What is Morton’s Neuroma?

Morton’s neuroma is a painful condition affecting the ball of your foot, typically between the third and fourth toe. This problem, which is caused by a thickening of the connective tissue between the toes that puts pressure on the intermetatarsal plantar nerve, can result in pain or numbness.

Morton’s neuroma produces a sharp burning or stinging sensation in the ball of your foot and/or tingling and numbness in your toes. It may feel as if you have a pebble stuck in your shoe, or that your sock is bunched up beneath your toes.

This problem is often associated with high impact sports such as jogging or running, and can be exacerbated by wearing high heels or tight footwear, such as those associated with skiing and rock climbing.

Treatment of Morton’s Neuroma

The recommended course of treatment for Morton’s neuroma depends on the severity of the symptoms. Reduced activity and ice massage can be used to reduce discomfort and prevent worsening of symptoms. Anti-inflammatories can also be used to reduce discomfort, but should not be viewed as a long-term solution.

Orthotics, including an arch support or a metatarsal bar, are commonly used to treat Morton’s neuroma. Changes to footwear, including the transition to a shoe with a wider toe box, might also be recommended. In some cases, steroid injections are used to reduce inflammation and relieve symptoms.

In severe cases, surgery to relieve pressure on the affected nerve, or to remove the nerve entirely, may be indicated. Seek the advice of a trained medical professional.

What is a Stress Fracture?

The term stress fracture refers to an incomplete bone fracture resulting from overuse, such as repeated jumping or long distance running. Stress fractures, which occur most commonly in the weight bearing bones of the feet and legs, can also result from bone weakening due to osteoporosis.

Symptoms of a stress fracture include: pain and swelling that may increase with activity, earlier onset of discomfort with each successive workout, tenderness in a specific spot, decreased pain and swelling with rest progressing to continued pain at rest as the problem progresses.

To reduce the likelihood of a stress fracture, increase activity levels gradually.

Treatment of Stress Fractures

The primary treatment for stress fractures is rest, often accompanied by a splint, walking boot, or cast to immobilize the affected body part. Prescribed rest periods are often 4-8 weeks, though they can be as long as 12-16 weeks in severe cases.

Following the prescribed rest period, activity should be re-introduced gradually. In rare instances, surgery may be indicated to ensure complete healing of the stress fracture. Seek the advice of a trained medical professional.

What is Iliotibial Band Syndrome (ITBS)?

The iliotibial band (IT band) is a long, flat sheath of connective tissue that extends from the outside of the pelvis, running over the hip and knee, and ultimately inserting just below the knee. The IT band plays a critical role in stabilizing the knee during running.

Repeated rubbing of the IT band over the lateral femoral epicondyle (the bony outside of the knee) associated with repeated flexion/extension of the knee can cause the IT band to become inflamed, resulting in iliotibial band syndrome (ITBS).

The primary symptom of ITBS is pain along the outside of the knee. This pain is typically aggravated by running, particularly downhill. It may not occur immediately during activity, but often becomes more intense as the activity progresses. Pain might also be present at the outside of the hip and/or in the buttocks.

Causes of ITBS include consistently running on a banked surface, such as the should over the road, inadequate warm up or cool down, excessive hill running, or foot/leg abnormalities including high or low arches, supination of the foot, uneven leg length, or bowleggedness.

Treatment of Iliotibial Band Syndrome (ITBS)

ITBS can be treated via the R.I.C.E. regimen. Anti-inflammatories can be used to reduce pain an inflammation. Self-massage and stretching, particularly involving a foam roller, are also known to be effective treatments. It is also important to identify and rectify the underlying cause of the problem to speed recovery and prevent recurrences.

If the discomfort persists, seek the opinion of a trained medical professional.

What is Delayed Onset Muscle Soreness

The term delayed onset muscle soreness (DOMS) is used to describe the discomfort that is often felt 24-72 hours after exercising. While DOMS is often attributed to a buildup of lactic acid, there is little empirical support for this view.

