Stress Fracture of the Fibula

The fibula is one of the two bones that make up the lower leg, and is the thinner of the two (the other bone is the tibia). Because your lower leg can bear quite a bit of weight and strain during sports that require running and jumping, these bones are prone to stress fractures, or tiny cracks in the bone. Although the fibula is the site of a stress fracture less often than is the tibia (because the tibia, being larger, takes on more of the weight and strain), the fibula can develop a stress fracture.

Athletes whose feet overpronate (rotate inward and downward) have a higher risk of a stress fracture of the fibula. That’s because overpronation means some of the muscles in the lower leg must work harder while running. Symptoms of a stress fracture of the fibula commonly include pain and tenderness, especially when you place weight on the leg or when you press on the bone with your finger.

If you think you have a stress fracture of the fibula, you should stop training and rest the leg. Stretching the muscles of the leg can facilitate healing, as can wearing a brace for support. It’s very important to make sure you are free from pain before you resume activity, since failure to allow the fibula to heal properly can cause the injury and pain to linger for months.

To prevent a stress fracture of the fibula, make sure you increase mileage and training gradually, and that you wear equipment and footwear that properly support your feet and legs, if applicable.

Plantar Fasciitis

Plantar fasciitis is among the most common causes of foot pain. It occurs when the thick band of connective tissue that runs across the bottom of the foot, known as the plantar fascia, degenerates, causing a sharp pain that is worst when you wake up in the morning and which may temporarily go away as your foot warms up and becomes more limber; the pain may return if you sit for long periods of time. Runners are at a particularly high risk of plantar fasciitis, especially those who are overweight or pregnant, or whose footwear fits improperly or does not provide sufficient support. Other sports that can cause plantar fasciitis include those that require running and jumping, such as basketball or ballet dancing.

First-line treatment of plantar fasciitis consists of resting the affected foot, icing it, stretching the plantar fascia, and using tape or a brace to support the plantar fascia and remove any strain that might be placed on it during everyday activities. You might also consider a night splint to support your foot.

If the pain doesn’t go away or gets worse, you should see a sports medicine professional. To make sure plantar fasciitis is really what’s causing your pain, he or she may recommend sports massage, physical therapy and store-bought or custom-made orthotics for your athletic shoes so they support your feet properly and promote healing. If all else fails, surgery may be necessary to lengthen or detach the plantar fascia.

To prevent plantar fasciitis or its recurrence, increase mileage gradually, keep your plantar fascia limber by stretching out the foot, and make sure your footwear provides proper support.

Navicular Stress Fracture

In many sports, the foot can take quite a beating, and over time, this can lead to a stress fracture. The navicular, a bone in the foot that sits atop the heel bone, can be vulnerable to stress fracture, and this injury is rather common among athletes who do a lot of jumping and running.

Sports that particularly increase the risk of navicular stress fracture include track and field, ballet, football, basketball, rugby and gymnastics. Common symptoms of the injury include swelling in the midfoot and pain that may last for months. This pain may fade away with rest, but tends to return when you resume activity. In addition, pressing on the so-called “N spot” between the foot’s arch and the heel on the bottom of the foot causes tenderness if a navicular stress fracture is present.

If you think you might have a navicular stress fracture, you should consult a medical injury specialist as soon as possible. That’s because letting this injury go untreated can cause long-term foot pain; early treatment is crucial. The specialist may use a bone scan or magnetic resonance image (MRI) to look at your bone and see whether it has the tiny cracks characteristic of a stress fracture.

If you do have a stress fracture, you likely will need a cast for at least six weeks, or until the tenderness in your foot is gone. Your sports medicine specialist might recommend physical therapy and rehabilitation and strengthening exercises to strengthen the foot and regain range-of-motion.

To prevent a recurrence of your navicular stress fracture (or to prevent it in the first place), make sure your equipment and footwear fit properly, and increase training and mileage gradually. Shock-absorbing inserts for your shoes can also protect the bones of your foot from the stress of your own body weight.

Extensor Tendonitis

The five tendons that stretch across the top of the foot are collectively known as the extensor tendons, and like other connective tissue, if these tendons become inflamed, it can cause pain and swelling, and this condition is known as extensor tendonitis.  The extensor tendons help pull the foot upward into an “L” shape, working as a team with the calf muscle, which pulls the foot downward. Athletes with the highest risk of extensor tendonitis are those who flex the foot repeatedly, such as in running, especially uphill.

Causes of extensor tendonitis can vary, from increasing mileage too quickly, to footwear that is worn out or  improperly supports the arch of the foot, to running on hills. Stiff calf muscles can also cause extensor tendonitis. Symptoms include pain on the top of the foot, discomfort while running, and swelling on the top of the foot.  Additionally, an inability to push the toes upwards toward the ankle when resistance is applied to the toes can be another sign of extensor tendonitis.

