Foot and Ankle Related Sports Medicine

Sports injuries involving the foot and ankle may occur for specific reasons that involve muscle-tendon imbalance, improper pre-activity stretching, uneven muscle strength, or simply improper footwear or support needed for your particular sport. Two of the more common conditions related to foot and ankle sports injuries include Achilles tendinitis and plantar fasciitis.

A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon, the longest tendon in the body, runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the “heel cord,” the Achilles tendon facilitates walking by helping to raise the heel off the ground and is used in activities that involve walking, running, and jumping.

Achilles tendonitis is an inflammation of the Achilles tendon. Inflammation is a natural response to injury or disease and often causes swelling, pain, and irritation in the area that is affected. There are two types of Achilles tendinitis named for where the tendon is affected.

• Non-insertional Achilles Tendinitis
  Non-insertional Achilles tendonitis affects the middle portion of the tendon, usually halfway between the heel bone and the muscular portion of the calf.

• Insertional Achilles Tendinitis
  Insertional Achilles tendinitis involves the portion of the heel where the tendon attaches (inserts) to the heel bone.

If not treated, inflammation in the tendon can progress to a degeneration of the tendon over time. This is called Achilles tendinosis. In this condition, the tendon loses its organized structure and is likely to develop microscopic tears that do not heal correctly. Sometimes the degeneration involves the site where the Achilles tendon attaches to the heel bone. In rare cases, chronic degeneration with or without pain may result in a rupture of the tendon.

• Pain, aching, stiffness, soreness, or tenderness within the tendon
  This may occur anywhere along the tendon’s path, beginning with the narrow area directly above the heel and upward to the region just below the calf muscle. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity.

• Tenderness or intense pain
  This occurs when the sides of the tendon are squeezed. There is less tenderness, however, when pressing directly on the back of the tendon.

• Nodules in the tendon
  When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged. Swelling that is present and worsens with activity.