Name My Pain

Acute Foot Injuries (Top) Name My Pain
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Lisfranc’s joint injury
Very uncommon in the athlete, but a very severe condition with disastrous consequences if not treated.
Traditionally can occur from falling backwards when the foot is fixed or entrapped, or a fall on to the point of the toes.
Pain is felt in the mid-foot area (just back from the toes) with marked swelling on the top of the foot, and possible bruising as well. The person will find it difficult to weight bear on their leg, and find it particularly hard if not impossible to rise up on to toes on affected leg, or push off foot in walking and running.
Any foot injury that involves the mid foot area, and that is painful for more than a week, should be investigated as a possible Lisfranc fracture.
The test below better helps to reproduce pain and help diagnose this injury.
For a more accurate diagnosis an x-ray in weight bearing is recommended.

Foot Foot
With heel fixed by hand, turn foot outwards away from the bodies midline. If this reproduces pain in the area marked then suspect a possible Lisfranc fracture.


Extensor tendinopathy
Generally results from either two causes- either excessively tight shoe laces or repetitive overuse of the extensors, that can occur with a large increase in running/training load, as the extensor tendons are required to lower the foot to the ground each stride in gait.
To better determine whether this is the injury the test of resisted dorsiflexion (or pointing toes) will bring pain on, and indicate extensor tendinopathy.

Foot Foot
Pointing toes will reproduce pain. Resisted dorsiflexion. Point foot up towards ceiling,with hand adding resistance. This will reproduce pain where indicated.
Foot Foot
Continuing to point toes up towards ceiling with added resistance will continue to cause pain where indicated. Further again pointing toes up towards ceiling with added resistance will continue to cause pain where indicated.


Midtarsal joint sprain
Characteristically occurs in the individual with loose foot ligaments, and who participates in activities that involve repetitive overuse and loading of the midfoot area, such as footballers, gymnasts and dancers. Windsurfers, kite surfers and tow in surfers who have a fixed foot position in straps attached to the board often get midtarsal joint strains.
This injury generally presents with pain that can decrease when the individual warms up, that worsens when they cool down and becomes stiff the next day following activity.
Depending on which ligament is injured there will be localised tenderness and swelling. Most commonly the pain is felt on the top outside of the foot.

Fractures of the fifth metatarsal
Fractures of the 5th metatarsal can occur due to one of three causes. Firstly as a result of an acute rolled ankle.
Secondly as an overuse injury affecting the middle section of the bone, (known as a Jones Fracture).
The third cause occurs in dancing, as a result of a fall from loss of balance when up on the toes and is called a ‘Fouette fracture’.
All present with acute pain and an inability to adequately weight bear. All must be immobilised in a non weight bearing cast to assisting with healing.
If this injury is suspected an xray is the best way to accurately diagnose.
Xray is best tool used for diagnosis.

First MTP joint sprain
More commonly known as ‘turf toe’, this injury presents in the athlete that competes or trains on artificial turf. The injury generally occurs when the toe is hyperextended back or forward. This happens most commonly when an athlete stubs his/her toe. It presents with localised pain and swelling at the first big toe joint.
To test whether this is the correct diagnosis the picture below shows bending the toes upwards and downwards with your hand which will cause pain and indicate this injury. (Plantarflexion and Dorsiflexion of the Metatarsalphalangeal)

Foot Foot
Dorsiflexion of toes (pulling toes up towards ceiling) will reproduce pain where indicated.. Plantarflexion of toes (pulling toes down towards the floor) will cause pain and indicate correct diagnosis.


Halluxrigidus/hallux limitus

This condition results in the joint behind the big toe becoming stiff and rigid, almost fixed and unable to move. Pain is generally felt deep to the joint and aches with movement, (i.e. walking, running etc). Can be made worse by tip toe walking, or walking in high heels.
There are a number of different causes but it most commonly occurs in athletes after excessive weight bearing through the balls of the feet.
To test whether this is the correct diagnosis the test below is used to better diagnose the injury, where there is an inability to bend the toe up towards the ceiling (or dorsiflex the big toe).

Foot
Inability to dorsiflex the toe, or flex the toe up towards the body,this will be stiff and painful and sometimes there will be an inability to do the activity shown below.


Morton’s interdigital neuroma
This generally occurs secondary to another condition such as some scar tissue or compression of the 3rd and 4th metatarsals. Characteristically there is pain radiating down to the toes with sharp shooting pain also experienced. Some patients describe pins and needles and numbness in the forefoot.
Most common in athletes with narrow fitting footwear.
The best way to test whether this is the injury is standing on tip toes/forefoot for a short period which will reproduce the symptoms of pins and needles.

Foot Example
Rising up on to toes brings on symptoms of pins and needles and numbness in the foot.

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