Foot

Last updated May 2017

Oswestry Sports Injury Surgery

There are a wide variety of foot disorders in sportsmen very many of which are over use and associated with the poor biomechanics correctable by orthoses. The exceptions which commonly come to surgery are stress fractures and problems with the big toe.

Turf toe was most widely described following the advent of astroturf in American football and was described as occurring with the toe being bent back.  With a large American footballer on his hands and knees with the toe bent back an opponent would fall on the back of the heel forcing the toe even further back.  This is often a severe injury and associated with tearing of the ligaments in the sole of the big toe joint.  It needs treatment with a bit of respect and Grade III injuries will often take six weeks to settle.  Occasionally surgical repair is required, but more commonly a key hole procedure to take the debris out of the joint and tidy up the bearing surface. This surgery is also sometimes needed for degenerative changes occurring in professional footballers where bony spurs develop commonly on top of the joint restricting the range it can be bent back to. 

Stress fractures in the foot are not uncommon. A march fracture of the second metatarsal “Beckham’s disease”! was first described in military recruits and really needs treating on its merits with a period of rest.  There are a few gadgets which may or may not accelerate healing, but they are rather expensive and not to be recommended routinely. The other common stress fractures that we see are around the ankle and in the heel, but over the last few years we have seen several examples of navicular stress fractures.  I have recently seen one in a premiership footballer and another in an international rugby union player.  These tend to come on insidiously.  There is no predisposing biomechanical abnormality.  The text books describe tenderness over the navicular bone itself, but in fact my experience is that this is just not the case.  The symptoms tend to be vague and poorly localised and the diagnosis is often usually only made after a scan.  The majority of these will heal, but the average time to heal is approaching six months.  For this reason some surgeons recommend early surgery to try and encourage healing, but there is really no evidence that this has an effect in accelerating healing. My recommendation would certainly be to try avoiding an operation and following healing closely with scans in the first instance and reserving surgery for cases where it fails to settle. 

Sir Robert Jones described a fracture of the fifth metatarsal base after his own injury sustained while dancing! There is some confusion since there are a number of different fractures which occur in this area on the outer side of the midfoot. Acute fractures right at the tip are sore for a bit and get better needing only a supportive shoe for comfort, but I regularly see an acute fracture super-imposed on a pre-existing stress pre-fracture. This commonly occurs just a little further down the bone and heals more reliably and probably quickly with an operation straight away, & I certainly recommend this in high level athletes. Other surgeons recommend a prolonged period of plaster cast with crutches, but the risks of surgery are low & worth considering for some patients.

 

Navicular stress fracture

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