Foot and Ankle Injuries in Professional Soccer Players

Soccer is a physically demanding and highly competitive sport with a high rate of injuries. The foot and the ankle joint are especially at danger. Risk factors of foot and ankle injuries in soccer players are: lack of structured warm up training, neuromuscular deficits, inadequate training, chronic fatigue, previous injuries, foul play, artificial turf, and others. While the most common injury is the ankle sprain, complex injuries like fractures, ligament tears, and cartilage damage can occur. Such injuries have a high impact on the player's career. Professional soccer players are pressured to meet the expectations of the clubs, and the public. While most injuries to the foot and ankle joint can be treated conservatively, complex injuries require anatomic reconstruction to allow for quick rehabilitation and return to play earliest possible.     

Ultrasound of the Foot and Ankle

For specific indications, ultrasound is an inexpensive and efficient alternative to magnetic resonance (MR) imaging of the ankle and foot. In addition to the tendons, the anterior joint, retrocalcaneal bursa, ligaments, plantar fascia, and soft tissues can be imaged with ultrasound. Tenosynovitis, tendon tears and tendinosis, joint effusions, intra-articular loose bodies, ganglion cysts, plantar fasciitis, and Morton neuromas can be demonstrated with ultrasound. In most cases, a focused ankle or foot ultrasound can be performed more rapidly and efficiently than magnetic resonance imaging. Direct correlation with the site of pain and rapid comparison with the asymptomatic ankle are possible with this modality. As pressure for cost containment continues, demand for ultrasound of the ankle and foot will likely increase.     

火箭兵踝关节军训伤的治疗探讨

目的探讨火箭兵踝关节军训伤的特点及治疗对策。方法回顾分析344例踝关节军训伤的伤情特点、治疗方法及预后,并对疗效进行比较。结果经6~12个月的随访复查总优良率89.5%,其中非手术治疗组总优良率89.3%,手术组总优良率91.3%;Ⅲ型韧带扭伤采用手术治疗优良率较高。结论火箭兵踝关节军训伤以外侧韧带扭伤多见;Ⅲ型韧带扭伤及Ⅲ型骨折易导致慢性踝关节不稳或创伤性关节炎,Ⅲ型韧带扭伤采取积极的手术治疗可大大改善预后。     

Detecting and Treating Common Foot and Ankle

Midfoot and forefoot fractures commonly seen in a primary care practice include navicular and metatarsal stress fracture, tarsometatarsal fracture-dislocation, and acute fracture of the metatarsals, sesamoid, great toe, or lesser toes. A careful history to determine the mechanism of injury and a methodical physical exam to detect sites of tenderness are essential. X-rays are usually required, but stress fractures may warrant bone scans. Compared with ankle and hindfoot fractures, sports-related midfoot and forefoot fractures are more often treated conservatively with casting or wooden shoes. Tarsometatarsal disruption and Jones fractures are more likely to require surgery.     

Diagnostic and Therapeutic Foot and Ankle Injections

For patients with disabling foot or ankle pain, medical or surgical treatment decisions can be difficult to make when multiple joints show changes of osteoarthritis or if the patient's pain clinically is related to a joint or tendon that is normal by other imaging studies. For these patients, injection of anesthetic, steroid, or both, into joints or tendon sheaths of the foot and ankle provides important diagnostic information and therapeutic relief. Diagnostic injections may show that the joints noted by other imaging studies have osteoarthritis that are not responsible for a patient's pain or that a normal joint is responsible. When multiple joints show changes of arthritis, anesthetic injections can help decide which and how many joints could benefit from surgical arthrodesis. Relief of pain after anesthetic joint injection correlates well with postoperative pain relief subsequent to arthrodesis. This article discusses the indications and the contraindications for performing diagnostic and therapeutic joint injections, and also presents the techniques for performing these studies.