Tag Archives: sports injury

Subungual haematoma – Bleeding under Nail

Summary

Often very painful, a subungual haematoma is a blood blister or bleeding under your toenail, and will cause swelling and bruising under and around your toenail.

How did I get this?

Usually a result of trauma, you may have stubbed your toe, dropped something on it, or been stood on.

You may also see this condition after endurance events e.g. running or hiking, or after wearing shoes that sre too small.

If you are taking anticoagulant medication you should take extra care.

What can I do about it?

Painkillers may help, but avoid those containing anti-inflammatories such as ibuprofen.

Piercing the toenail to release the pressure will give immediate relief, but this should be carried out by a medical professional if possible.

What help can I get for this?

Your Doctor or Podiatrist will carefully release the pressure and fluid from beneath the toenail, and advise you on appropriate dressings.

Your podiatrist can help if the toenail comes loose, or is not growing properly.

When will it get better?

Releasing the fluid from beneath the toenail usually gives immediate relief. Sometimes you will lose the toenail, but it should grow back again.

Ingrowing toenail

Summary

  • Ingrowing toenails occur when the hard nail plate causes a wound in the soft flesh around the nail.
  • They can be very painful and become infected.
  • There may be an overgrowth of tissue around the nail due to irritation of the wound.

How did I get this?

  • Direct trauma from tight footwear or stubbing your toe
  • Long term pressure from a thickened or curved toenail
  • Poor nail cutting leaving a sharp corner on the nail
  • Swollen toes and sweaty feet can weaken the skin around the nail.

What can I do about it?

  • Avoid footwear which presses on the toe.
  • Bathe the foot in salt water and apply an antiseptic dressing.
  • Trim the toenail as short as possible but do not cut into the painful side

What help can I get for this?

  • A podiatrist can remove the part of the nail that is causing the problem. This may be done under local anaesthetic if necessary.
  • A Podiatrist can advise on appropriate footwear and how to avoid further problems.
  • A doctor may prescribe antibiotics if the toe is infected, however the nail will still need treatment to prevent further infection
  • A Podiatrist can permanently remove the problem piece of nail and prevent regrowth. This procedure is performed under local anaesthetic and is a lasting solution

When will it get better?

  • Without treatment the nail will continue to grow and penetrate the wound.
  • Removal of the piece of nail provides immediate relief.
  • Careful nail care and the right shoes can prevent recurring problems

Ingrown toenail

Nerve entrapment / Neuroma

Summary

  • Thickening of the tissue that surrounds the nerve leading to the toes. Burning pain in the ball of the foot that may goes into the toes which generally intensifies with activity or wearing shoes. There may also be numbness or an unpleasant feeling in the toes.

How did I get this?

  • Anything that causes compression or irritation of the nerve can lead to the development of a neuroma (e.g. wearing high healed or tight shoes). Foot deformities are risk factors. Injury and trauma to the feet can also lead to this condition.

What can I do about it?

  • Placing an icepack on the affected area helps reduce swelling.
  • Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
  • Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
  • Padding techniques provide support lessening the pressure on the nerve and decreasing the compression when walking.

What help can I get for this?

    • Podiatry consultation for treatments that include footwear advice, padding, orthotics, and may advise guided injections for alleviating the pain.
    • Surgery may be considered if not responded adequately to non-surgical treatments.

When will it get better?

  • Appropriate treatment can provide swift relief, but you will still need to consider long-term measures to help keep your symptoms from returning.

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LISFRANC INJURY

Summary

  • Lisfranc injuries occur at the midfoot where a cluster of small bones forms an arch on top of the foot between the ankle and the toes. Lisfranc fracture-dislocations are swollen and painful with some bruising and inability to put any weight on the foot.

How did I get this?

  • Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot.Commonly occur in automobile accident victims, military personnel, runners, horseback riders, football players and participants of other contact sports, or something as simple as missing a step on a staircase.

What can I do about it?

  • Refrain from putting weight on the foot.
  • Oral anti-inflammatory medications (ibuprofen) help reduce pain and inflammation.
  • Swelling is reduced by icing the affected area and keeping the foot elevated.