If you think you may have extensor tendonitis, the first step to recovery is to take a break from training. Resting, icing, using compression bandage and elevating the affected foot can all expedite healing. If pain persists or gets worse despite this treatment, however, you should consult a sports medicine specialist. He or she can rule out other possible injuries that could be causing your pain, such as a stress fracture, and can prescribe other ways to help your foot heal. It may be necessary to wear a brace or cast to support the foot, and special exercises–such as those that loosen the calf muscles–also might help speed healing.

After your extensor tendonitis has healed, keep it from coming back by wearing shoes that fit properly, and by increasing mileage gradually.

Footballer’s Ankle

As every athlete knows, repetitive motions can lead to wear and tear which can give way to painful injuries over time. The movement of kicking–such as in sports like soccer, also known as football–is no different. The repetitive strain kicking a ball can place on the connective tissue, or ligaments, in the front of the ankle, can lead to the painful condition known as footballer’s ankle. Because footballer’s ankle also can be the result of flexing the foot–not necessarily kicking with it–the condition also sometimes occurs in dancers, basketball players and baseball catchers.

Kicking repetitively can enflame certain ligaments and tendons in the ankle, making it painful to stretch the foot downward, straightening the toes. The extra room that these irritated ligaments can take up can mean they get trapped between the bones of the ankle, making it painful to move the foot upward, flexing it into an “L” shape. This is known as impingement syndrome because the ligaments get pinched between the bones. Extra bone growths known as osteophytes also can develop in the ankle, causing further pain when you flex your foot.

Footballer’s ankle can also cause weakness in the ankle, and you may experience a clicking sound as you flex and straighten the ankle.

If you think you may have footballer’s ankle, you should see a sports injury specialist as soon as possible. He or she can examine your ankle and rule out other causes of the pain. He or she will look for signs of swelling and establish which movements cause you pain. Finally, an X-ray might be necessary to evaluate whether you have developed bone growths in the ankle.

Sometimes rest, icing, using a compression bandage, and elevating the affected foot, along with stretches and exercises to encourage range-of-motion, are enough to clear up footballer’s ankle. If not, however, surgery may be necessary to shave away excess tissue and bone growths.

Muscle Contusion

Muscle contusions, in which the skin and underlying muscle is bruised, can occur in any contact sport, such as football, hockey or rugby, or during any activity that increases the chances of falling on a hard surface, such as figure skating. Usually this injury is minor and doesn’t even require taking a break from training. Sometimes, however, a particularly serious contusion can cause long-lasting pain or other complications, including acute compartment syndrome and myositis ossificans.

In addition to the discoloration that is the signature of a bruise, a contusion can cause swelling at the injury site. A very severe contusion also should alert you to the possibility of damage to the underlying muscle or bone, and a contusion in the abdominal area could potentially cause damage to internal organs.

For these reasons, you should consult a sports medicine specialist if you have symptoms of a contusion. He or she will perform a physical examination to identify exactly where the bruise is located, and may also use a computed tomography (CT) scan, ultrasound, or magnetic resonant imaging (MRI) to make a diagnosis and rule out any other injuries.

To speed recovery, rest, icing, compression and elevation may be enough for relatively minor contusions, and your specialist may recommend you take an NSAID or other painkiller, such as Advil. Don’t massage the injured area.

Within a few days, swelling should go down, but you shouldn’t resume training until your specialist says you’re ready. Stretching, strengthening and range-of-motion exercises can all help you heal and regain your strength and flexibility.

Taking these precautions and treating your contusion correctly may knock you out of the game for a few weeks, but it can help you avoid more serious and potentially dangerous conditions.

Myositis Ossificans

A muscle contusion, when the skin and underlying tissue become bruised, can be a painful condition. But infrequently, this injury can give way to myositis ossificans: the growth of bony protrusions within the bruised muscle. After six or seven weeks, this bone growth stops and is slowly reabsorbed; still, the bone itself remains and can be felt through the muscle and skin. Even after this resorption, however, some bone may remain in the muscle.

The reason why some contusions cause myositis ossificans and others don’t isn’t known. However, injuries that are very severe, aren’t properly managed and treated, or occur repeatedly can increase the chance of this bone growth. Because contusions are often caused by blunt trauma to the body, athletes most at risk are those in sports in which a ball or another player can hit them, such as football, hockey, cricket or rugby.

Myositis ossificans is not detectable immediately; initially, symptoms are those of a contusion, such as pain, tenderness and swelling in the affected area. After a few weeks, however, bone growth may begin, and it may be detected as a hardness or lump within the muscle; accompanying this may be increased pain upon waking in the morning, and increased discomfort with activity. Eventually, the bone stops growing and begins to be reabsorbed by the body; it’s possible this new bone will never be completely absorbed, however.

If you suspect you have developed myositis ossificans, consult a sports medicine specialist. He or she will examine the area, try to identify the source of the injury, and X-ray the affected limb to detect bone growth. A magnetic resonance image, or MRI, or an ultrasound might also be necessary to rule out other causes of pain.

