Posts for category: Sports Injuries
Lisfranc injuries result if bones in the midfoot are broken or ligaments that support the midfoot are torn. The severity of the injury can vary from simple to complex, involving many joints and bones in the midfoot.
The midfoot is the middle region of the foot, where a cluster of small bones forms an arch on the top of the foot. Five long bones (metatarsals) extend to the toes. The bones are held in place by connective tissues (ligaments) that stretch both across and down the foot. However, there is no connective tissue holding the first metatarsal to the second metatarsal. A twisting fall can break or shift (dislocate) these bones out of place.
The midfoot is critical in stabilizing the arch and in walking (gait). During walking, the midfoot transfers the forces generated by the calf muscles to the front of the foot.
The Lisfranc joint complex has a specialized bony and ligamentous structure, providing stability to this joint.
The most common symptoms of Lisfranc injury include:
- Swelling and tenderness on the top of the foot.
- There may be bruising on both the top and bottom of the foot. Bruising on the bottom of the foot is highly suggestive of a Lisfranc injury.
- Pain that worsens with standing or walking.
Treatment for a Lisfranc injury depends on the severity of the injury. If the bones have not been forced out of position, a cast or cam walker boot will need to be worn for four to six weeks. When the cast is removed, you may have to wear a custom orthotic.
Often, operative treatment is needed to stabilize the bones and hold them in place until healing is complete. Pins, wires or screws are options for fixation. Afterwards, you will have to wear a cast and limit weightbearing on the foot for six to eight weeks. In some cases, if arthritis develops in these joints, the bones may have to be fused together.
BELOW IS A LINK ABOUT A PROFESSIONAL BASKETBALL PLAYER WHO SUSTAINED A LISFRANCS SPRAIN AND WILL BE OUT FOR 4-6 WEEKS.
Heel pain is one of the most common complaint that we see in our practice. Heel pain can sometimes be misdiagnosed as plantar fasciitis. If you have been suffering from heel pain and you haven't had relief with aggressive conservative treatment such as stretching, icing, NSAIDS, cortisone injections, night splints, and custom orthotics than MRI may be an option. MRI will aid in ruling out a heel fracture or plantar fascial tear. The typical course of treatment for a heel fracture or plantar fascial tear is different from the treatment of plantar fasciits. Here is some treatment options and long term outlook for three common complains of heel pain.
- If you have a positive MRI for calcaneal (heel) fracture, the treatment is 3 months in a removable boot.
- If you have a positive MRI for plantar fascial tear, the treatment is 3 months in a removable boot.
- If you have a positive MRI for intense inflammation only, the tapered cortisone course, with contrasts and ice, with a short course of removable boot, with some PT or accupuncture are all helpful.
- If you have a positive MRI for any of the above, you may still have nerve trauma/sensitivity concurrently. The pain from nerves is difficult to treat, and has been solutions.
- If you have a negative MRI, then you have plantar heel bursitis (may not show well on MRI) or nerve trauma, or both. If I think there is bursitis, with a negative MRI, I like ice massage, physical therapy, or cortisone shots (which you correctly are not a fan of, but may be crucial).
For more information on heel pain please refer to our website at carolinafootspecialists.net
Neuromas are a common diagnoses that we see in our practice. A neuroma is an inflammation of a nerve or nerves on the ball of the foot. Neuromas are typically found most commonly in women that wear high heel shoes and individuals who are active on their feet. Neuromas can causes sharp pain on the ball of the foot and burning and tingling that radiates into the toes. Neuromas are most commonly found in between the third and fourth toes and the 2nd and 3rd toes. Pain is usually relieved with taking your shoe off and rubbing your foot.
We employ many conservative treatments for neuromas. Conservative treatment consist of custom orthotic and pads to take pressure off the nerve, cortisone injections, antiinflammatory mediation, alcohol sclerosing agent, consultation of appropriate shoe gear/training modification and as a last resort surgical excision of the neuroma.
If you feel like you have any of the symptoms of a neuroma please contact our office.
For more information on Neuromas you can refer to our website at www.carolinafootspecialists.net
PRP (Platelet Rich Plasma)
A new state of the art treatment for chronic heel pain is PRP (Platelet Rich Plasma) injections. A small amount of blood from the patient, similar to giving blood for a routine test. The vial of blood is subjected to very high speeds in a machine called a centrifuge. A yellow material is obtained containing cells called platelets, that are very abundant with factors that aid in healing. These growth factors are believed to decrease the inflammation causing plantar fasciitis. The platelets from the patient's own blood is injected into the area of pain in the heel. Patients are then fitted for a removable walking boot, and will use crutches to prevent putting any weight on the heel for one week or less. After that, they advance to sneakers, and although the range of time for pain relief is variable, it can be appreciated as early as 10-14 days.
For more information please contact our office at carolinafootspecialists.net
NFL quarterback Tom Brady recently suffered a stress fracture of his foot in a playoff game.
Stress fractures are small, hairline breaks that can occur in the bones of the foot. Typically stress fractures can be caused by overtraining, improper training habits, improper shoe gear, flatfoot or other foot deformities, and even osteoporosis. Tom Brady's injury was more likely due to trauma from blunt force on his foot.
Pain, swelling, and possibly bruising can be signs of a stress fracture. The metatarsal bones are one of the most common locations of stress fractures of the foot. X-rays are used to diagnose stress fractures. Stress fractures may not be visible for 10 to 14 days on x-ray examination. Possible treatments include rest and possible immobilization of the foot ( with a cam walker walking boot/or below knee cast). In Tom Brady's case he may have a fracture that is not in a proper alignment or a fracture that is in a location that won't allow it to heal properly. His surgery will more likely involve screws and possibly a plate to stabilize the fracture. Fractures can take between 6-8 weeks to heal.
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