Sport Injury

From A2FWiki


Sunday, September 5, 2010	Enquiry line: (+44)(0)113 2185908/09	Email: Nick Harris

1 What we do
2 Common Sport Injuries

What we do

Sport Injuries require specialist treatment

Many sports place huge stresses on the ankle and foot up to 4 times your body weight. In the Ankle to Foot Clinic we regularly treat professional and non professional sportsmen and women with injuries to their ankles and feet. Working with an experienced team we aim to get you back to fitness and sport as soon as possible.

Common Sport Injuries

Ankle Fractures

Two thirds of injuries to the foot and ankle involve the ankle. Accurate reduction and stable fixation is the mainstay of treatment for displaced ankle fractures. This usually involves the insertion of plates and screws. Patients often require a period of non-weight bearing usually 6 weeks followed by intensive physiotherapy. It is often possible to return to high level sports within a period of 12 weeks depending on the fracture type.

Ankle Instability

Illustration showing stress x-rays of an unstable ankle

Inversion injuries to the ankle are the commonest sporting injury - approximately 6,000 injuries occur each day in the UK. The anterior talo-fibular ligament is the most commonly injured ligament. Treatment in most instances is functional and the majority of patients make an excellent recovery. Persistent instability leading to recurrent sprains and chondral injuries are the two most common causes for persistent symptoms. Persistent instability can be treated surgically in most instances by an anatomic repair of the ligaments. The management of chondral injuries is more difficult. Debridement, drilling and osteochondral autografts have all been described.

Posterior Impingement

Posterior impingement is common in dancers who go ‘en-pointe’. There is often a predisposition to this in which patients have a bony prominence at the back of the ankle called an ‘os trigonum’. Ordinarily this is asymptomatic but when a dancer goes ‘en-pointe’ the os trigonum impinges on the back of the tibia causing pain. One treatment for this is to remove the bony prominence. This is quick simple and effective.

Peroneal Tendon Injuries

The two commonest problems affecting the peroneal tendons are tenosynovitis and subluxation or dislocation. Tenosynovitis usually occurs because of over use. Tenosynovitis may also occur as a result of a plantar flexion inversion injury to the ankle. This can be associated with a tendon tear or rupture. The peroneus longus usually compresses the brevis against the fibula causing a longitudinal split. Subluxation or dislocation usually occur as a result of a specific traumatic event. The most common mechanism of injury being forced dorsiflexion. The peroneal tendons sublux anteriorly around the lateral edge of the fibula. Although conservative treatment with a period of immobilisation has yielded good results in at least 50% of patients, operative treatment is advocated in the young athlete. This usually consists of an anatomic repair of the superior peroneal retinaculum combined with a fibular groove deepening procedure.

Achilles Tendon Disorders

The Achilles tendon is the largest and strongest tendon in the body. The tendon may be required to withstand forces of up to 10 times the patient's body weight with activity. The Achilles tendon is prone to tendonitis, tendinosis and ruptures. Tendonitis can be divided into insertional and non-insertional. There are two bursae associated with the insertion of the Achilles tendon, one deep to the tendon the retro-calcaneal bursa and one superficial. Achilles tendonitis is associated with over use syndromes, postural problems, problems with shoe wear and also inflammatory arthropathies. Achilles tendonitis can be classified into three stages (Table 4).

Table 4 - Classifications of Tendonitis
Stage 1 - Peritendonitis
Stage 2 - Peritendonitis and Tendinosis
State 3 - Tendinosis

The Achilles tendon does not have a true synovial sheath but a peritenon. The treatment of Achilles tendonitis can be divided into operative and nonoperative. Non-operative treatment consists of rest, anti-inflammatories, orthotics and activity modification. Should symptoms persist despite this approach then surgery has been described. Surgery usually consists of resection of the inflamed peritenon together with a debridement of the degenerate tendon. In cases of insertional Achilles tendonitis this may need to be combined with a resection of a prominent Haglund deformity (a prominence of the posterior superior aspect of the calcaneus). Rupture of the Achilles tendon is well recognised ana usually occurs in the middle aged patient. Patients usually experience a snap or blow to the back of the leg. Most ruptures occur in the intra tendinous region. There is still a range of opinion regarding the best way of managing ruptures of the Achilles tendon. Non-operative treatment in an equinus plaster is associated with a higher rerupture rate and the tendon healing in an over lengthened position. Operative treatment allows accurate tensioning of the gastroc-soleus complex. Surgery also carries with it a lower re-rupture rate and a higher chance of returning to the level of sport at which the injury was sustained. Surgery however carries with it risks, in particular poor wound healing, infection and nerve injury.

Navicular Stress Fractures

$Illustration showing screw fixation of navicular stress fracture in an international runner$

Illustration showing screw fixation of navicular stress fracture in an international runner

Navicular stress fractures represent a career threatening injury to athletes who suffer them. There remains a significant delay to diagnosis often 3-4 months. They occur commonly in runners aswell as football and rugby players. Patients often present with vague pain in the midfoot. Initial x-rays are usually normal. The diagnosis being made with an MRI scan. If they are diagnosed acutely then the majority heal in a non weight bearing plaster. If there is a significant delay to diagnosis or the fracture is displaced then they require screw fixation. The illustration shows screw fixation of navicular stress fracture in an international runner.

5th Metatarsal Stress Fractures

Illustration shows a screw in the 5th metatarsal in a professional footballer

Metatarsal Stress Fractures are common in footballers and rugby players and tend to occur most commonly in the pre-season period. Patients usually experience vague discomfort over the outer aspect of their foot for several weeks followed by a sudden exacerbation of pain without any major trauma. The initial x-rays may be normal and the diagnosis is made on an MRI scan. Depending on the duration of the symptoms the fracture can either be managed in plaster or more usually with a screw into the metatarsal. The illustration shows a screw in the 5th metatarsal in a professional footballer.

Lis-franc Injuries

These injuries represent serious midfoot dislocations involving the tarso-metatarsal joints. Up to 20% are missed. The usual mechanism of injury is loading a plantarflexed foot. The treatment is accurate reduction and fixation. Despite this many patients go onto experience chronic symptoms. The illustrations show screw fixation of the tarso-metatarsal joints in a professional rugby player.