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Slowing Down For Foot And Ankle Injuries
Category: Ankles and Feet
Sep 11, 2006
By Kristen Gerencher, MarketWatch
SAN FRANCISCO (MarketWatch) -- Feet and ankles are vulnerable to injury in sports such as soccer, dancing and basketball, but it's also possible to break a foot off the playing field -- in my case, by running to catch a bus and falling off a curb.
In a spectacular move of botched choreography, I recently took a spill and fractured both an ankle bone and my fifth metatarsal, a long skinny bone that runs parallel to the edge of the foot.
Countless athletes such as Yao Ming have been felled by a fifth-metatarsal fracture. It's also what kept actress Christina Applegate from making her Broadway debut in "Sweet Charity" last year.
My visible injury has prompted a silent club of past sufferers to relive their struggles. Upon seeing my cast-boot and crutches, they recount stories of their old foot injuries and offer sympathy.
Luckily for me, many former foot-breakers have shared encouraging tales of recovering normal function, though they hated being sidelined for several months as much as I do. But others repeated a troubling refrain: that they either didn't take the injury seriously at first or were misdiagnosed, leading to an excessively long and painful recovery.
It doesn't have to be that way. One of the biggest myths about foot injury is that it can't be a fracture if you can walk on it, medical experts say. Even low-grade pain can indicate a problem.
"A lot of people can tolerate a lot of pain and can walk around on darn near anything," said Dr. James Sferra, section head of foot and ankle surgery at the Cleveland Clinic in Ohio. "We see people all the time who complete a game and then realize they've broken a bone."
"It is a good indicator if you can't walk on it that something serious is wrong," he said. "But just because you can walk on it doesn't mean nothing's wrong."
People who suffer trauma to their feet or ankles should practice the RICE method -- rest, ice, compression and elevation -- for the first two days after the injury, he said.
Those unsure whether to seek medical evaluation need to see if pain and swelling disappear overnight. If pain continues, they should seek care and get X-rays from an urgent-care clinic, primary-care doctor or emergency room, depending what's open at the time, Sferra said.
People with confirmed fractures need to see an orthopedic surgeon or sports-medicine specialist to avoid further injury, said Dr. Ron Navarro, an orthopedic surgeon in Los Angeles.
"For those urgent problems we always have the time," Navarro said. "Fractures are seen within three to five days at most."
Best foot forward
Foot injuries are hardly uncommon. Foot, toe and ankle problems prompted more than 11 million doctor's office visits in 2003, according to the American Academy of Orthopaedic Surgeons. Of that total, ankle sprains were responsible for more than 2 million visits while ankle fractures drove 800,000 visits to physicians.
With ankle injuries, sprains and fractures require slightly different treatments, Navarro said.
"You want to mobilize a sprain earlier so you don't develop long-term stiffness," he said. "You can certainly move it in space but not put weight on it, whereas a fracture needs to be immobilized a lot longer so you can allow the bony ends to heel."
Sferra agreed. "Typically we can get a soft-tissue injury moving a little quicker than a bone injury, but that's not always the case," he said, noting that an Achilles tendon rupture, for example, often takes a long time to heal.
With fractures, surgery may be needed, depending on how and where the bone broke, he said.
"The big thing with a fracture is whether or not it is displaced," Sferra said. "If you cracked a bone but it stays in place, it still hurts like heck but nothing typically has to be done to it from a surgical standpoint. Immobilizing it for a period of time and [physical] therapy are going to take care of it."
Although it's been common practice to give fracture patients anti-inflammatory drugs, increasing evidence suggests allowing inflammation to happen may increase the healing potential, Navarro said.
"The process of inflammation is good for the body to enact because it helps healing to occur, but sometimes the effect of the inflammatory process can be painful," he said.
"Probably in order to decrease the pain you should use either a non-narcotic type pain medication like Tylenol, acetaminophen, or a mild narcotic," Navarro said. "The inflammation should be approached via the typical older mechanism: rest, ice, elevation."
Stretch of time
As a general rule, an ankle sprain that's properly treated and still causing discomfort after eight weeks requires further evaluation, while an ankle fracture typically takes three months, Sferra said. "The most important thing after a fracture is assessing the X-rays. A gap between fracture pieces can start getting wider again, usually indicating that something's wrong."
When it's finally time to come out of a cast or cast-boot, physical therapy can help patients' muscles return to normal strength, easing the transition back to mobility and a normal gait, he said.
"Physical therapy is typically very beneficial to people immobilized for anything longer than 10 days," Sferra said. "We're big proponents of physical therapy. It can be very helpful to people."
As for prevention, Sferra recommends staying fit and knowing when to quit. "Don't get to the point of exhaustion in exercise because that's usually where a lot of injuries occur."
Kristen Gerencher is a reporter for MarketWatch in San Francisco.