Foot sprain

What is it?

A foot sprain is a tear of ligaments, the tough bands of fibrous tissue that connect bones to one another inside a joint. Sprains range in severity from Grade I to Grade III.

• Grade I — The injury is fairly mild, causing microscopic tears or stretching of the ligaments.
• Grade II (moderate) — The ligaments may be partially torn, and the stretching is more severe.
• Grade III (severe) — The ligaments are completely torn, so the foot may be unstable and no longer able to bear weight.

Because the foot bears the entire body's weight with each step and contains numerous bones and joints, you may expect the foot to be at high risk of sprains. However, sprains of the foot are fairly rare, except in people who participate in certain sports or occupations that subject the feet to abnormal twisting motions or bends.

When foot sprains occur, they usually involve one of two distinct areas:

Midfoot — The midfoot is the central area that includes the arch of the foot. In athletes, midfoot sprains usually occur because of a sports-related fall, a collision or an isolated twist of the midfoot, particularly during snowboarding, windsurfing, horseback riding or competitive diving. Among female ballet dancers, midfoot sprains typically happen when the dancer loses her balance while en pointe (on her toes) and spinning or when she lands with her foot abnormally flexed or rotated after a jump. Among people who do not compete in high-risk activities, about one-third of midfoot sprains happen by accident, simply because of an odd twist of the foot during an ordinary stumble or fall. Less often, severe midfoot sprains are the result of high-impact trauma, especially trauma caused by a motor vehicle collision or a fall from a high place. This type of injury is likely to produce not only Grade III sprains, but also foot fractures and open wounds.

First metatarsophalangeal joint — This is the joint at the base of the big toe. A sprain of this joint is commonly called "turf toe." It is usually caused by hyperextension (extreme backward bending) of the big toe. The typical scenario involves either a football player or a ballet dancer who falls forward while the big toe is planted flat against the ground. In football, turf toe is most common in players who wear lightweight soccer-style shoes while competing on artificial playing surfaces. The relatively flexible soles of their shoes probably don't offer enough protection for the first metatarsophalangeal joint, increasing the risk of a turf toe injury. The situation is probably similar for ballet dancers, particularly males.

Symptoms

In a mild or moderate midfoot sprain, your midfoot area will be swollen and tender, and there may be some local bruising (black and blue discoloration). In more severe sprains, you may not be able to bear weight on your injured foot.

If you have turf toe, the base of your big toe will be painful and swollen.

Diagnosis

After reviewing your symptoms, your doctor will ask you to describe exactly how you injured your foot. He or she also will want to know about your occupation, recreational activities, participation in sports, any previous foot trauma or foot surgery and the type of shoes you usually wear.

The doctor then will examine your feet, comparing your injured foot with the uninjured one. During this exam, your doctor will note any swelling or bruising, as well as any changes in flexibility or range of motion. Your doctor also will gently press and feel your injured foot to check for tenderness or bone abnormalities.

If you cannot bear weight on your injured foot or if the results of your physical examination suggest that you may have a more severe foot injury, X-rays of the foot may be recommended.

A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the foot may be done in certain patients, especially professional dancers or athletes, who have unusual pain or joint instability in spite of having normal X-ray results.

Expected duration

Mild midfoot sprains usually heal within a few weeks, whereas more severe sprains may take up to two months. The pain of turf toe usually subsides within two to three weeks.

Prevention

In some cases, you may be able to prevent foot sprains by wearing stiff-soled shoes or by taping or bracing the foot to help stabilize it. A stretching and strengthening program can help to prevent sprains.

Treatment

For milder midfoot sprains, initial treatment follows the RICE rule:

• Rest the joint.
• Ice the injured area to reduce swelling.
• Compress the swelling with an elastic bandage.
• Elevate the injured area.

Your doctor also may suggest that you take acetaminophen (Tylenol and others) for pain or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin and others), to relieve pain and ease swelling.

For more severe midfoot sprains, especially in dancers and other professionals whose livelihoods depend on their feet, the doctor may immobilize the foot in a cast and recommend temporarily avoiding bearing weight on the injured foot. As symptoms subside, you can gradually resume weight-bearing and other normal activities, and you will need to start a rehabilitation program of stretching and strengthening. Because a serious midfoot sprain can threaten the career of professional athletes or dancers, they often need to follow special treatment and rehabilitation regimens to ensure that the injured foot heals with a proper balance of flexibility and stability.

Turf toe usually is treated with RICE, an NSAID and splinting. To help protect the injured joint, your doctor may recommend that you wear stiff-soled shoes or use a shoe insert.

When to call a professional

Call your doctor whenever you have symptoms of a sprained foot, such as pain, swelling or bruising, especially if pain prevents you from bearing weight on your injured foot or does not subside over a day or two.

Prognosis

Because most sprains heal with time, the outlook is usually excellent, particularly in people who do not participate in high-risk activities that twist or bend the feet. In rare cases, a midfoot sprain may cause long-term complications, such as chronic (long-lasting) foot pain or a fallen arch.

Additional info

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/

American Podiatric Medical Association (APMA)
http://www.apma.org/

National Rehabilitation Information Center (NARIC)
http://www.naric.com/