Ankle Injuries Common to Soccer Athletes

Some of the most common injuries involving youth soccer players occur to the foot and ankle.  Common foot and ankle injuries that adolescent soccer players may incur include ankle sprains, heel pain secondary to inflammation of the growth plate (Sever’s Disease), and fractures/stress reactions involving the foot and ankle bones.

Ankle sprains occur when the ligaments that support the ankle stretch or tear and can range in severity from mild to severe depending on how much damage and tearing there is to the ligaments.  Most ankle sprains are lateral ankle injuries that are often minor in severity and can heal on their own with rest and home treatments.  The length of time that an athlete may be out of action can vary from a few days to 4-6 weeks.  A majority of ankle sprains occur when the foot turns inward (i.e., “rolling” the ankle), damaging the supporting ligaments on the outside/lateral aspect of the ankle.  Everyone that sustains an ankle sprain can benefit from instruction in an exercise program to promote optimal recovery and restoration of stability, which can reciprocally decrease the likelihood you will re-injury.  When there is injury to the ligaments that support the bones, nerves within the ligamentous tissue that help with balance that are within ligaments are also affected which increases the likelihood that you may sustain future ankle sprains.  The best way to minimize your ankle sprain from becoming a chronic issue is to perform exercises that help to strengthen the muscles around the ankle and improve your balance on the injured leg.  Repeated ankle sprains can lead to long term problems, including chronic ankle pain, arthritis, and ongoing instability.

A high ankle sprain is a more severe form of injury and occurs when the ligaments and strong connective tissue, called the syndesmosis, between the two lower leg bones are torn and injured during a twisting movement.  The recovery from a high ankle sprain is typically much longer than a lateral ankle sprain.

Sever’s disease, also known as calcaneal apophysitis, is one of the most common causes of heel pain in growing children and adolescents.  It is inflammation of the growth center in the heel (calcaneus) bone where the Achilles tendon attaches.  When a child becomes fully grown; the growth plates close and are replaced by solid bone.  Until this occurs, the growth plates are weaker than the surrounding tendons and ligaments and are vulnerable to stress.  Sever’s disease is caused by repetitive stress to the heel and most often occurs during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly.  Sever’s disease affects the part of the growth plate at the back of the heel where bone growth occurs.  This growth area serves as the attachment point for the Achilles tendon, where the calf muscles attach to the back of the heel bone. Children and adolescents who participate in activities that involve running and jumping are at increased risk for this condition, particularly when an element of calf muscle tightness is present.  Additional stress from the pulling of the Achilles tendon at its attachment point can sometimes further irritate the heel. In most cases of Sever’s disease, rest combined with over-the-counter medication, change in footwear, and physical therapy that consists of stretching and strengthening exercises will relieve the symptoms and allow a return to activities with resolution of symptoms.

Injuries such as fractures resulting from significant force and direct trauma to the bones of the foot and ankle or stress fractures from overuse and repetitive activity are not uncommon in young soccer players.  Most fractures of the ankle involve the outside bone of the lower leg called the fibula.  Management of the fractured bone can vary depending on the type of fracture and how much displacement there is between the two ends of the broken bone.  X-rays and MRI are commonly used imaging techniques to diagnose the injury and help guide treatment decision making.  Sometimes surgery is necessary in order to properly align the two ends of the broken bone to ensure proper healing and minimize the risk of nonunion of the fracture, in additional to stabilizing/repairing any associated ligamentous injury.

Pain along the outside border of the foot, particularly when acute in onset and associated with perception of a “pop” and difficulty with weight bearing can sometimes be a specific fracture called a Jones fracture.  This fracture is tough to get to heal without surgery given the poor blood supply to this region of the bone.  Due to risk of poor healing or re-injury with conservative treatment, orthopedic surgeons often choose to fix the fracture surgically which usually involves placement of a screw across the fracture site.  Jones fractures are most often due to stress or overuse, but can also be due to trauma.

A stress fracture is a small crack in a bone, or is sometimes referred to as a stress reaction when severe bruising within a bone occurs.  Most stress fractures/reactions are caused by overuse and repetitive activity, and are common in athletes who participate in running sports such as soccer.  These injuries occur over time when repetitive forces result in microscopic damage to the bone that the body is unable to heal/recover from with continued activity.  Overuse stress fractures occur when athletic movements/activities are repeated so often that the weight-bearing bones and supporting muscles do not have enough time to heal between training sessions.  Bone is in a constant state of turnover – a process called remodeling in which new bone develops and replaces older bone.  If an athlete’s activity is too great, the breakdown of older bone occurs rapidly and can outpace the body’s ability to repair and replace it.  As a result, the bone weakens and becomes vulnerable to fracture (e.g., stress fracture).  The most common cause of stress fractures is a sudden increase in physical activity.  This increase can be in frequency, duration, and/or intensity of activity.  The most common symptom of a stress fracture in the foot and ankle is pain.  The pain typically develops gradually and worsens during weight bearing activity, and is often relieved with rest.

Although all too frequently utilized, self-diagnosis and delay in treatment can be one of the more harmful things you can do for an ankle/foot injury, particularly those mentioned above.  If you experience an ankle injury and are in need of treatment you can request an appointment with one of our 25 board-certified orthopedic physicians at our physician-owned hospital on our website www.kcoi.com.  If you are needing physical therapy treatment for your injury you can receive treatment through “self-referral”, which means you do not need a prescription or a physician referral to begin your treatment.  For immediate diagnosis and treatment our Ortho Urgent Care is open seven days a week and our hospital is equipped with diagnostic imaging on-site for all of your x-ray and MRI needs.

 

References: https://orthoinfo.aaos.org

https://medbridgeeducation.com

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Kansas City Orthopaedic Institute

3651 College Blvd Leawood, KS 66211 (913) 319-7633