Overuse injuries of the ankle and foot

Daniel Murawski, M.D.
Orthopaedic Surgeon / Foot & Ankle Specialist
850.916.8700
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 Q: How do overuse injuries of the ankle and foot occur?
Daniel Murawski, M.D.: Overuse injuries of the ankle and foot are very common. It's probably the biggest category of problems that I see in the office. If you think about, the ankle and the foot has to deal with a lot of stresses on a daily basis. We all take thousands of steps every day and our foot is designed to deal with that stress and sort of dissipate that stress so that way we can remain upright and function on a daily basis. But certainly there's a lot of stress that is dealt with by the foot and ankle and it's a very structure. The foot has 26 bones in it and part of the reason for that is because you can dissipate all that stress and accommodate uneven ground and different terrain. There are many times when we exceed the fatigue limit of the ankle and the foot. So I see injuries that go all the way from your elementary school athlete, middle school athlete, high school athlete, all the way through college and even professional athletes that have overuse injuries. It’s usually in that category more of improper training rather than to overtraining in that category. Certainly you can see some overuse, but many times it’s improper training, meaning they're using the wrong shoe for the terrain that they're involved with, or they're just not spacing out the intervals enough where they're doing the wrong type of conditioning for what they want to accomplish.

But I also see your young adults who want to continue running through their 20’s and 30’s that are just dealing with stress injuries that occur from running. Sometimes there are pushing themselves beyond what they can do. And then I also see your middle age, you know patient who is in their 40’s and 50’s and they haven't been training for a long time and all of a sudden they put on some extra weight and they want to lose some weight. So they try to get back into being active. Well the there are a lot of overuse injuries in that group because there's the tendons, ligaments or bones can undergo changes where it's not ready to get back to a more vigorous lifestyle. So I see a lot of injuries particularly of the Achilles tendon and also some other structures around the foot and ankle that just occurred because the tendon through deconditioning has gone undergone some degeneration and now you’re asking it to go through some training that it's not ready for. So that's actually probably the bulk of my practice is that age group of you know, 40 - 50 year olds trying to play tennis, golf or to get back to running. They want to do a half marathon and six months and they haven't run in 10 years and you know, they want to get back. So a lot of what I do is dealing with some of those injuries that I can that I can occur from that.
 Q: What are treatment options for overuse injuries of the ankle and foot?
Daniel Murawski, M.D.: Well, there is general approach to overuse injuries. I look at it basically from three different standpoints. Number one is identifying what is causing the pain in the injury. Number two is identifying what kind of shoe the patient is the patient wearing – understanding what kind of interface they have with the terrain that they are involved with. Number three is basically stiffness and many times a contracture of some of the of the surrounding structures. For the foot and ankle for example, the calf muscle is tight almost always. A lot of injuries can be traced back to having a tight calf muscle. Calf muscles are known as the gastrocnemius and soleus, and when you have a tight muscle in that area it can lead to things such as achilles tendonitis and plantar fasciitis. Those are probably the two most common things that I see in the office. And so the approach is dealing with understanding what's causing this problem, what kind of shoes are you wearing and are you working on keeping your calf muscle flexible?
 Q: When do you decide if surgery is the best option for a patient with an overuse injury?
Daniel Murawski, M.D.: Well, you know the make great majority of these overuse injuries can be treated with physical therapy. So I really try to educate my patients and push them towards physical therapy because it can make a huge difference. This day and age, we’re all trying to get things done quickly, we all have to work, we have kids, we have so many things that are on the agenda that we don't take time to deal with the overuse injury. I make it a point to take time to explain to the patient that if they spend some time with physical therapy, I can almost guarantee that you're going to get better but you have to spend the time. I mean that's a conversation that I have to have because the majority can be treated on operatively. Now when you get to about three to six months of non-operative treatment and you're still not doing well, that's when we start thinking about having to do surgery for these overuse conditions. And again the most common thing would be the achilles tendon. I do a lot of achilles surgeries a lot of plantar fasciitis surgeries, and that's when you know, maybe 10% of patients just can't get better even with the right physical therapy and the right non-operative treatment.

 

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