Dr. Mark Drakos, Orthopedic Surgeon, Answers Your Questions about Ankle & Foot Sports Injuries

by Dr. Mark Drakos

Q1. Does running on pavement increase the chances of foot injuries? 

Studies have shown that there are higher stresses on your feet when running on asphalt as opposed to running on grass (reference #1). This suggests that runners who are prone to stress fractures may be at a higher risk of injury running on pavement than running on softer surfaces such as grass, a rubberized track or a treadmill.  The risk of foot injuries has been correlated with an increase in miles run, foot type, runner experience, previous foot injury and certain footwear.  I would recommend changing running shoes every 500 miles as after that distance the ability of the shoe to absorb the shock of running decreases and that may increase the risk of foot injuries.

Q2. Some NBA basketball players have been missing games because of sprained ankles. How long does a sprained ankle take to heal and what are preventative measure?

Ankle sprains are the most common musculoskeletal injury among NBA basketball players. In an HSS study we performed with the NBA, ankle sprains accounted for over 1600 injuries and a total of 13% of all injuries (reference #2). It was also the second most common reason for games missed by players.  How much time is missed depends on the severity of the injury as well as the specific location of the sprain.  For example, lateral ankle sprains are graded 1, 2 and 3 with grade 3 the most severe.  Grade 1 usually takes only a week or two before the player can return to play while grade 3 may take 4-6 weeks.  In addition, a “high” ankle sprain, which is more severe involving the ligaments higher up in the ankle, may take 8-12 weeks for recovery.

One of the major risk factors for ankle sprains is whether or not the athlete has had a prior sprain, which indicates a more likely change of experiencing another. To prevent further sprains try taping up the ankle before engaging in any sport or wearing a supportive ankle brace.  Studies have shown that certain ankle braces can prevent future sprains and you should consult a health care professional to determine the best brace for you.  Focus on strengthening the muscles and tendons around the foot and ankle to prevent a sprain.

Q3. I usually run 4-5 times a week and don’t have any foot pain. A few days ago I ran up a steep hill, then 5 miles the following day and afterwards I was in so much pain that I couldn’t walk. The pain is on the outside of both of my feet below my ankle. What could be wrong with my feet?

If you have recently increased the distance or the intensity of your training you may be developing a stress fracture. If you truly cannot walk I would recommend seeing a medical professional to make sure that you do not have a fracture. Tendinitis is also a common problem with runners.  Tendinitis usually resolves with proper treatment including rest, ice, compression and elevation.  Occasionally physical therapy may be appropriate.  It is best to consult with an orthopedic specialist.

Q4. I play soccer once a week and every now and then I have pain on the bottom inner part of my feet near the heel. I think I have plantar fasciitis—how should I treat it and prevent it from happening again?

Plantar fasciitis is the most common cause of heel pain and is very common in athletes.  It is often associated with a tight achilles tendon.  Both the achilles tendon and the plantar fascia insert on the heel bone.  So if the achilles is tight it can pull on the heel bone more and can affect the plantar fascia.  Plantar fasciitis can usually be treated conservatively with achilles and plantar fascia stretching 2-3 times a day.  To stretch the plantar fascia you can roll a tennis or golf ball, or frozen water bottle on the bottom of your foot 20 times, three times a day.   It is important that before you play soccer to allow adequate time for stretching and wear the appropriate shoes.  Sometimes a gel heel pad can be placed inside the cleats to take pressure off this area. It is best to be evaluated by a physician to determine if that is the source of your pain before starting any regimen of treatment.

Q5. I have a recurrent problem with sesamoiditis.  I am not a serious athlete but participate in martial arts and I try to walk at least a couple miles a day.  I have been to a podiatrist and had a couple of cortisone injections.  They do provide temporary relief.  Is anyway to manage the condition without further injections?  I try to stretch the area but I am not really sure how or if I even should.  There are no breaks in the sesamoid and the podiatrist sees nothing unusual in the foot structure.  It can be very painful and frustrating. 

Sesamoiditis can be a difficult problem to treat.  The sesamoids are two small bones underneath the big toe that help normal toe function and push-off during running.  These bones can become irritated because they are exposed to 3-8 times the body weight of an individual when running.  If acutely irritated rest and apply ice.  Orthotics are also an option. To prevent it from happening again make sure that you are wearing the appropriate footwear.

Q6. When I walk my foot rolls a lot and I tend to be prone to ankle sprains. What can I do to prevent injury?

Work on  strengthening the muscles and tendons around the foot and ankle,  specifically,  the peroneal tendons that run along the outside of your ankle and assist in ankle stability.  You should also consider wearing an ankle brace or high top sneakers when performing activities that may cause ankle sprains. These interventions can help prevent recurrent sprains in the future.  If despite these treatments you still have pain and recurrent sprains you should see a health care professional to make sure that there is not a more serious ankle problem.

References
1) In-shoe plantar pressure distribution during running on natural grass and asphalt in recreational runners. Tessutti V, Trombini-Souza F, Ribeiro AP, Nunes AL, Sacco Ide C.  J Sci Med Sport. 2010 Jan;13(1):151-5. Epub 2008 Oct 31.

2)  Injury in the National Basketball Association: A 17-Year Overview.   Mark C. Drakos, MD;  Benjamin Domb, MD;  Chad Starkey, PhD, ATC;  Lisa Callahan, MD; Answorth A. Allen, MD. Sports Health: A Multidisciplinary Approach. July/August 2010; 2(4): 284-290.