Foot Injury Treatment

Overview

Your foot has technology that would astonish any engineer. To support your weight and move you through your everyday routine, 26 bones, 33 joints, and over 100 tendons, muscles, and ligaments all function together. Faults in the inner workings of your foot, like the most advanced machine, can cause injuries, just as flaws in the most advanced equipment can cause injuries.

What is Foot Injury?

Every year, millions of Americans seek treatment for foot and ankle problems at their local podiatrist's clinic. Many of these patients, who complain of discomfort, stiffness, swelling, or other deformities, are identified and treated for minor foot ailments such as bunions, corns, flat feet, athlete's foot, warts, or ingrown nails. Patients with more significant musculoskeletal issues should seek the treatment of a skilled orthopedic Foot & Ankle specialist.

If you are experiencing symptoms of a foot or ankle problem, we invite you to schedule an appointment to obtain a correct diagnosis and build an effective treatment plan.

Foot Anatomy

Your foot is an intricate element of your body. It is made up of 26 bones divided into three divisions. Muscles, tendons, and ligaments support your feet's bones and joints, allowing them to carry your entire body weight while walking, running, and jumping. Despite this, trauma and stress can result in bone fractures or serious foot injuries.

• The hindfoot

It consists of two bones. The talus bone, which links to your lower leg bones, and the calcaneum bone, which forms your heel. Extreme force causes fractures in your hindfoot, such as your heel.

• The midfoot

It includes the navicular, cuboid, and 3 cuneiform bones.

• The forefoot
  
  • It has 5 metatarsal bones and 14 toe bones called phalanges.
  • A joint called the mediotarsal separates your hindfoot from your midfoot.
  • The Lisfranc joint separates your midfoot from your forefoot.

Achilles Tendonitis or Tear

The Achilles tendon is the most powerful tendon in the human body. The plantaris, gastrocnemius, and soleus tendons attach to the calcaneus bone via this tendon. The paratenon is a sheath-like structure made up of a single layer of cells that surrounds the tendon. The paratenon is responsible for a large amount of the blood flow to the tendon. Studies have revealed a hypovascular region 2 to 6 cm proximal to the calcaneal insertion; this is a common site of damage. The Achilles tendon permits the calf muscles to act on the heel during walking or running.

Achilles tendinopathy includes tendinitis (acute inflammation) and tendinosis (chronic inflammation). It is a condition characterized by Achilles tendon discomfort, inflammation, and stiffness. The inflammation restricts the functioning of the lower extremities. Achilles tendinopathy takes a long time to heal; the tendon thickens and loses suppleness over time. The discomfort is caused by a change in the mechanical characteristics of tension and stiffness of the Achilles tendon aponeurosis.

Evaluation

Physical exploration:  Localized pain, focused or diffuse sensitivity, edema, stiffness/morning pain, felt rigidity in the Achilles tendon, positive arc sign, Royal London Hospital test, and Thompson test are all clinical indications and symptoms of Achilles tendinopathy.

Tests used to diagnose Achilles tendinopathy:

• Lateral and axial calcaneus x-rays: Calcifications in the proximal extension of the tendon insertion and bony prominences in the upper section of the calcaneus may be seen. X-rays can also help rule out pathological bone cancers.
• Ultrasound: Can assist detect tendon damage and forecast the likelihood of tendinopathy and rupture. Ultrasound may demonstrate increased Achilles tendon thickness with hyperemia and hypervascularity, a reduction in the gastrocnemius-soleus rotation angle, and a decrease in the length of the Kager fat pad. Ultrasound can also be used during interventional procedures.
• Magnetic Resonance Imaging: With a study in many planes in static and dynamic perspectives, it provides considerable information regarding the status of joint structures. According to one study, MRI had lesser sensitivity than ultrasound in detecting early enthesopathy alterations. Another research showed great agreement between magnetic resonance imaging and ultrasound for measuring tendon thickness.
• Computed Tomography (CT): The CT scan can be used to rule out calcaneus trabecular structural abnormalities in Achilles pathology of insertion. It does, however, expose the patient to radiation.
• Victoria Institute of Sports Assessment - Achilles (VISA-A) remains the gold standard for assessing pain and function, but it requires additional studies to increase its reliability. Nevertheless, it is an essential tool for patient post-treatment follow-up. 
  

Achilles Tendinopathy Management

Achilles tendinopathy can be treated conservatively or surgically. Furthermore, whether the illness is acute or chronic must be considered. Finally, individuals with a complete rupture are typically treated surgically.

