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The Clinical Director of the London Foot and Ankle Centre, Consultant Orthopaedic Surgeon Mr Mark Davies describes the Management of Sports Injuries.

Sports injuries are common and account for a significant percentage of referrals to The London Foot & Ankle Centre. I treat the whole spectrum from Premiership footballers and professional rugby players to part-time amateur sportspeople. The injuries range from minor sprains, which lead to little time out from sports participation, to potentially career-ending injuries. They also include over-use injuries which often occur as a result of poor training techniques. It is of paramount importance to any sports person not to be mis-diagnosed and for treatment not to be delayed.

The commonest injuries are to the ankle but there is no part of the foot that is immune to injury. Ankle sprains need active treatment: putting ankles into plaster and/or ignoring them is detrimental to recovery. All patients with an ankle sprain should have physiotherapy and if progress is slow or symptoms fail to settle they should see a specialist who will often request an MRI scan to define the injury precisely. There are many “occult” injuries which will only respond to surgical intervention and must be diagnosed early to avoid deterioration of the condition not to mention the overall fitness and morale of the individual. Steroid injection into the ankle will often help reduce inflammation but often surgery to tidy up the joint (arthroscopy) or ligament reconstruction is required to allow a return to full activity. I will only sanction an injection into the ankle if I have MRI proof that the only significant pathology is post-traumatic synovitis. I have a young female patient who, one year after a sprain and three injections later, was barely able to walk. Her problem was an unstable ankle and six months after a Brostrom’s stabilisation procedure, she is back marathon running.

Tendon injuries are also very common, the Achilles being probably the most frequently torn tendon but injuries to the peroneii and tibialis posterior occur much more commonly than is generally realised. Again, physiotherapy can be very helpful for tendonitis problems but surgery to repair tendons is required when the tendon is ruptured or split and often highly successful. I now treat almost all fresh ruptures of the Achilles with the new Achillon device. This allows accurate repair of the tendon through a 2cm transverse incision and patients are out of a cast and receiving physiotherapy at two weeks post-op. I have performed this type of surgery on a Premiership soccer player and return to full training was achieved in under 12 weeks.

Ankle fractures can occur to any person but are a major source of morbidity to sportspeople, particularly if surgical fixation does not completely restore the normal anatomy. A mal-united ankle fracture leads almost universally to crippling arthritis quite rapidly and this condition guarantees an end to a sporting career. In the past ankle fractures associated with injuries to the syndesmosis have been treated with a diastasis screw but this has to be removed before full training can be resumed: a lengthy recovery of six months or more is not uncommon. A recent development in surgery known as the “tightrope device” now allows players to start training much sooner and it does not need to be removed.

Looking after sports injuries is immensely satisfying. Watching Wayne Bridge of Chelsea and England play again after recovering from a devastating ankle injury was very exciting for all of us involved in his treatment. Early and accurate diagnosis followed by appropriate treatment should be available to all but sadly this is not the case. At The London Foot & Ankle Centre patients get what I believe to be gold standard treatment for sports injuries of the foot and ankle.

Podiatry and the Athlete
Podiatrist Antony Kontos of the London Foot and Ankle Centre describes the benefits of podiatry for all sportsmen and women.

The increasing awareness of exercise and its role in combating the risk factors of cardiovascular disease has involved people of all ages in the participation of sport. With the benefits come the potential for injury and the podiatrist may be called upon to treat individuals who have suffered injury very often when it is related to ‘over use’.

Many of these so-called ‘over-use’ syndromes could be prevented by correct preparation and training. This sometimes, from a podiatrist’s point of view, involves carrying out a biomechanical assessment. Biomechanics is the science whose origins are derived from anatomy, medicine and engineering and helps our understanding of the complexity of running and other sports disciplines.

A podiatric biomechanical assessment essentially involves the entire lower extremity but particularly the foot and ankle. During the clinical examination the
range of motion of all the major joints is looked at in terms of structure and function as well as muscle strength and bone alignment.

Further information can be gained by gait analysis which sometimes involves the use of the treadmill and video. More specialist ‘tools’ have also been introduced in recent years, one particular system is the F Scan which can be offered by the London Foot and Ankle Clinic. This is essentially an in-shoe pressure measurement system. It looks at the pressure development on the sole of the foot during running, walking or other exercises and how the foot performs in terms of other parameters, such as timing.

The system can be employed to evaluate treatment outcomes, for instance before and after orthotic therapy or surgery. Assessments of this nature not only help in devising treatment regimes, but also help to predict those inviduidals whose weaknesses and ‘inbalances’ may pre-dispose to specific foot and leg injuries.

An example of this may be in the study of the hyperpronated foot. Features of the hyperpronated foot are:

1. Decreasing height of the medial medial longitudinal arch
2. Increased ‘everted posterior calcaneus’ (heel bone)
3. Increased convexity of the medial border mid foot
4. Forefoot abductions in respect of the rear foot

The hyperpronated foot can suffer various conditions which include plantar fasciitis, heel spur syndrome, sesamoiditis and achilles tendonitis. It can also give rise to lower and upper leg conditions because of abnormal biomechanics. This includes chondromalacia patella, 'shin splints', iliotibial band syndrome and trochanteric bursitis.

The podiatrist may advocate treatment with prescription orthotics and may make recommendations for anti pronatory running shoes.

This may be supplemented by various stretching exercises and physiotherapy and sometimes referral to orthopaedic colleagues may be appropriate.