What help can I get for this?

  • Podiatrist will place the affected foot in a cam walker to keep it immobile, and crutches are used to avoid putting weight on the injured foot.
  • Orthopaedic foot surgeon for possible surgical treatment to realign the joints and return the broken (fractured) bone fragments to a normal position.
  • A surgeon to correct the associated deformity which is causing the synovitis.

When will it get better?

  • The majority of the recovery occurs in the first 6 months, but it is often a year or more before patients reach their point of maximal improvement. If the surgical treatment fails or the joint damage from the injury leads to severe arthritis, then a fusion (arthrodesis) of the Lisfranc joints may be necessary. Despite the stiffness of a fused joint most patients with successful fusion of the midfoot joints have good function of the foot.

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Synovitis

Summary

  • Inflammation of the tissues that line the joints, often under the ball of the foot. It causes redness, swelling, warmth, and pain on weightbearing or with joint motion.

How did I get this?

  • Pressure overload on the toes due to an associated deformity, wearing inappropriate footwear such as high heels or isufficient width, and arthritis.

What can I do about it?

  • Wear good fitting shoes.
  • Avoid high heels.
  • Wear a protective pad.
  • Hot or cold packs may help.
  • See a podiatrist.

What help can I get for this?

  • A podiatrist may provide padding to reduce pressure on the area, footwear advice, orthotics, strapping.
  • Your doctor may administer a cortisone injection in the injured area.
  • A surgeon to correct the associated deformity which is causing the synovitis.

When will it get better?

  • The earlier the diagnosis and treatment, the better and sooner the outcome will be. If left untreated synovitis could result in rupture and permanent deformity.

Sinus Tarsi Syndrome

Summary

  • The sinus tarsi is a small cavity located on the outside of the ankle. This cavity contains numerous anatomical structures including ligaments and joint capsule. These structures may be injured following an ankle sprain or due to the repetitive strain associated with an excessively pronated (flat) foot. When this occurs, the condition is known as sinus tarsi syndrome. Patients with sinus tarsi syndrome typically experience pain over the outside of the ankle. There may also be swelling and tenderness in the region. Symptoms are typically worse in the morning and may present as pain and stiffness that slowly improves as the patient warms up. Symptoms may also be aggravated during walking or running especially on slopes or uneven surfaces.

How did I get this?

  • Sinus tarsi syndrome usually occurs following an ankle sprain or due to the repetitive strain associated with walking or running on an excessively flat foot.

What can I do about it?

  • Rest sufficiently from any activity that increases your pain.
  • Icing and short term anti-inflammatory medication (e.g. Ibuprofen) may help to significantly reduce inflammation.
  • Elevation of the affected foot to decrease inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe an ankle brace, appropriate footwear, and orthotics, along with strengthening exercises.
  • Your doctor may prescribe a steroid injection.

When will it get better?

  • Most patients with this condition heal well with an appropriate treatment program. This can be a lengthy process and may take several months in patients who have had their condition for a long period of time. Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Early treatment is vital to hasten recovery and ensure an optimal outcome.

Sesamoiditis – pain behind big toe

Summary

  • The sesamoids are two baked bean sized bones in the tendons under your big toe joint.
  • They can become inflamed and even fracture causing pain particularly when wakling quickly or running.

How did I get this?

  • Sesamoidits is usually seen in people who have a sharp blow to the joint, or have a high arched foot with a prominent big toe joint. Dancers and people that wear high heels are more prone to this.

What can I do about it?

  • Wear flat cushioning footwear such as joggers. Ice the area.
  • Short term use of anti inflammatory drugs such as ibuprofen may relieve the symptoms.

What help can I get for this?

  • See a podiatrist for footwear advice, padding, strapping, and possible orthotics to relieve stress on the sesamoids.
  • Immobilisation in a cam walker may be necessary for severe cases.
  • If there is a fracture that does not respond to conservative treatment then surgery may be necessary.

When will it get better?

  • Conservative measures should see improvement over a few months.
  • Surgical intervention will require a longer recovery period.