1. Conservative therapy:  It is the first line of management and includes the following:

• Reduction of activity levels
• Administration of non-steroidal anti-inflammatory drugs (NSAIDs)
• Adaptation of footwear, manual therapy directed at local sites may enhance the rehabilitation
• Eccentric stretching exercises should be incorporated into physiotherapy because they can reduce pain by 40%; intermediate level evidence favors eccentric exercise over concentric exercise for pain relief.
• Tendon loading exercise at short- and long-term follow-up
• If initial care fails, extracorporeal shock wave therapy lowers pain by 60%, with 80% patient satisfaction, increasing functioning and quality of life, with a 4-week follow-up; this may be the first choice due to its safety and efficacy.
• Physiotherapy improves the pain and functioning of Achilles tendinopathy of the middle section; nevertheless, studies reveal no preference for one activity over another - altogether, using a splint to an eccentric exercise regimen or using orthoses to improve pain and function is not recommended.
• Current evidence shows a lack of efficacy on the use of platelet-rich plasma for Achilles tendinopathy
  

2. If conservative therapy fails after six months, Surgical surgery is a possibility for 10% to 30% of patients. The success rate is greater than 70%, while complications range from 3 to 40%. With a tendon rupture of greater than 50%, the Achilles tendon should be reattached.

Ankle Sprains

Ankle sprains are common injuries that affect people of all ages and activity levels; in fact, they are the leading cause of lost athletic participation. An ankle sprain happens when the strong ligaments that support the ankle strain and rip. The severity of a sprain depends on the number of ligaments affected as well as the extent to which the ligaments are ruptured.

• Ankle Sprains Causes

Patients frequently report suffering a twisting injury to their foot or ankle. If the ligaments are severely ripped, you may hear or feel a snap. Sprains can occur suddenly during a variety of activities, including:

• • Walking or exercising on an uneven surface
  • Falling down or tripping
  • Participating in sports that require cutting or jumping actions, such as trail running, basketball, tennis, football, and soccer
    
    
• Symptoms

The types and severity of symptoms for a sprained ankle vary widely depending on the degree of the injury. Symptoms may include:

• • Pain, both at rest and with weightbearing or activity
  • Swelling
  • Bruising
  • Tenderness to touch
  • Instability of the ankle, or feeling that your ankle is giving out

Symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation. 

Depending on how many ligaments are injured, your sprain will be classified as:

• • Grade 1 (mild), 
  • Grade 2 (moderate), or
  • Grade 3 (severe).

• Treating Your Sprained Ankle
  
  

Properly treating your injured ankle may avoid persistent discomfort and looseness. Follow the R.I.C.E. standards for a Grade 1 (mild) sprain:

• Avoid walking on your ankle to rest it. Limit weight bearing and, if required, use crutches. If there is no shattered bone, you can place weight on the leg. While the ligaments recover, an ankle brace can help minimize swelling and offer stability.
• To reduce swelling, apply ice to the affected area. To avoid frostbite, do not apply ice directly to the skin (place a thin piece of cloth, such as a pillowcase, between the ice bag and the skin) and do not freeze for more than 20 minutes at a time.
• Compression can assist reduce swelling while also immobilizing and supporting your injury.
• Elevate the foot by reclining and propping it up above the waist or heart as needed.

Follow the R.I.C.E. guidelines for a Grade 2 (moderate) sprain and give additional time for recovery. Your injured ankle may be immobilized or splinted by a doctor.

A Grade 3 (severe) sprain increases your chances of persistent ankle looseness (instability). Surgery may be required to heal the injury on rare occasions, particularly in competitive athletes. For serious ankle sprains, your doctor may recommend a brief leg cast or a walking boot for 2-3 weeks. People who sprain their ankles on a regular basis may require surgical surgery to strengthen their ligaments.

Plantar Fasciitis and Heel Spurs

The most prevalent cause of discomfort on the bottom of the heel is plantar fasciitis. Every year, around 2 million individuals are treated for this illness. Plantar fasciitis arises when the strong band of tissue that supports your foot's arch becomes inflamed and irritated.

The plantar fascia is a long, thin ligament that runs down the sole of the foot, immediately beneath the skin. It links your heel to the front of your foot and supports your arch.

The plantar fascia is intended to withstand the tremendous stresses and strains that our feet experience. However, excessive pressure might cause tissue injury or tear. Plantar fasciitis is caused by the body's natural reaction to damage, which causes heel pain and stiffness.

