Ben Yates Consultant Podiatric Surgeon
Wiltshire
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Mr Ben Yates
Consultant Podiatric Surgeon
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Sports Injuries
Achilles Tendon Injuries
Link Achilles testimonials and Achilles tendonopathy leaflet
The Achilles tendon is the most powerful tendon in the body and can be injured and damaged in a number of
ways. The most common problem is when the tendon is damaged usually over a long period of time and
becomes thickened and scarred. This is termed tendonopathy and normally occurs in the middle part of the
tendon at the back of the ankle.  Tendonopathy can also occur where the tendon attaches to the heel bone
and in this location bony spurs can develop.
 
Achilles ruptures can be treated by both surgical and conservative means. There are advantages and disadvantages to both methods and these will be discussed in detail with you. The main advantages to surgical repair are faster and stronger healing. In some cases this can be done by minimal incision surgery. 
If the tendon ruptures and is not diagnosed straight away then surgery is nearly always required and this involves a longer recovery period.
 
Ankle sprains
Ankle sprains are one of the commonest sports injuries to occur. The vast majority of sprains (over 90%) heal quickly and don’t need specialist treatment other than following the acronym of;
Rest
Ice
Compression
Elevation
 
Anti-inflammatory medication can also speed up the healing process by reducing swelling and inflammation in the first 3-5 days.
Persistent pain following ankle sprains requires specialist assessment to determine the cause. Some of the commonest causes for persistent pain include;
  • Ligament disruption (link to ankle instability)
  • Tendon injuries
  • Bone bruising
  • A missed small fracture
  • Cartilage damage
 
To work out what is the cause often requires imaging investigations such as ultrasound, MRI or CT scanning. The recommended treatment will depend upon the cause but is likely to include; physiotherapy, activity modification/rest, injection therapy and sometimes surgery.
 
Ankle instability
If the ligaments on the inside or outside of the ankle have been significantly damaged then the ankle will often feel and become unstable. In this situation physiotherapy is required to build up strength around the ankle and improve proprioception (balance and body awareness).  If this fails then surgery will often be required to repair the damaged ligaments.  
This type of surgery is usually day case and can be performed under general, sedation or local anaesthetic. The ligament repair is protected in a cast or ski  boot (cam walker) for up to 4 weeks and this is followed by post-operative physiotherapy. Surgery is generally successful although occasionally the ankle can become unstable again over time.
 
Stress fractures
There are 28 bones in the foot and any one of these bones can develop a stress fracture. This is when the bone develops a micro-fracture due to fatigue. The most common sport for stress fractures to occur in is running. The repetitive nature of the sport is associated with very high impact forces going through the bones and joints. This can cause excessive stress to the bone which fails leading to fracture.
In addition to the chosen sport there are other factors that can increase the risk of developing a stress fracture. These include hormonal imbalance, inappropriate diet, reduced bone density and structural mal-alignment of the lower limbs. It is important to assess all potential factors when deciding on the best treatment.
Most stress fractures will heal with rest. However some bones are poor at healing after a stress fracture and these are known as high risk stress fractures. Several of these bones are in the feet; sesamoid, navicular, talus, base of the second metatarsal. These stress fractures may require surgery in order to get the bone to heal.
 
Stress Reaction
This condition is a pre-cursor to a stress fracture. It can only be confirmed on an MRI scan where the inflammation in the bone can be seen. It is associated with localised pain and swelling. The main aim of treatment is to work out how the affected bone has become stressed to enable it to heal and prevent further damage. This will involve a similar assessment as for stress fractures. 
 
Sesamoiditis
This condition is associated with inflammation or damage to one of the little bones underneath the big toe joint. These bones are prone to injury in many sports, especially those that use studded footwear such as football and rugby. In these sports the shoe has reduced cushioning and often increased peak forces at the location of the studs. Sometimes these bones can fracture which will require prolonged treatment and frequently surgery.   
Treatment for sesamoiditis will vary depending upon the severity and cause of the pain. Frequent treatments will involve injection therapy and orthotic insoles to redistribute pressure away from the little bone. In more severe cases surgery is required.
 
Plantar Fasciitis
 
 
 
 
 
 
Toe Nail Problems
There are several problems that can occur to the toe nails with sport. One of the most common is bleeding under the nail, which is called a subungual (beneath the nail) haematoma (bruising). This can occur following an acute injury or due to chronic repetitive forces to the nail. The acute form is usually very painful and will often require treatment to drain the blood from under the nail. Frequently the nail will eventually fall off and new nail will develop.
In the chronic form there is a gradual build up of blood under the nail and the pain is less. The chronic version is usually seen in long distance runners. If this is a persistent problem then it may require proper assessment to determine the cause such as faulty foot mechanics or shoe wear fit.
Ingrown toe nails are also a common sports injury and often require surgical treatment. See Ingrown toe nails.
 
Athletes Foot
Athletes foot is a fungal infection of the skin and or nails of the foot. It is more common in people who play sports due to increased moisture of the feet in athletic footwear. The use of communal showers can also increase the risk of cross infection. The vast majority of athletes foot can be treated without specialist help through the use of over the counter anti-fungal agents and good foot hygiene before and after sport.
 
Blisters
Chronic repetitive friction at high pressure points around the foot and ankle will frequently cause blisters to develop. Although these can be painful they will usually settle without specialist treatment. Blisters are most frequently seen in long distance runners. The use of blister plasters and blister socks can help prevent blisters from developing. If a blister is very painful due to a build up of fluid this can be drained to relieve the pressure and pain.

Achilles Tendonitis

Ben Yates