Foot & Ankle Common Injuries | San Francisco, CA

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Achilles Tendon Injury

The Achilles tendon is a thick band of tissue along the back of the ankle that attaches the calf muscle to the heel bone. It is under stress during activities that use the calf repeatedly, like jumping and running. Achilles tendinopathy refers to the condition where there is small tears and/or damage to and around the tendon. Being overweight, having diabetes, or having feet that toe-in or toe-out can also affect the tendon. An Achilles tendon rupture involves a complete tear of the tendon. It occurs most commonly in patients who are in their 30s to 40s but can happen at any age. It typically affects males more often than females. Ruptures are seen in activities that involve sprinting or pushing off, such as basketball and tennis. Most ruptures happen without a specific injury, and most athletes do not have Achilles tendon pain prior to their rupture. Risk factors include older age, poor flexibility, those who only exercise occasionally, medications, and certain medical conditions, including diabetes, gout, rheumatoid arthritis, and kidney disease.

Symptoms include pain and swelling over the tendon. The symptoms may worsen with physical activity. If there is a tear in the tendon, there can be sudden severe pain along with weakness at the ankle.

Treatment often includes a period of rest, activity modification, heel lifts, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and discussion of the best treatment options.

Ankle Arthritis

Ankle arthritis occurs at the joint between the tibia and talus. Over time the cartilage wears down and causes the bones to rub together causing pain. There are many causes including wear and tear over time, trauma, infection, chronic injury, etc.

Symptoms include pain, weakness, and loss of motion. Patients may note catching, locking, or popping.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Ankle Sprain

Ankle sprain is one of the most common musculoskeletal injuries. An ankle sprain is an injury to the ligaments that help stabilize the ankle. Typically caused by a sudden twist or roll to the ankle, ligaments on the sides of the ankle can stretch or tear. Most ankle sprains occur when a sudden inward and downward movement of the foot stretches the ligaments on the outside of the ankle. Risk factors include sports requiring quick changes in direction. Cutting and pivoting, such as those involved in soccer, football, tennis, volleyball, and basketball are especially high risk. Those who have had ankle sprains before are also at higher risk. Those who return too quickly to their sport after a sprain are more likely to re-injure their ankle.

Symptoms include a sudden onset of pain followed by possible bruising and swelling. Depending on how severe the sprain is it may be difficult to walk.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson, our tendon specialist, uses ultrasound for accurate diagnosis and supervises a safe return to activity.

Extensor Tendinopathy

Extensor tendinopathy is a condition that causes pain of the tendons along the top of the foot, which are responsible for flexing the foot and toes up. The tendons involved include those of the muscles extensor hallicus longus, extensor digitorum longus, extensor halluces brevis, and tibialis anterior. The injury is commonly one of overuse but can be associated with excessive compression of the middle of the foot by laces that are too tight, or improperly fitting footwear. This condition is common in dancers, figure skaters, skiing, and runners.

Symptoms include pain over the top of the foot, which can be accompanied by swelling.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and supervises a safe return to activity.

Flexor Hallicus Longus Tendinopathy

The flexor hallucis longus tendon originates from the calf muscle and courses along the instep of the ankle and foot, assisting with flexion of the big toe. Irritation of this tendon can occur with repeatedly pushing off the foot and toes, which is commonly seen in ballet dancers. Runners can be affected as well. This injury can be further worsened with rolling out the foot, often in young dancers who have improper form when performing the turnout maneuver.

Symptoms include pain and swelling over the back part of the ankle.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and supervises a safe return to activity.

High Ankle Sprain

A high ankle sprain is a sprain to the strong ligaments that hold the two leg bones, the tibia and fibula, together at the ankle. It is called a high ankle sprain because the area injured is above the region of a common ankle sprain. A high ankle sprain occurs when the foot is forcefully rotated outward. Because of the shape of the bones, this force pulls the two leg bones away from each other and can injure the ligaments that hold them together. Athletes who participate in collision sports such as football, ice hockey and rugby are at higher risk. Athletes who have a history of high ankle sprain are at increased risk of re-injury.

Symptoms include pain and swelling along the front of the ankle joint. Bruising is also common. There may be difficulty putting weight on the injured leg when walking.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and supervises a safe return to activity.

Lisfranc Injury

Lisfranc injury is a midfoot injury that occurs when the bones of the midfoot are fractured or ligaments that support the midfoot are torn. The severity of the injury can vary from simple to complex, involving many joints and bones in the midfoot. Injuries are more common in males in their 30s. The injury is typically caused by indirect rotational forces and axial load through hyperplantar flexed forefoot. These injures are often mistaken for a simple sprain; however, they can be severe and can take months to heal and may require surgical intervention.