Rather, it seems more likely that DOMS is a byproduct of microscopic tearing of muscle fibers caused by over-exertion. The extent of these micro-tears, and thus the amount of discomfort that they cause, largely depends on the type of exercise and the level of exertion.

Whatever the cause, the symptoms associate with DOMS can include muscle pain, inflammation, stiffness, and weakness.

Treatment of Delayed Onset Muscle Soreness

Perhaps the best course of action is to prevent DOMS before it happens. Warming up before exercise and cooling down afterwards, along with proper stretching, can help to reduce the incidence and severity of DOMS. It is important to keep in mind, however, that excessive stretching can cause DOMS.

While the R.I.C.E. regimen may alleviate the symptoms associated with DOMS, the often diffuse nature of this sort of muscle soreness makes it difficult to apply in many cases. Nonetheless, there is evidence to suggest that rest, ice, compression, and elevation all have the potential to speed recovery.

Active recovery, which involves light aerobic exercise to increase blood flow throughout the body, has been suggested as a means for minimizing the occurrence of DOMS in the first place, as well as for reducing symptoms once it occurs. While anti-inflammatories such as ibuprofen may be effective at reducing the discomfort and inflammation associated with DOMS, they do nothing to reduce weakness.

Finally, though massage has been suggested as an effective treatment for DOMS, the data here are mixed. Likewise, it has been suggested that nutritional supplements such as vitamin C and fish oil may help to alleviate the symptoms of DOMS, but there is little in the way of scientific support for this view.

What is Turf Toe?

A metatarsalphalangeal joint sprain is an injury to the connective tissue between the foot and one of the toes at the base of the toe. When this injury involves the big toe, it is known as “turf toe.” This sort of injury occurs as a result of hyperextension of the toe.

Turf toe is especially common when playing sports with excellent traction, such as artificial turf. Wearing shoes with cleats that improve traction also increase the risk of injury, as do shoes with overly-flexible soles.

Treatment of Turf Toe

Turf toe is often treated by following the R.I.C.E. regimen. The toe should also be immobilized with a brace, taping to limit dorsiflexion (upward bending) of the toe, or a rigid-soled shoe that does not allow bending. Anti-inflammatory medications can also be used to reduce inflammation.

Recovery from turf toe typically takes 3-4 weeks depending on the severity of the injury. If left untreated, or if an athlete tries to return from the injury too soon, turf toe can develop into a chronic problem, potentially resulting hallux rigidus, which is essentially a “stiff” big toe with limited range of motion.

Surgery is rarely required, but could be helpful under certain circumstances. Seek the advice of a trained medical professional.

What is a High Ankle Sprain?

The term “high ankle sprain” refers to the stretching and/or tearing of the syndesmotic ligaments of the ankle. The syndesmotic ligaments of the ankle include the anterior tibiofibular ligament, the interosseous ligament, and the posterior-fibular ligaments. These three ligaments connect the tibia (i.e., shin bone) and fibula (i.e., calf bone) just above the ankle.

While low ankle sprains are caused by the foot twisting or rolling inward, a high ankle sprain is caused by the foot/lower leg twisting or rolling outward. High ankle sprains can be difficult to diagnose because there is typically much less swelling with a high ankle sprain as compared to a low ankle sprain.

High ankle sprains might be evidenced by pain when the ankle is rotated outward, or when the calf is squeezed (this latter approach is referred to as the “squeeze test”). However, proper diagnosis of a high ankle sprain often requires an x-ray and/or CT scan of the lower leg.

Treatment of a High Ankle Sprain

The recommended treatment of a high ankle sprain depends on the severity of the injury. Recovery times can range from 2-3 weeks for a minor high ankle sprain to six months or longer for a severe high ankle sprain.

In a stable high ankle sprain, the placement of the tibia and fibula remains normal, and the syndesmotic ligaments remain largely intact. A stable high ankle sprain can typically be treated by immobilization for a period of up to six weeks followed by rehabilitation.