Plantar Plate tear/rupture – pain under toes

Summary

  • The plantar plate is a thick ligament on the underside of your foot, running along the first joint of each toe. Its purpose is to act like a support cable and protect the toe joints from pressure and injury, and to prevent the joint from bending upward beyond the normal range of motion. Injury to the plantar plate results to mild to severe pain and swelling under the ball of the foot, extending toward the toes (most commonly the 2nd or 3rd). One or more of your toes may be splayed or clawed. You may also have a sensation of numbness or “burning pain” in your toes, or a feeling like you’re walking on the bones of your foot.

How did I get this?

  • Injury to the plantar plate is usually caused by overuse, such as from running; obesity, which puts too much body weight on the ligament; or wearing high heeled shoes too often which locks the forefoot into a flexed position and requires the plantar plate to carry all of your body weight.

What can I do about it?

  • Icing the injured area.
  • Short term anti inflammatory medications (e.g. ibuprofen) to reduce pain and inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe strapping the toe into a downward position to align it in order to help healing, footwear modifications, orthotics.
  • Podiatrist prescribe special boot or shoe if your case is severe to keep weight completely off the ball of your foot.
  • Foot and ankle surgeon for surgical treatment when non-surgical measures fail to alleviate pain and begin to limit your lifestyle.

When will it get better?

  • Treatment for this acute condition can take time, with most patients pain free with 3-4 months. Initial symptoms improvement allows most people to return to activity within 1 month.

LISFRANC INJURY

Summary

  • Lisfranc injuries occur at the midfoot where a cluster of small bones forms an arch on top of the foot between the ankle and the toes.Lisfranc fracture-dislocations are swollen and painful with some bruising and inability to put any weight on the foot.

How did I get this?

  • Lisfranc injuries occur as a result of direct or indirect forces to the foot. A direct force often involves something heavy falling on the foot. Indirect force commonly involves twisting the foot.Commonly occur in automobile accident victims, military personnel, runners, horseback riders, football players and participants of other contact sports, or something as simple as missing a step on a staircase.

What can I do about it?

  • Refrain from putting weight on the foot.
  • Oral anti-inflammatory medications (ibuprofen) help reduce pain and inflammation.
  • Swelling is reduced by icing the affected area and keeping the foot elevated.

What help can I get for this?

  • Podiatrist will place the affected foot in a cam walker to keep it immobile, and crutches are used to avoid putting weight on the injured foot.
  • Orthopaedic foot surgeon for possible surgical treatment to realign the joints and return the broken (fractured) bone fragments to a normal position.

When will it get better?

  • The majority of the recovery occurs in the first 6 months, but it is often a year or more before patients reach their point of maximal improvement. If the surgical treatment fails or the joint damage from the injury leads to severe arthritis, then a fusion (arthrodesis) of the Lisfranc joints may be necessary. Despite the stiffness of a fused joint most patients with successful fusion of the midfoot joints have good function of the foot.

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High ankle sprain

Summary

  • A high ankle sprain occurs when there is an injury to the large ligament above the ankle that joins together the two bones of the lower leg. Symptoms include pain when the ankle is externally rotated (turned to the outside) or when the calf is squeezed.

How did I get this?

  • A high ankle sprain occurs from a twisting or rotational injury. The high ankle sprain also can occur in the setting of an ankle fracture, which means the bones of the ankle are broken.

What can I do about it?

  • Rest the leg.
  • Ice application for 20 minutes every two to three hours for minimizing inflammation.
  • Gently compress the leg, and elevate the leg with the toes higher than the nose to decrease inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist for possible immobilization and taping of the ankle for healing.
  • Feet and ankle surgeon for possible surgery if there is a broken bone or widening of bones involved.

When will it get better?

  • The recovery for high ankle sprains can take considerably longer than typical ankle sprains. It usually takes six weeks or more to return to play, but can sometimes take even longer. One good indication that you are ready to go back to sports is if you can hop on the foot 15 times. Surgery will make even more time for recovery and rehabilitation.