Are You a Sportsperson? 7 Steps for You to Prevent Ankle and Foot Injuries

If you are a sportsperson, perhaps foot and ankle injuries are your career-long companions. This could be more so if you are into body contact sports like baseball and football, or involved in high-intensity sports like tennis, marathons etc. However, with a little precaution on your part, you can keep these ‘companions’ far away from you. You can enjoy your favorite sports to the fullest without worrying about getting hurt or being tethered to your bed for months, after an injury. 

Here are seven steps, when followed, will help you prevent ankle and foot injuries.

1. Warm up before your start: It's important to do a number of warm up exercises before you start any sports activity. For instance, you can do toe spread, calf stretch, seated arch stretch or calf drops to warm up your muscles. Even a slow jog for 2-3 minutes can serve the purpose.
2. Get your muscles ready for the sport: You should gradually increase the amount of time you spend for each activity to build muscle mobility and strength rather than doing it all at one go. You can consider indulging in different activities for cross training to condition your muscles.
3. Choose appropriate shoes suitable for your foot type: Apart from wearing good quality footwear, you should also be careful while choosing shoes for your use. For instance, if your feet have low arches, you should opt for shoes that provide support both at the front and under the arch of your feet.
4. Replace your shoes at regular intervals: To keep your feet healthy, it's important to change your shoes at regular intervals. You should observe carefully when the heels wear down or the tread wears out; that’s the time to get your footwear replaced. It’s ideal to change your shoes every six months. In case you are an avid runner, you may have to replace your athletic shoes even before that.
5. Take proper care while running uphill: Running uphill is one of the greatest workouts for all athletes. But you should acclimatize your body to this strenuous workout gradually, to avoid foot and ankle injuries. You should be equally careful while running downhill too; not being cautious may give rise to serious injuries.
6. Don't run or step on bumpy surfaces: While running on uneven surfaces, you need to be very careful; you may stumble upon roots, holes, tree stumps or other obstacles. If you are bedeviled by cramps or other problems of your lower legs, foot doctors advise running on a soft surface instead.
7. Listen to your body: While playing a sport, you should never ignore what your body tells you. In case you are experiencing ankle or foot pain during a specific activity, podiatrists advise you to avoid that particular activity. If needed, you can modify the activity to a certain extent and do it on a moderate level until the pain has subsided or is under control.

Apart from following these seven steps, you should follow some additional preventive measures. For instance, you should walk on your toe and heels alternatively. Also, you should not forget practicing cooling down exercises once your sports session ends. This would let your body relax gradually and shift to a resting or near-resting state.

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More in our next post.

Getting Claw Toes Treated

Claw toe is one of the most common foot diseases that people suffer from. This condition is triggered by wearing shoes that squeeze your toes. Wearing extremely high heels is also a reason of developing claw toes. This condition often occurs as a result of nerve damage that is caused by alcoholism or diabetes. Apart from weakening the muscles of your feet, claw toes also causes unbearable pain. If left untreated, it can get worse and may also cause permanent deformity.

What are the symptoms?

There are certain symptoms that can tell whether you are suffering from claw toes or not. These include if your toes are bent downward or upward at the middle joints or at the ball of the foot. Sometimes, corns may develop either under the balls of the foot or over the top of the toe.

What are the causes?

This condition can be caused by cerebral palsy, rheumatoid arthritis, brain and nervous system disorders, any kind of ankle surgery or fracture, and Charcot-Marie-Tooth disease.

Wearing a shoe that is too tight for your feet may also lead to claw toes. If you wear pointed shoes, the situation may get even worse. In case you wear pointed shoes with high heels, the foot will get constantly pushed downwards to a wall, which may cause severe pain and eventually lead to claw toes.

How to treat claw toes?

Although claw toes get cured normally in case they are at the initial stage, they might gradually turn out to be extremely hard in some cases. In the initial stage, it's advisable to use a tape or splint to hold the toes in the correct position. Additionally, you should make sure to wear shoes with roomy and soft toe boxes.

It’s important to wear the appropriate shoes for any activity that you may be involved in. Some foot doctors may recommend using non-medicated hammer toe pads that fit around your toe joint’s pointed top and help ease painful pressure.

To relive pain and swelling caused by claw toes, you can gently massage the affected area or apply ice packs wrapped in cloth.

Exercising and stretching your toes will help combat the condition. Try crumpling a towel laid flat on the floor or consider picking up marbles with your toes.

Surgical methods

If a claw toe doesn't get cured with the non-surgical methods, surgery is often recommended. The usual procedure followed for curing this ailment is called arthroplasty. This refers to the process of replacement or reconstruction of a joint. There are different types of surgery procedures followed to cure claw toes, which include: 

• PIP Joint arthroplasty – It is performed on the PIP joint. In this process, an incision is made over the joint.
• DIP Joint arthroplasty – It is suggested mainly for correcting hammer toe. This method is performed through a small incision on top of the toe over the DIP joint.
• MTP Joint arthroplasty – Foot doctors recommend this method when it becomes difficult to cure claw toes with other methods. This is performed by making an incision over the MTP joint.

