have only been on their jobs a short period of time.

Treatment for this type of injury is complex, involving stabilization of bones and the soft tissue, dealing with nerve dysfunction and rehabilitation. Aggressive therapy and the involvement of a pain management specialist will likely be needed.

Calcaneus fractures are generally caused by a fall from a height when you land on your feet, and these are often work-related injuries. Data shows men aged 25 to 45 are affected at higher rates and may be more likely to go on long-term disability as a result. The effects of the injury may vary, and be dependent on the general health of the patient. These fractures may also come with spine injuries.

Surgery may be indicated in cases of calcaneus fractures, but some non-operative treatments are available. Care will include treatment for any wounds as well using antibiotics and other methods. Physical therapy and return-to-work plans will vary by patient. With treatment, improvements are usually seen from nine to 24 months after the injury. Twelve to 26 percent of people don't return to work, and 40 to 50 percent return to a less physically demanding activity. 

Getting timely, professional care is key to making the fullest possible recovery. If you have an ankle or foot injury, make an appointment with orthopedic experts or sports medicine specialists who can evaluate and offer an individualized treatment plan that gets you back to your maximum level of activity and function.

For immediate treatment of foot and ankle injuries, visit an ortho urgent care clinic. 

Complete Guide to Joint Pain 

Topics: Ankle Injuries

About the author: David N. Garras, MD

author-image

Dr. Garras is an orthopedic specialist in foot and ankle orthopaedic surgery, with an emphasis on total ankle replacement, work and sports injuries, ligament and tendon repairs/reconstruction, minimally invasive and arthroscopic techniques, deformity correction and reconstructive surgery, foot and ankle fracture care. He completed his medical degree at Duke University School of Medicine and completed his residency at Thomas Jefferson University Hospital, Rothman Institute, in Philadelphia, PA.

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