Crush injuries of the foot are serious and can be difficult to manage. These complex injuries often involve soft tissue and bone structures. Potentially devastating complications and long term effects can occur if these injuries are underestimated or mismanaged – prompt and meticulous care is essential.
The painful damage caused by a crushing blow to the foot, is different from all other injuries in the amount of unpredictability and the damage caused, including the amount of scar tissue and the time required for healing.
Crush injuries are usually caused by a car tire rolling over the foot or a large and heavy object falling on top of the foot. Occasionally the foot is caught between two moving objects, and often times these are work-related injuries. The same way that some ankle sprains can be worse than a fracture, the same is with crush injuries because the soft tissue damage tends to be so extensive.
According to the American Academy of Orthopaedic Surgeons, doctors have noticed an increase in the number and severity of broken ankles since the 1970s, due, in part, to the Baby Boomer generation being active throughout every stage of their lives.
The ankle has two joints, one on top of the other, and three bones. A broken ankle can involve one or more of the bones, as well as injury to the surrounding connecting tissues or ligaments.
There are a wide variety of causes for broken ankles, most commonly a fall, an automobile accident, or sports-related trauma. Because a severe sprain can often mask the symptoms of a broken ankle, every ankle injury should be examined by a physician.
Symptoms of a broken ankle include:
The treatment for a broken ankle usually involves a leg cast or brace if the fracture is stable. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to secure the bones in place so they will heal properly.
Nearly one-fourth of all the bones in your body are in your feet. A broken (fractured) bone in your forefoot or in one of your toes is often painful, but rarely disabling. Most of the time, these injuries heal without operative treatment.
There are two types of foot fractures: stress fractures and general bone fractures. Stress fractures usually occur in the bones of the forefoot extending from the toes to the middle of the foot. Stress fractures are like tiny cracks in the bone surface. They can happen with sudden increases in exercise (such as running or walking for longer distances or times), improper training techniques, or a change in surfaces.
Most other types of fractures extend through the bone, and are called bone fractures. They may be stable, in which there is no shift in bone alignment, or displaced, in which the bone ends no longer line up properly. Bone fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. If the fracture does break through the skin, it is called an open fracture.
Because of the complex structures in the foot, there are some other, more specific types of fractures that can occur. For example, the fifth metatarsal, known as the little or pinky toe, is susceptible to a variety of different fractures. The relationship between the ankle and the foot can be compromised by an ankle-twisting injury, which may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is known as a Jones fracture, which occurs near the base of the bone and disrupts its blood supply. This injury may take longer to heal or require surgery.
Osteochondromas are benign bone tumors that form in the bone beneath the toenail. Osteochrondromas account for about half of all benign bone tumors, and occur mostly in children and young adults. Unless they cause irritation to the surrounding tissue, they are generally not painful.
In some cases, osteochondromas may cause a deformity in the toenail or lead to an ingrown toenail. When problematic, osteochondromas may be removed surgically. However, they can recur after the procedure.
Osteochondritis (stiff ankle)
Osteochondritis are lesions that usually cause pain and stiffness of the ankle joint and affect all age groups. Osteochondritis is caused by a twisting-type injury to the ankle. Symptoms include swelling and ankle pain.
Immobilization of the foot and ankle for a period of time usually resolves the problem. In more severe cases, however, surgery may be prescribed. During the surgery, loose fragments of cartilage and bone are removed from the ankle joint and, in some cases, small drill holes are made in the defect to stimulate new blood vessels and to help form scar tissue that will fill the defect.
Shin splints refer to pain on either side of the leg bone that is caused by muscle or tendon inflammation. The problem is usually related to a collapsing arch, but may be caused by a muscle imbalance between opposing muscle groups in the leg.
Proper stretching before and after exercise and sports, corrective shoes, or orthotics (corrective shoe inserts) can help prevent shin splints.
Many sports are hard on the feet because of quick repetitive movements, constricting footwear, and/or increased exposure to injury or trauma. Following is a brief overview of some of the most common injuries that result from particular sports.
Martial Arts and Kick Boxing
Injuries commonly seen as a result of martial arts and kick boxing include plantar fasciitis, Achilles tendonitis, sesamoiditis, and ankle sprains. Stretching is recommended to help prevent injury: specifically, a minimum of 15 minutes of stretching before performing any kicking or punching.
Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot. That is why proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability.
Activities such as football, baseball, basketball, soccer, field hockey, and lacrosse often lead to ankle injuries as a result of play on artificial surfaces, improper footwear, and/or inadequate stretching.