• Risk Factors

In the majority of instances, plantar fasciitis develops for no apparent cause. However, there are other circumstances that might make you more susceptible to the condition:

• • Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin
  • Obesity
  • Very high arch
  • Repetitive impact activity (running/sports)
  • New or increased activity
    
    
• Heel Spurs

Although heel spurs are common in persons with plantar fasciitis, they are not the cause of plantar fasciitis discomfort. One out of every ten persons has heel spurs, although only one out of every twenty (5%) suffers foot discomfort. The discomfort can be managed without removing the spur because it is not the cause of plantar fasciitis.

• Symptoms

The most common symptoms of plantar fasciitis include:

• • Pain on the bottom of the foot near the heel
  • Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain subsides after a few minutes of walking
  • Greater pain after (not during) exercise or activity
    
    
• Doctor Examination

Your doctor will examine your foot after you have described your symptoms and discussed your worries. Your doctor will check for the following symptoms:

• • A high arch
  • An area of maximum tenderness on the bottom of your foot, just in front of your heel bone
  • Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down
  • Limited "up" motion of your ankle
    
    
• Tests

Your doctor may conduct imaging tests to ensure that your heel discomfort is due to plantar fasciitis and not something else.

• • X-rays
    X-rays give detailed pictures of bones. They help to rule out other possible reasons of heel discomfort, such as fractures or arthritis. An x-ray can reveal heel spurs.
  • Other Imaging Tests
    Other imaging techniques, like as MRI and ultrasound, are not commonly utilized to detect plantar fasciitis. They are rarely requested. If the first therapy options do not cure the heel discomfort, an MRI scan may be used.
    
    
• Treatment
  
  

1. Nonsurgical Treatment. More than 90% of plantar fasciitis sufferers will improve within 10 months after beginning easy treatment approaches.
   
2. Rest. The first stage in pain reduction is to reduce or altogether eliminate activities that aggravate the pain. You may need to discontinue sports activities that require your feet to pound on hard surfaces (for example, running or step aerobics).
3. Ice. It is useful to roll your foot over a cold water bottle or ice for 20 minutes. This can be done three to four times each day.
4. Nonsteroidal anti-inflammatory medication. Ibuprofen and naproxen are pain and inflammation relievers. Use of the medicine for more than one month should be discussed with your health care physician.
5. Exercise. Tight muscles in your feet and calves cause plantar fasciitis. The most effective technique to ease the discomfort associated with this issue is to stretch your calves and plantar fascia.
6. Cortisone injections. Cortisone, a steroid, is an effective anti-inflammatory drug. It can be injected into the plantar fascia to relieve pain and inflammation. Your doctor may restrict the number of shots you receive. Multiple steroid injections can rupture (tear) the plantar fascia, resulting in a flat foot and chronic discomfort.
7. Supportive shoes and orthotics. Standing and walking pain can be reduced by wearing shoes with thick soles and additional padding. When you step and your heel contacts the ground, you put a lot of strain on your fascia, which creates microtrauma (tiny tears in the tissue). A cushioned shoe or insert relieves this stress and the microtrauma caused by each stride. Soft silicone heel cushions are cheap and effective in elevating and cushioning your heel. Prefabricated or bespoke orthotics (shoe inserts) are also beneficial.
8. Night splints. The majority of individuals sleep with their feet pointed down. This relaxes the plantar fascia and contributes to morning heel discomfort. While you sleep, a night splint stretches the plantar fascia. Although it might be uncomfortable to sleep with, a night splint is quite effective and does not need to be worn after the discomfort has subsided.
9. Physical therapy. Your doctor may advise you to engage with a physical therapist on a stretching regimen for your calf muscles and plantar fascia. A physical therapy program may include specific cold treatments, massage, and medication to reduce inflammation around the plantar fascia, in addition to the activities listed above.
   
   

• Surgical Treatment

Only after 12 months of rigorous nonsurgical therapy is surgery considered.

Gastrocnemius recession.

The calf (gastrocnemius) muscles are surgically lengthened. Because tight calf muscles put additional strain on the plantar fascia, this technique is beneficial for individuals who, despite a year of calf stretches, still have difficulties bending their foot.

One of the two calf muscles, the gastrocnemius, is stretched to increase ankle motion in gastrocnemius recession. The surgery can be done using a standard open incision or through a smaller incision and an endoscope, which is a tiny camera-equipped equipment. Your doctor will recommend the procedure that will best fit your needs.

Complication rates for gastrocnemius recession are low, but can include nerve damage.

Plantar fascia release.

If you have a normal range of motion in your ankles but still experience heel discomfort, your doctor may consider a partial release treatment. The plantar fascia ligament is partially severed during surgery to reduce tissue strain. If you have a significant bone spur, it will also be removed. The procedure can be conducted endoscopically but it is more challenging than an open incision. Furthermore, endoscopy has a larger risk of nerve injury.