After the surgical methods are performed, patients are usually advised to wear a post-op shoe with a wooden and stiff sole that prevents the foot from bending.

 

So, the moment you notice any symptoms of claw toes or experience pain in the toe joints, consult a foot doctor immediately.

Treatment and Rehabilitation for Post-Tib Tendonitis

Posterior tibial tendonitis is a condition where the posterior tibial tendon is put under strain, becomes torn or inflamed.  As a result, the tendon may not provide support and stability for the arch of the foot, thus causing a flat foot.

The most common cause of post-tib tendonitis is the overuse of the tendon. Some common symptoms of this condition include a nagging pain along the inside of the ankle, foot, or on the outside of the ankle, or pain that worsens with high-impact/high-intensity activities.

Treating Post-Tib Tendonitis

The best way to take care of post-tib tendonitis is to control the activity of your feet. Adequate rest helps the tissues of the feet to heal. Once they heal, you can get back to your daily routine. Some of the most common treatment options for this condition are as follows:-

Non-surgical Treatment

With appropriate non-surgical treatment, symptoms in most cases are relieved quickly. However, the pain may last for over 3 months even with treatment during the early stages. Patients suffering from pain for a long time may have to beat it for as long as 6 months after treatment begins.

• Adequate rest: The first step is to stop all those physical activities that can increase the pain. Doctors may even recommend switching to low-impact exercises like swimming or walking.
• Ice packs: Applying ice packs on the affected area is another effective way to decrease pain. You can apply cold packs for 20 minutes at a time for 3 to 4 times a day for getting relief. However, you should never apply ice directly on the skin.
• Medications: Taking some anti-inflammatory, non-steroidal medicines about 30 minutes before you begin exercising can help limit inflammation in and around the tendons.
• Physical therapy: This is another method that strengthens the tendons and helps patients suffering from mild to moderate levels of posterior tibial tendonitis.

Depending on your condition, you doctor may even suggest the use of orthotics and braces or cortisone injections.

Besides these non-surgical treatments, there are some surgical methods to deal with post-tib tendonitis. Surgery should be considered only if the pain or inflammation of the tendon does not subside after 6 months of treatment. 

Some of the common surgical methods used are:-

• Tendon transfer
• Gastrocnemius Recession (surgical lengthening of the calf muscles)
• Osteotomy (cutting and shifting of bones to create a “normal” arch), and
• Tenosynovectomy (resection or excision of a tendon sheath)

Rehabilitation

With some easy rehabilitation exercises, you can get relief from the pain and return to normal activities soon. Some exercises worth considering are:-

• Towel Stretch: You need to sit on a hard surface and stretch your injured leg at front. Place a towel around your foot’s ball and then pull it towards your body, keeping the knee in a straight position. You have to hold this pose for at least 15 to 20 seconds. Doing this exercise 3 times a day would help.
• Heel Raises: You have to balance your body on your toes as you stand behind a chair. You need to hold this pose for at least 5 seconds, after which you can come down to the earlier position. You can start with a set of 10 a day and slowly increase it to 3 sets of 10 reps a day.
  
  A few other exercises that can provide relief from post-tib tendonitis are the “Standing Calf Stretch”, “Resisted Inversion”, “Balance Exercises” (both dynamic and static) etc.
  
  Consult your foot doctor today to get the condition assessed and start treatment on time. Remember, with the right treatment and rehabilitation exercises, you will be able to control the swelling and pain and return to your favorite activities soon, albeit with some limitations.    

A to Z of Charcot Foot Reconstruction

People suffering from neuropathy (considerable nerve damage) have weakened bones in the foot, which are prone to stress buildup, and may eventually suffer a crack or fracture. This condition is called Charcot foot. With continued walking, the injured foot or ankle is subjected to continuous pressure. As the disorder reaches an advanced stage, it can finally lead to a collapse of the joints, which would give an abnormal shape to the foot.

Charcot foot is an extremely serious disease that can cause disability and deformity. Some cases may even lead to amputation. That’s why it becomes important for those with diabetes, a disease connected to neuropathy, to take preventive measures and consult a doctor as soon as they spot symptoms of Charcot foot. 

Symptoms

Common symptoms of Charcot foot could include:

• Redness in the foot
• Feeling of warmth in the affected foot
• Soreness
• Swelling in the area
• Pain

Treating Charcot Foot

The optimal treatment for this condition, which could be either amputation or salvage, has been a subject of long-term debate among orthopedic surgeons. Though non-operative treatment options include limiting any walking, weight bearing and loading of the foot and ankle until the bone has healed, it may not give effective results in severe cases. During such instances, surgical intervention may become necessary. 

Depending on the extent of ulcerations, foot deformities and instability, the best surgical option is assessed. From simple exostectomy with ulcer excision, exostectomies with rotational flaps, free tissue transfers, to arthrodesis (major elective reconstruction) as well as internal and external fixation, there are various surgical treatment options available today. However, the key to successful reconstruction depends on proper selection of the procedure and patient compliance. Though patient compliance may seem like a foregone conclusion, it becomes important to educate patients about the need for a period of non-weight bearing post-operative phase where the foot heals slowly and eventually becomes free of pain.

