Sports Medicine
Sports Injury Prevention & Rehabilitation

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Sprained Foot

Also known as Foot Sprain, Midtarsal Joint Sprain)
What is a sprained foot?

A sprained foot is a condition characterized by damage or tearing of the connective tissue (such as ligaments, cartilage and joint capsule) of one or more joints of the foot.
The rear foot comprises of seven bones collectively known as the tarsals. The mid foot comprises of five long bones known as the metatarsals. The toes each comprise of several small bones known as the phalanges. Each bone within the foot attaches to the adjacent bones forming joints. Each of these joints comprises of strong connective tissue wrapping around the bony ends and cartilage which lies between the joint surfaces, cushioning the impact of one bone on another during activity.
During certain movements of the foot, stretching or compression forces are placed on the joints of the foot. If these forces are excessive due to too much repetition or high force, injury to the joints may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. When this occurs, the condition is known as a sprained foot and may affect one or more joints.

Causes of a sprained foot
A sprained foot typically occurs due to a specific incident involving a forceful twisting or bending movement of the foot (normally during weight bearing). This may occur during activities such as jumping (especially following an awkward landing), running (especially with change of direction or on uneven surfaces), gymnastics and contact sports such as football (often due to a collision). Foot sprains are also relatively common in windsurfers who have their feet strapped in and suddenly move forward over one foot.
Occasionally, a sprained foot will occur due to repetitive strain associated with overuse. This may be the case in patients who perform repetitive activities involving end of range movements of the foot and are more common in patients with unstable foot types such as flat feet.

Signs and symptoms of a sprained foot

Patients with a sprained foot often experience a sudden onset of pain during the causative activity. However, patients may also experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms may be felt on the top, bottom or sides of the affected joint. Occasionally pain may be referred into the toes or ankle on the affected side. Symptoms are generally exacerbated with activities that place pressure on the affected joint such as walking (especially up hills or on uneven surfaces), running, kicking, jumping or standing on tip toes. It is also common for patients to experience pain on firmly touching the affected region.

Diagnosis of a sprained foot

A thorough subjective and objective examination from a physician is usually sufficient to diagnose a sprained foot and to determine the likely structures affected. Investigations such as an X-ray, MRI or CT scan may be required to confirm diagnosis and rule out other injuries (particularly fractures).

Treatment for a sprained foot

Most patients with a sprained foot make a good recovery with appropriate therapy. One of the key components of treatment is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. Crutches or protective taping are often required for a period of time to protect the joint from further damage.
Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Treatment of a foot sprain in the first 48 – 72 hours is vital to reduce bleeding, swelling and inflammation. This should involve following the RICE which comprises of rest from aggravating activities (crutches are often required), regular icing, the use of a compression bandage and elevation of the affected limb. Anti-inflammatory medication may also be useful in this initial phase of injury and can hasten the healing process by reducing the pain and swelling associated with inflammation.
It is also important for patients with this condition to perform range of movement and strengthening exercises early in the rehabilitation process to prevent stiffness and weakness from developing and to ensure the foot and ankle are functioning correctly. These exercises should generally be implemented as soon as pain allows and should be guided by the treating therapist. A gradual return to activity should occur once the patient is pain-free, provided symptoms do not increase.
In cases of foot instability or poor foot posture, orthotics may sometimes be required as part of treatment and prevention.

Prognosis of a sprained foot
In cases of a minor to moderate foot sprain, return to sport or normal activity can usually occur in 2 – 6 weeks with appropriate management and treatment. Patients with a more severe injury will usually require a longer period of rehabilitation to gain optimum function.

Therapy for a sprained foot
Therapy for a sprained foot can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • joint mobilization
  • the use of crutches
  • protective or postural taping
  • ice or heat treatment
  • exercises to improve flexibility, strength and balance
  • education
  • activity modification advice
  • a graduated return to activity program

Other intervention for a sprained foot

Despite appropriate therapy management, a small percentage of patients with a sprained foot do not improve adequately and require other intervention. When this occurs the treating therapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, CT scan or MRI, pharmaceutical intervention, corticosteroid injection or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. A review with a podiatrist for the prescription of orthotics may sometimes be indicated.