Broken Metatarsal

A typical foot has five metatarsal bones, numbered 1 through 5, from the one linked to the big toe to the outside of the foot. They have a straight form with a slightly expanded base and a knob-like part at the end that links to the toe bones (the head).

They begin at the midpoint of the foot and stop just before the toe webs. The closer ends of the metatarsal bones (around the center of the foot) form connections with other midfoot bones for the first through third metatarsals, but these joints do not move much. However, the joints comprised of metatarsals and toe bones move a lot towards the opposite end of the bones near your toes. This mobility and placement are what determine the therapy for each specific foot issue.

• Mechanism and Epidemiology

Metatarsal bones typically shatter as a result of a crush accident, a falling heavy item, a twisting injury, or getting your foot hooked in something while the body is still moving. A stress injury caused by overuse, such as unexpectedly increasing running distance when preparing for a marathon, can occasionally cause the bone to break.

• Initial Treatment

If your metatarsal fracture was caused by a crush or twisting injury, the pain will most certainly be severe enough to require emergency medical treatment. You may choose to visit an emergency department or your health care physician. X-rays are commonly used to make a diagnosis.

If the bone does not penetrate the skin, the emergency department clinician would normally place you in a splint (half cast), place you on crutches, give pain medicines, and suggest you to follow up with either your health care provider or an orthopedic surgeon. You should also elevate your foot as much as possible for the first 2-3 days and use ice to assist reduce swelling and discomfort.

General Treatment

The majority of metatarsal fractures are treatable without surgery. It is possible to employ a stiff-soled shoe, a walking boot, or even a cast. The amount of pressure you may apply to your foot will be determined by whatever bones are shattered. This will be decided by your treating physician. Your discomfort will subside as your fractured bone(s) heal over the next 8-12 weeks. Over time, you may be able to apply greater pressure on your foot.

If you are diagnosed with a metatarsal stress fracture, you will be recommended to discontinue the activity that caused it. You will most likely be instructed to rest your foot for 4-6 weeks, if not longer, until the discomfort decreases. Following a time of rest, you may begin a gradual return to activities.

Some metatarsal fractures can be helped by surgery. These include fractures that have penetrated the skin as well as fractures that are so far apart that they do not line up well enough to mend or function effectively afterward. This is particularly true for first metatarsal fractures. When surgery is required, the bones are frequently straightened and kept in place using temporary pins. In roughly 6-10 weeks, these pins can be removed in the office. A cut on the top of your foot may be required to realign your bones, and the bone will be fixed with metal plates and screws. 

When to Go to Urgent Care or the Er For a Foot Injury?

Even though many foot injuries heal on their own, some foot injuries require immediate treatment.

You should go to urgent care for injuries with:

• Mild to moderate pain,
• Difficulty walking or bearing weight,
• Swelling that does not get better within a few days of an injury,
• Bruising,
• New foot or toe deformities, or
• Tingling, burning, or numbness in your foot.

Go to the emergency room if:

• There’s an open wound on your foot.
• Pus is coming out of your foot.
• You can’t walk or put weight on your foot.
• You experience severe bleeding.
• There are broken bones coming through your skin.
• You feel lightheaded or dizzy.
• You think your foot could be infected.

If the skin around your injury is warm, red, or sensitive, you may have an infection. If you have a temperature of more than 100 degrees F, you may have an infection.

Foot and Ankle Tendon Surgery

Foot tendon surgery may be suggested to heal significant rips, damage, and illness when non-surgical techniques are ineffective. Tendon repair surgery is creating a tiny incision above the tendon. Surgeons will remove any damaged tissue using specialist surgical instruments. A tendon from another part of the body may be removed and grafted to the injured tendon. This strengthens and repairs the weak tendon.

A tendon transfer may be necessary in some instances. A tendon transfer is the removal of a tendon from another part of the body or from a cadaver to replace a damaged tendon.

Diabetes & Foot Injuries

Diabetes patients are more likely to suffer from nerve damage in their feet (diabetic neuropathy). Nerve injury might impair your ability to experience feelings in your feet.

You may not notice wounds or sores on your feet if you have diabetes. Even though your feet feel OK, you should consult a doctor if you have a foot injury. Diabetes can also make it more difficult to heal scratches and sores on your feet. This is because diabetes impairs regular blood flow inside your body.

Conclusion 

The feet and ankles are among the most utilized parts of the body, bearing a significant amount of weight on a regular basis. When you have a foot or ankle injury, it might be difficult to walk, let alone conduct your everyday duties. If you have a foot injury, you may want to seek foot injury therapy. However, knowing where to go for it might be difficult at times.