For treating Charcot joints, the clear winner is arthrodesis. This procedure involves joint fusion between two bones via surgery that helps in realignment and correction of deformities, improves function, eliminates instability and helps in the maintenance of such corrective steps. 

Usually, the level of fusion (triple, mid-foot or ankle arthrodesis) is determined by the extent of the deformity. In these complex fusions, the use of screws, plates and intramedullary nails has become a standard practice these days as they offer improved outcomes with better solid fixation. In recent years, an increase in the usage of external fixation has been noticed. In reconstructive surgery of the Charcot foot and ankle, surgeons may use external, internal and combined fixation, after assessing what the situation demands.  

Past vs. Present

Earlier, standard methods of internal fixation were used for corrective surgery, which was performed as a staged procedure. The first stage involved resection of the infected bone while internal fixation was applied at the second operation. Today, fine-wire external fixation is used to conduct a single-stage resection along with correction. To maintain the correction, a fine-wire (multi-plane) external fixator is used.  

Charcot foot adversely affects the patient’s quality of life and creates a severe negative impact on his/her overall health. Therefore, it becomes important to consult an orthopedic or foot and angle surgeon on time to avoid amputation and get the limb salvaged.

Know All About Ankle Arthroscopy

Ankle arthroscopy refers to a surgical procedure used to treat ankle problems. This minimally invasive procedure employs an arthroscope (thin fiber-optic camera) that magnifies images of the ankle and transmits them to a video screen. The aim of this surgery is to decrease ankle pain and improve overall function.

Conditions and Causes that Require Ankle Arthroscopy

This procedure can be used to identify and treat several disorders of the ankle joint. Some conditions that can be treated with ankle arthroscopy include:-

• Ankle arthritis
• Ankle instability
• Severe fracture or sprain in the ankle
• Arthrofibrosis
• Athlete’s ankle
• Loose bodies (free floating bone, cartilage and scar tissue in the joint)
• Infection
• Synovitis (inflammation of the synovial tissue)
• Infection in the joint
• Osteochondral defect

At times, patients may develop symptoms in and around the ankle that other diagnostic techniques fail to explain. In such cases, ankle arthroscopy can help the surgeon look directly into the joint to identify the issue and decide on the treatment.
 

When Do You Require Ankle Arthroscopy?

Ankle arthroscopy is usually recommended for injuries caused by sports activities, accidents and age-related bone conditions. This surgical procedure is performed to diagnose a problem in the ankle or when an ankle injury fails to settle. Those suffering from inflammation and arthritis can get relief when ankle arthroscopy is used to repair damaged tissue and cartilage or remove loose bodies.

Why is ankle arthroscopy better than an open surgery?

Arthroscopy is an advanced option that minimizes post surgery effects and scars. Some of the key benefits due to which ankle arthroscopy is adopted by the patients as well as the doctors include:-

• Pain levels are significantly lower than open procedure
• Faster healing of the wound and hence, movement of ankle and physiotherapy can be conducted early on
• No obvious scars
• Probability of infections are low
• Quick return to normal activities
• Most often, it is a single day procedure including the admission and discharge procedures

Treatment Procedure of Ankle Arthroscopy

• Before Surgery: The option to undergo an ankle arthroscopy should always be the combined decision of the individual and the surgeon. You need to know about the procedure as much as possible. In case you have questions or concerns, make sure to talk to your surgeon. Once the decision to proceed with the surgery has been taken, your surgeon may recommend going to your regular doctor for a complete physical examination. This exam will help ensure that you are fit to undergo the operation. You may also be advised to talk to the physical therapist who will be managing your post-surgery rehabilitation in order to get a head start on your recuperation. The therapist will examine your present pain levels, capability to do your activities and the strength and movement of each ankle. She/he will also teach you how to walk safely using a walker or crutches as well as teach some exercises that you can do during your recovery.
• The Actual Procedure of Ankle Arthroscopy: Most often, local anesthesia is administered in the ankle region. However, in some cases, a general anesthesia might be required. Your ankle would be placed on a traction table with an arthroscope, TV screen, and other essential tools set up and connected through portals and tubes to your ankle joints. The actual procedure involves making minimal incisions in the area of injury. The surgeon performs the procedure on completion of which the openings would be closed with stitches. The leg would be elevated throughout and after the procedure to avoid swelling.
• Post Surgery: You would be given medications for healing and pain relief as the surgeon deems fit. The dressings will be removed within a few hours though the feet would be covered in minimum surgical plasters. Most often, the weight bearing is done on the same day with or without the help of crutches. You may even be allowed to drive or return to your sport within one week, depending on your recovery time.

Today, ankle arthroscopic procedures are adopted even for reconstructive surgeries. No two individuals have the same type of problem or heal the same way. Therefore, it is essential for you to go through all the stages of surgery according to the advice of your general doctor and the surgeon in charge of the procedure.