There is little that can be done to speed up the rate at which the extra bone is reabsorbed. However, your sports medicine specialist might recommend exercises to increase range of motion, and instruction to avoid activities that aggravate the pain. In some cases, surgery is performed to remove the bone growth, but this remains a controversial method as in some cases it can accelerate the regrowth of the bone.

In the future, prevent myositis ossificans by promptly and properly treating injuries with rest, ice, a compression bandage and elevation of the injured limb. These treatments can not only put you on the road to recovery more quickly than continuing to use the injured muscle–it can also prevent further conditions such as myositis ossificans.

Snapping Hip Syndrome

If you experience a snapping or clicking sensation when you flex or extend your hip (by bringing your knee towards your waist or by straightening the hip joint), you may have snapping hip syndrome, also known as clicking hip. This condition is harmless unless it is accompanied by pain, which can persist for months or even years if untreated.

Snapping hip syndrome is most common among athletes whose sports require repetitive movements, such as runners, soccer players and equestrians. The more common type of snapping hip syndrome, known as extra-articular snapping hip, occurs when the connective tissue that runs down the outer side of the leg, from the hip to the knee, becomes thickened. This enables the band to rub against and catch on nearby bones or on the fluid-filled sac on the outside of the hip bone, known as a bursa. This rubbing can cause the pain that sometimes accompanies snapping hip syndrome.

The other, less-common type of snapping hip syndrome is known as intra-articular snapping hip syndrome. This occurs when the tendon stretching from the inner thigh to the pelvis becomes inflamed. In this case, the clicking sensation is caused by the tendon snapping over the head of the hip bone.

If your snapping hip is not painful, there’s no need to consult a sports medicine specialist. If, however, your hip is bothering you, simple at-home measures may heal your hip. These include cutting back on your training, applying ice to the hip, and modifying the way you exercise to minimize repetitive hip movements. Anti-inflammatory medications, such as ibuprofen, can also reduce discomfort.

If the pain persists, consult a professional. He or she can diagnose the condition and put you on the road to recovery. Your sports medicine specialist will ask you to move your leg to recreate the snapping sensation, and he or she might even be able to feel the tendon snap as you move. He or she might also order X-rays to rule out other causes of the clicking such as bone problems.

Once you have recovered from snapping hip syndrome, make sure you keep the muscles of your hip strong and flexible. Also increase your mileage gradually so you don’t overtax your hip before it’s in training condition.

Winged Scapula

When the shoulder blade, or scapula, sticks out, sometimes causing pain or pressure, the condition is known as winged scapula. The scapula sticks out most when you lift your arms or when you push against something with your arms, and you might have stiffness or trouble elevating your arms all the way. It may also be difficult to lift objects that ordinarily are not too heavy for you.

Winged scapula results from nerve damage along the shoulder from trauma to the joint or a contusion, such as being hit by a ball or another player in contact sports such as football. When this nerve is damaged or bruised, it can paralyze a muscle in the shoulder known as the serratus anterior muscle, allowing the scapula to poke out abnormally. From the time of trauma to when the scapula begins to stick out, weeks may elapse, since the the muscle known as the trapezius must stretch before the shoulder blade can protrude.

If you think you have a winged scapula, consult a sports medicine specialist. He or she can conduct tests to evaluate the extent of the nerve damage. Then, he or she might prescribe rehabilitation exercises to re-train the shoulder muscle, if the damage is mild. If damage is more extensive, however, surgery might be necessary. A surgeon will make a small incision to decompress the nerve that has been damaged. As you recover, sleeping in certain positions and maintaining proper posture can help the nerve heal.

Clavicle Fracture

If you fall onto your outstretched arm or you shoulder, or are directly hit on your collarbone, this can cause a fracture of the collarbone, or clavicle. Symptoms commonly include pain and swelling around the collarbone, and you may also be able to feel the fracture through the skin. You may feel sharp pain whenever you make a movement that disturbs the clavicle.

Sports that increase the risk of a clavicle fracture include those that put you at risk of falling, such as figure skating and hockey, and those that often involve collisions with other players, such as football.

If you think you have fractured your clavicle, consult a sports medicine specialist. Also, try to avoid moving the affected arm, and apply ice to decrease swelling and ease pain.

A sports medicine specialist likely will examine your clavicle, and will take X-rays to determine whether the collarbone has been fractured. Depending on the severity of the fracture, you may need to keep your arm in a sling to give the collarbone a chance to heal. In most cases, the bone heals by itself, and no surgery is necessary.

If, however, the fracture is so severe that immobilizing the arm doesn’t heal it, or if parts of the bone are sticking out of the skin, surgical methods likely will be necessary to help the bone heal. Surgery to repair the bone generally involves inserting a metal plate and screws to hold the bone in place. Once the bone has healed, this metal plate can be removed, but often is simply left in place.

After the clavicle has healed, whether from surgery or from immobilization in a sling, it’s important to regain range of movement and strength through rehabilitation exercises, which your sports medicine specialist will prescribe to you.