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Foot Sprain

* Explanation * Symptoms * Diagnosis * Duration
* Prevention * Treatment * Call a Professional * Prognosis

Explanation

A foot sprain is a tear of ligaments — the tough bands of fibrous tissue that connect bones to one another inside a joint. Sprains range in severity from Grade I to Grade III. In a Grade I foot sprain, the injury is fairly mild, causing microscopic tears that merely stretch the foot ligaments out of shape. In a Grade II sprain, the stretching is more severe, and the ligaments may be partially torn through. In a Grade III sprain, the ligaments are completely torn, so the foot may no longer be able to bear weight.

Because the foot contains 28 bones and 57 joints, it might seem that the foot would have a high risk for sprains. In reality, however, sprains of the foot are fairly rare, except in people who participate in certain sports or occupations that subject the feet to abnormal twisting motions or bends. When foot sprains do occur, they usually involve one of two distinct areas: the midfoot (the central area that includes the arch of the foot) or the first metatarsophalangeal joint (the joint at the base of the big toe).

Midfoot sprain — In athletes, midfoot sprains usually occur because of a sports-related fall, a collision or an isolated twist of the midfoot, particularly during snowboarding, windsurfing, horseback riding or competitive diving. Among women ballet dancers, midfoot sprains typically happen when the dancer loses her balance while en pointe and spinning, or when she lands with her foot abnormally flexed or rotated after a jump. Among people who do not compete in high-risk activities, about one-third of midfoot sprains happen by accident, simply because of an odd twist of the foot during an ordinary stumble or fall. Less often, severe midfoot sprains are the result of high-impact trauma, especially trauma caused by a motor vehicle collision or a fall from a high place. This type of injury is likely to produce not only Grade III sprains, but also foot fractures and open wounds.


Sprain of the first metatarsophalangeal joint — This injury, which is also called "turf toe," is usually caused by hyperextension (extreme backward bending) of the big toe. The typical scenario involves either a football player or a ballet dancer who falls forward while the big toe is planted flat against the ground. In football, turf toe is most common in players who wear lightweight soccer-style shoes while competing on artificial playing surfaces. The relatively flexible soles of their shoes probably offer less protection for the metatarsophalangeal joint, increasing the risk for a turf toe injury. The situation is probably similar for ballet dancers, particularly males.

Foot sprains are fairly uncommon injuries, and statistical information about them is rare. Foot sprains are usually included in a larger blanket category of "foot strains, sprains, tears," which accounts for only 1 percent of the disabling occupational injuries in workers each year. Among snowboarders, only about 0.5 percent of all injuries are foot sprains, with ankle sprains being 16 times more common.

Symptoms

In a mild or moderate midfoot sprain, your midfoot area will be swollen and tender, and there may be some local bruising ("black and blue" discoloration). In more severe sprains, you may not be able to bear weight on your injured foot.

If you have "turf toe," the base of your big toe will be painful and swollen, but the joint itself will remain fairly stable.

What Your Doctor Looks For

After reviewing your symptoms, your doctor will ask you to describe exactly how you injured your foot. Your doctor will also want to know about your occupation, recreational activities, participation in sports, orthopedic/podiatric history (especially previous foot trauma or foot surgery) and the type of shoes you usually wear.

Diagnosis

The doctor will begin by performing a physical examination of your feet, comparing your injured foot with the uninjured one. During this exam, your doctor will note any swelling or bruising, as well as any changes in flexibility or range of motion. Your doctor will also palpate (gently press and feel) your injured foot to check for tenderness or bone abnormalities.

If you cannot bear weight on your injured foot or if the results of your physical examination suggest that you may have a more severe foot injury, you may need foot X-rays. In most cases, both of your feet will be X-rayed for comparison purposes.

Rarely, a computed tomography scan of the foot is necessary in selected patients (especially professional dancers or athletes) who have unusual pain or joint instability in spite of having fairly normal foot X-rays.

Expected Duration

Mild midfoot sprains usually heal within a few weeks, while more severe sprains may take up to two months. The pain of a "turf toe" usually subsides within two to three weeks.

Prevention

In some cases, you may be able to prevent foot sprains by wearing stiff-soled shoes that help to stabilize the foot.

Treatment

For milder midfoot sprains, initial treatment follows the RICE rule: Rest the joint; Ice the injured area to reduce swelling; Compress the swelling with an elastic bandage; and Elevate the injured area. Your doctor may also suggest that you take a nonsteroidal anti-inflammatory drug, such as ibuprofen, to relieve pain and ease swelling.

For more severe midfoot sprains, especially in dancers and other professionals whose livelihood depends on their feet, the doctor may immobilise the foot in a cast and instruct the patient to temporarily avoid bearing weight on the injured foot. As symptoms subside, the patient will gradually resume weight-bearing and other normal activities, and begin rehabilitation. Because a serious midfoot sprain can threaten the career of professional athletes or dancers, they often need to follow special treatment and rehabilitation regimens to ensure that the injured foot heals with a proper balance of flexibility and stability.

"Turf toe" is usually treated with RICE, a nonsteroidal anti-inflammatory drug and splinting. To help protect the injured joint, your doctor may recommend that you wear stiff-soled shoes or use a custom-molded orthosis or a spring-steel shoe insert.

When To Call A Professional

Call your doctor whenever you have symptoms of a sprained foot, especially if pain prevents you from bearing weight on your injured foot.

Prognosis

Since most sprains heal with time, the prognosis is usually excellent, particularly in individuals who do not participate in high-risk activities that twist or bend the feet. In rare cases, a midfoot sprain may cause long-term complications, such as chronic foot pain or a fallen arch.

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