In the case of an unstable high ankle sprain, two or all three of the syndesmotic ligaments are torn and the tibia and fibula are free to move around. In such cases, surgery is typically indicated, and a “syndesmotic screw” is used to hold the tibia and fibula in place while the syndesmotic ligaments heal. If surgery is required, recovery can take six months or longer.

What is a Calf Pull, Strain, or Tear?

The “calf muscle” is actually comprised of two muscles — the gastrocnemius and the soleus — located on the back of the lower leg. These muscles are together known as the triceps surae. A strained/torn calf occurs when the calf muscle is separated from the Achilles tendon. This injury most commonly occurs during acceleration or sudden changes in direction.

A calf strain is similar to an Achilles tendon rupture, but occurs higher up in the back of the leg. As with an Achilles tendon rupture, you might hear a “pop” and feel a sudden burst of pain when you strain your calf.

Treatment of a Calf Pull, Strain, or Tear

This injury is typically treated by following the R.I.C.E. regimen. Pain and inflammation can also be reduced through the use of anti-inflammatories.

Pulled calf muscles can be avoided via proper stretching/warmups. In the case of a severe injury, seek the opinion of a trained medical professional.

Please see separated shoulder for a description of, symptoms associated with, and treatment options for a sprained AC joint.

What is Sever’s Disease?

Sever’s disease, also know as calcaneal apophysitis, is a common source of heel pain in young, growing athletes. The most common symptoms are pain or tenderness in one or both heels, discomfort when the heel is squeezed, and more severe pain when walking, running, jumping, or playing sports.

The pain associated with Sever’s disease is typically localized to the side and back of the heel bone, though there may sometimes be pain at the bottom of the heel. In severe cases, Sever’s disease can result in limping.

Sever’s disease is caused by irritation of the bony growth plate at the back of the heel bone, and is directly related to overuse of the bone and tendons in the heel. Sever’s disease occurs in children ages 7-15, though it is most common in 10-14 year olds. Overuse can come from participation in sports (e.g., soccer, basketball, or football) or any other activity that involves a lot of heel movement.

Sever’s disease is sometimes associated with starting a new sport, or the start of a new season.

Treatment of Sever’s Disease

Sever’s disease is “self-recovering,” meaning that it will go away on its own when activity subsides, or when the heel bone is done growing. Symptoms generally subside within two to eight weeks after activity levels are reduced, though Sever’s disease can recur following an increase in activity, such as at the start of the next sports season.

Possible treatments include elevation of the heel, regular stretching of the hamstring and calf muscles, following the R.I.C.E. regimen, and the use of foot orthotics. In severe cases, a cast or medication might be necessary. Seek the advice of a trained medical professional.

What is a Concussion?

The term concussion refers to a mild traumatic brain injury (MTBI) resulting in a temporary loss of awareness or consciousness. Concussions can result from falls in which the head strikes against an object, or when a moving object strikes the head.

The length of unconciousness may relate to the severity of the concussion, and affected individuals often have no memory of the events preceding the injury or immediately after regaining consciousness. Other symptoms include vomiting and unequally sized pupils.

Concussions are classified into five grades, as follows.

Grade I: Involves only confusion.

Grade II: Involves anterograde amnesia of less than five minutes as well as confusion.

Grade III: Involves the Grade I and II symptoms as well as retrograde amnesia and unconsciousness lasting up to 5 minutes.

Grade IV: Involves the Grade I, II, and III symptoms as well as unconsciousness lasting 5-10 minutes.

Grade V: Same as Grade IV, except unconsciousness lasts longer than 10 minutes.

Treatment of a Concussion

The best course of action depends on the severity of the concussion. In all cases, care should be taken to avoid a second blow to the head until well after the symptoms have subsided. If you are unsure of how best to proceed, a trained medical professional should be consulted for guidance.