Common Orthopedic Injuries & Conditions
Lower Extremity: Foot & Ankle

Achilles Tendon Injuries

The Achilles tendon is one of the thickest, strongest tendons in the human body. It is responsible for helping calf muscles support individuals standing on their toes. The contraction of the calf muscles pulls the Achilles tendon, which in turn pushes the foot downward. This contraction enables individuals to stand on their toes as well as walk, run and jump.

An injury can occur when this fibrous tissue, which connects the heel to the muscles of the lower leg, is overused or stressed by daily activities and sports performed in improper foot ware or other unstable type of environment. Accidents and reaction to certain medications can also cause injury to the Achilles tendon.

With every step, each Achilles tendon is subjected to an individual's entire body weight - with increases of up to 3-12 times that during a sprint or push off.

Those at Risk
Athletes, particularly the female athlete, placing excessive stress on the tendon are at greatest risk for an Achilles tendon injury.

Treatment
Very often such tendon injuries are addressed nonsurgically by Houston foot doctor Kaare Kolstad. He recommends a period of rest and refrain from the activity that prompted the injury or irritation. Chronic ankle pain and inflammation may benefit from minimally invasive arthroscopy.

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Fractures and Dislocations

Fractures and dislocations are very common sports injuries and are found in both high contact and low contact sports alike. In high contact sports such as football as well as in extreme sports, the fracture resulting from a hit or fall is generally the result of a strong force or impact - and can be more severe complete breaks with associated soft tissue damage. In low impact sports such as baseball, basketball and soccer, stress fractures and dislocations can result from repetitive, overuse of the same limb, or an awkward turn or fall. Often times these types of fractures are not complete (breaking completely across the bone). Fractures describe a break in the bone - either partial or complete. Dislocations describe the malalignment of a joint. Shoulder dislocations are among the most common types of dislocations seen in sports medicine.

Types of Fractures
Fractures are defined based on the severity and the impact on surrounding tissue. Some fractures may only cause a slight crack in the bone, while others sustained by blunt force may result in a shattered bone.

Fracture may be either open or compound, which is a fracture that pierces through the skin creating an open wound, or a closed or simple fracture, which does not break through the skin.

Other classifications defining the types of fractures include:

• Transverse Fracture - A fracture at right angles to the long axis of the bone.
• Greenstick Fracture - A fracture on only one side of the bone, which causes the other side to bend but does not constitute a complete break. These types of fractures are most commonly found in children with more "pliable" bones.
• Comminuted Fracture - A fracture resulting in three or more bone fragments.
• Intra-articular Fracture - A fracture that involves the joint.

Those at Risk
While bone health, affected by genetics, age, diet and exercise, plays a role in determining those at greatest risk for fractures and dislocations, activity level and activity choices are also key factors. Under the age of 65, athletes involved in contact sports and repetitive motion sports are at greatest risk for this type of injury. As the body matures and hormonal changes and bone density become increasingly significant in bone tolerance, risks increase despite reduced activity levels.

The most common causes of a bone fracture in a young athlete are forceful impacts from a fall or a blow and excessive overuse motions such as that of a pitcher, quarterback or kicker.

Athletes experience a higher number of upper extremity fractures and dislocations than the non athlete, because of either the repetitive nature of their position, such as throwing a ball, or the forceful nature of their sport, such as football.

Treatment
Treatment depends on the severity of a fracture or dislocation and any accompanying soft tissue damage. A pain level assessment and X-ray will help in the diagnosis and treatment decision.

Houston podiatrist Kaare Kolstad addresses many fractures with closed reduction, realigning the bone, and casting. More severe breaks, particularly those accompanied by other soft tissue damage may require surgery.

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Heel Spur

Similar in symptoms and diagnosis to plantar fasciitis, which refers to the inflammation of the plantar fascia, or the tissue forming the arch of the foot, a heel spur is a protruding piece of bone that can form on the heel bone (calcaneus) and is often associated with plantar fasciitis.

In fact, nearly 70 percent of those diagnosed with plantar fasciitis also have a heel spur visible on an X-ray. Though, many patients without painful symptoms can also have a heel spur. Other than the proximity and similarly distressing activities impacting the foot, the exact relationship between plantar fasciitis and heel spurs is not entirely understood.

Those at Risk
Those most affected by heel spurs generally have a history of plantar fasciitis. While these conditions are most often seen in middle-aged men and women, but may also be found in all age groups. The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem. A heel spur diagnosis is made when an X-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.

Treatment
Heel spur treatment is similar to that which is used to treat plantar fasciitis - RICE (rest, ice, compression and elevation), NSAIDs (non steroidal anti inflammatory drugs) and rehabilitative exercises in our Houston rehabilitation center. In persistent cases, injection treatment may be indicated.

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Plantar Fasciitis

A painful inflammatory condition of the foot, plantar fasciitis is an overuse injury often caused by the excessive wear of the plantar fascia or plantar aponeurosis, which supports the arches of the foot. The pain usually is felt on the underside of the heel, and is often more intense with the first steps of the day. Plantar fasciitis is commonly associated with long periods of weight bearing activity or sudden changes in rigorous foot activity. Jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, a sudden increase in weight and over activity are also associated with the condition.

A diagnosis of plantar fasciitis means that the tough, fibrous band of tissue (fascia) connecting the heel bone to the base of the toes has become inflamed.

Those at Risk
Those at greatest risk for suffering from plantar fasciitis are women, the overweight, and those working jobs that require long hours of walking or standing on hard surfaces. Others at risk include avid walkers or runners, particularly if tight calf muscles limit how far ankles are allowed to flex. Those with extremely flat feet or high arches are also more susceptible to plantar fasciitis.

Most mild cases of plantar fasciitis are treated conservatively with rest and non steroidal anti inflammatory drugs (NSAIDS). This will also be combined with a specific rehabilitation program.

If the condition persists, Houston foot and ankle specialist Kaare Kolstad will administer an injection treatment.

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