Ankle Sprain
Injuries to the ankle are very common especially among highly active individuals but it can happen to anyone. Even simple day to day activities can cause an ankle sprain if too much unexpected force is applied to the foot. Patients often recall taking a wrong a step off a curb and feeling a "pop." One patient said he ran after the mailman and actually heard a "pop" from his leg. So what could that "pop" be?

The ankle joint consists of three important bones, tibia, fibula, and talus, held together by ligaments. The common "popping" sound comes from tearing any one of these ligaments, most commonly the anterior talofibular ligament. This ligament is located on the outside ankle towards the front of the foot. Sometimes, this injury is overlooked because people are still able to walk on it. Some swelling, bruising, and pain may be noted at the ankle and are key indicators of an underlying injury.

It is important to know when this type of injury requires medical attention. For the most part, common ankle sprains can be alleviated by the acronym "RICE." Resting the injured foot by limiting motion until the swelling goes down; icing the area with a bag of frozen vegetables or ice pack, compression such as a fabric bandage wrapped around the ankle, and elevating the foot will help the swelling to go down too. Taking over the counter pain medicines should help with some of the discomfort.

However, if there is a break in the skin and bone appears to be protruding through the skin, or new bumps appear in the skin, seek care immediately. Other signs that require emergent care includes the inability to walk a few steps, unbearable pain, and if the color of your foot turns dusky and pale. These may be signs that a bone has been broken and healing prognosis is better with early detection.

If in doubt, seek professional advice from your podiatrist. They may want you to come into the office and run additional tests if necessary. Some tests they may order includes evaluating that the nerves and arteries are in-tact, x-rays to see if bones are injured, ultrasonography to evaluate the ligaments, and sometimes CT scans. The physician may also order crutches and/or apply a brace to help your ankle heal properly.

There are many things you can do to prevent future injuries. Strengthening exercises can be recommended by a physical therapist. Proper shoes that provide ankle stability are helpful, such as high top tennis shoes. However, high heeled shoes actually put the ankle in an unstable position so are best avoided to avoid ankle injuries.

Surgery is uncommon for this type of injury but may be indicated if the ankle does not heal with conservative treatment. Good news is that the majority of ankle sprains will not require any surgery and will benefit with strengthening exercises to prevent future injuries. These preventive measures can be discussed with your podiatrist.

Is a Stress Fracture Hindering Your Running?

With the increased running craze, many people are attempting to run a marathon or participate in the triathlon. As a result, I am seeing more patients with a stress fracture come into the office. Many of them are new to running and have not gone through the proper training for their event. As a result, they are running long distances which put an increased force or stress on their bones which can cause hairline cracks or breaks in the bones of the feet. They wonder why their foot hurts and swells.

Signs of stress fractures can include pain, redness, swelling and sometimes a bruised appearance. Many people think it is not possible to walk on a foot with a fracture. This is not true. Just because you can walk on the foot, does not mean that the bone is not broken or that there is not a more serious problem.

Improper training is a common cause of stress fractures in athletes. Many people try to do too much too soon. A good rule is not to increase your mileage by more than 10 percent per week. You should also allow time for rest between workouts for your body to repair itself.

It is also important to wear the proper shoes and shoes that fit properly. If your feet pronate excessively, you may need custom orthotics to help prevent injury.

Early diagnosis and treatment are important to ensure proper healing. If you think you may have a stress fracture, follow the RICE principle. R is for rest, I for ice, C for compression and E for elevation. If pain continues for a few days, then you should come into the office for diagnosis and treatment.

With proper care, you will be on your way to reaching your athletic goal.

Golfers get pain more often in which foot?

Golf is a very popular sport here in the Coachella Valley. Golfers can put excessive stress to their feet during the swing, and over the course of 18 holes, can develop many different injuries. Most common types of injuries are metatarsalgia or pain in the ball of the foot, heel pain, tendonitis, and neuromas.

Neuromas most often occur in the opposite foot to which the person is swinging, i.e.: if swinging right handed, the neuromas is typically in the left foot. This is due to the excessive pressure and forces on that foot during the swing, and becomes more pronounced on longer shots. The symptoms can include burning, tingling, numbness and shooting pains into the toes, usually the third and fourth toes.

Ankle pain can also occur due to the extra motion noted at the rear foot ( heel) area during the golf swing, especially on the follow through. This occurs mostly on the opposite ankle of the swing. Repetitive stress causes the ligaments to become strained and painful. Sometimes the ankle can swell.

Tendonitis can also develop in golfer's feet. Many times the driver of a golf cart will develop tendonitis due to the brake pedal of the golf cart being made of two pieces. The golfer may complain of pain on the top of the foot, along the tendons. The bones are not painful.

Heel pain is another common complaint. Because of the excessive pronation of the feet during the golf swing, stress and pulling of the plantar fascia occurs. This repetition of pulling can cause heel pain in either foot. Over time, this becomes chronic and the pain increases.

So if pain during golf is getting you down, come see us for treatment to get you back on your feet quickly.

Turf Toe

Turf toe is an injury to the first toe joint of the foot. It is a soft tissue injury to the tissues around the big toe joint. Anyone can get turf toe. If you apply a force that causes the big toe to extend beyond its normal range of motion, the soft tissues can be injured and turf toe can ensue.

When you sprain the ligaments around the big toe joint, the result is turf toe. The ligaments allow the toe to move up and down at the joint. If they become sprained, there is pain each time the toe moves. Turf toe is commonly associated with football players playing on artificial turf, however anyone can develop this injury if the force through the big toe joint is abnormal, causing a hyper-extension of the toe.

Usually the injury and force is a sudden force to the big toe joint, hence more common in athletes. Not only does it occur on artificial turf, but can occur on grass surfaces if the shoe is too flexible and does not have enough support for the foot. This can allow the foot and big toe joint to bend to far, stressing the ligaments.

Turf toe symptoms include pain at the base of the big toe. Swelling may occur. Moving the toe becomes painful and decreased range of motion follow.

To diagnose the injury, examination of the foot will be done. X-rays, ultrasound, and other imaging tests may be needed.

Treating turf toe begins with resting the injured area and restricting motion of the joint. Physical therapy may be needed after the injury heals, to re-gain motion and strength of the injured toe. Sometimes, orthotics are needed to be worn so the foot will be better supported and functioning better.