December 28, 2021
As colder weather approaches, we start to transition into the Winter months which brings in our winter athletes! This time of year, is very busy in the orthopaedic office where Dr. Miller sees many of his athletes participating in various sports including: hockey, basketball, wrestling, and gymnastics. Here we talk about many of the common injuries these athletes may endure during their Winter sports season.
Rotational injuries to the ankle or what we call an inversion injury, where the heel moves inside the leg, are the most common in Orthopaedics. Rotational injuries are most susceptible to athletes landing awkwardly and jumping in sports such as basketball and gymnastics. Also commonly seen in wrestling due to the number of awkward positions and manipulations of the extremities by the opponent. This injury is the third most common in wrestling following behind knee and shoulder injuries.
High ankle sprains:
In Ice hockey, due to the ankle being in a hard skate, the ankle is not able to roll (or invert) as much. We see rotational injuries where both the skate and the foot rotate externally, leaving the leg behind resulting in a high ankle sprain. A high ankle sprain is the injury to the ligament that goes up the leg connecting the big bone the tibia and the small bone the fibula. High ankle sprains can occur in any type of athletic activity but are seen most often in ice hockey. If seen in basketball, we recommend wearing high tops to increase the susceptibility to rolling the ankle.
Symptoms and treatment:
If an athlete believes to have rotated their ankle, lookout for signs such as swelling. If the swelling is coming on gradually and mild, the injury is likely an ankle sprain. With a more severe ankle sprain you may see significant bruising over the region of the injury. If the level of pain is severe, the athlete may get an evaluation with Dr. Miller to perform x-rays and determine the best healing process. To learn more about an ankle sprain refer to a past blog “Is it a Broken Ankle or a Sprain?”
An over-use injury is seen most in gymnastics with younger females who may not be fully skeletally mature or haven’t completely aged. Generally, females stop growing around 14 years old and males around 16 years old. Many teens will get pain along the growth plate in the calcaneus (heel) and it often comes on with impact, over-use, and repetitive activities. This may lead to growth pain/injuries known as Severs disease. The athlete may feel pain in the back of the heel, but after several hours of resting it begins to feel better. This is a repetitive injury as the athlete remains active. The only cure to this is aging however, along the way we recommend a lot of flexibility in the calf. This allows the Achilles tendon to pull less on the growth plate. Another option is offering a silicon cushion, heel cup as an additional protective layer. One recommended proactive measure would be giving the athlete an anti-inflammatory such as Motrin before their game or meet.
Sometimes pain does not go away with overuse and repetitive activities result in stress fractures. This type of pain may take weeks to improve with the right amount of protection. Appropriate immobilization includes boot therapy or brace.
Another repetitive injury is sesamoid pain which is common in wrestling and gymnastics with the athlete being barefoot. This causes lots of focused pressure on the ball of the foot under the big toe. This affects two little bones that are underneath the big toe, causing lots of swelling and pain in the area. To accommodate the injury, we try and offload this in a shoe. Also encouraging calf stretching to gain mobility while going up and not so much when the athlete lands and is coming down. More severe pain is amenable to temporary boot.
Accessory navicular bones
Has your athlete noticed a bump on the side of their foot getting irritated? Very common in ice hockey due to hockey skates being so unforgiving, the bump or accessory bone on the inside of the foot may be experiencing lots of pain due to exhaustion. Pain along the inside of the foot is often an issue with overuse in ice hockey due to the skate. Usually this can be accommodated by a custom skate fit if the athlete is consistently playing. If pain does not resolve, removal may be necessary for pain relief.
Trauma to the foot:
One very common injury Dr Miller sees is a Lisfranc injury. This is caused by an awkward landing when coming down, disrupting the axile impact. When athletes land, many times seen in basketball and most commonly gymnastics due to lack of shoe protection, the awkward landing causes the middle of the foot to twist inadvertently, potentially tearing the ligaments in your foot.
What to look out for in potential injury is swelling, pain along the top of the foot, bruising seen on the bottom of the foot, and difficulty walking. A Lisfranc injury can be mild or more severe. Sometimes we refer to them as a mid-foot sprain and we declare as being stable which would require a boot therapy for treatment and improvement. Some we consider unstable after evaluation would need surgery. It is important to get a Lisfranc Injury looked at to prevent future collapse and arthritis. Tough to know without an evaluation! To learn more about a Lisfranc injury check out the Fall Sports Injuries blog.
If you’re an athlete seeking for care do not wait, we are here to help! Dr. Miller is Beacon Orthopedics foot and ankle specialist and is available at several locations around the Cincinnati area. Contact us today for more information! Click here to learn more and schedule an appointment with Dr. Miller for your foot and ankle injuries.