Symptoms include pain and swelling of the top of the foot. There may be bruising on both the top and bottom of the foot. Bruising on the bottom of the foot is highly suggestive of a Lisfranc injury. Pain that worsens with standing, walking or attempting to push off on the affected foot.

Treatment often includes a period of rest, immobilization, activity modification, and physical therapy. Our tendon specialist, Dr. Sampson, will confirm the diagnosis and supervise a safe return to activity.

Metatarsophalangeal (MTP) Arthritis

MTP arthritis occurs at the joint between the metatarsal and phalange. Most commonly seen at the base of the big toe. Over time the cartilage wears down and causes the bones to rub together causing pain. There are many causes including wear and tear over time, trauma, infection, chronic injury, etc.

Symptoms include pain, weakness, and loss of motion.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Peroneal Tendon Injury

The peroneal muscles and tendons run down the outside of the lower leg and into the foot. The peroneus brevis tendon attaches to a bone on the outside and middle of the foot. The peroneus longus tendon runs under the foot and attaches near the inside of the arch. Together, they serve to help stabilize the foot and ankle. Injury is often from improper or rapid increases in training, or overuse in sports or activities that involve repetitive ankle motion, such as dancers, runners, and soccer players. Athletes with poor fitting shoes, higher arches or inward-turned heels may be at higher risk for developing peroneal tendon injuries due to the increased stress placed on the peroneal tendons.

Symptoms include pain and swelling along the lateral aspect of the ankle. There may also be a feeling of ankle weakness or instability, especially when pushing off the toes. In cases of subluxation, a snapping sensation along the outside of the ankle will be felt while walking.

Treatment often includes a period of rest, activity modification, insoles, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Plantar Fasciitis

The plantar fascia is located on the underside of the foot, and it is a thick band of fibrous tissue that runs from the inside edge of the heel to the toes. The plantar fascia provides support to the arch, and it is also a shock absorber. When the fascia is overloaded, pain can develop anywhere along the course of the plantar fascia, but most commonly the pain is located where the plantar fascia attaches to the inside edge of the heel. Risk factors to developing plantar fasciitis are tight calf muscles, flat feet or a recent increase in your activity level.

Symptoms include pain of the heel and is worse with the first step in the morning. Usually, the pain will improve with movement, and then it can return after periods of rest.

Treatment often includes a period of rest, activity modification, insoles, night splints, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Posterior Tibial Tendinopathy

The posterior tibial muscle and tendon help stabilize the ankle. They are responsible for pointing the foot in and down. For most athletes, such as in runners, dysfunction of the tendon occurs gradually due to overuse and over-pronation. Less commonly, such as in dancers, it can occur suddenly due to overloading of the tendon. In both cases, individuals with flat are more prone to this condition.

Symptoms usually include pain behind the inside ankle bone, especially with walking or lifting up the foot. The pain may sometimes travel up to the back inside of the calf.

Treatment often includes a period of rest, activity modification, insoles, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Sever’s Disease

Sever’s disease is a common overuse injury that affects the heel of active children and young teenagers. Pain may occur due to inflammation and stress where the Achilles tendon inserts onto a growth plate located in the heel bone. Activities such as running and jumping cause increased stress on the heel bone’s growth plate. Sever disease is most commonly seen in young athletes who participate in soccer, gymnastics, basketball, tennis, baseball, and football. It is caused by repetitive stress to the heel bone growth center. It is more common when athletes run and jump constantly, not allowing time for the area to heal. It typically affects those ages 7 to 14.

Symptoms include heel pain that develops slowly and occurs with activity. The pain usually goes away with rest. The pain may be in one or both heels. Children may walk or run with a limp, or they may walk on their toes to avoid pressure on her heels.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson will confirm the diagnosis and supervise a safe return to activity.

Stress Fracture

A stress fracture is a fracture that is caused by too much stress being put on a bone. It is not typically caused by trauma and it develops gradually over time. It most commonly affects bones of the lower extremity, such as the tibia in the lower leg, the metatarsal bones of the foot, and the femoral neck at the hip joint. However, it can occur in any bone. Upper extremity stress fractures can occur in overhead athletes and gymnasts. Causes include repetitive high-impact exercise, increase in training volume or intensity, poor fitting athletic equipment, low bone density, and poor nutrition.

Symptoms include a gradual onset of pain with activity that progresses to affect daily activities. The pain will develop at the site of the fracture.

Treatment often includes an extended period of rest with immobilization in a cast, walking boot, and/or crutches. Our tendon specialist, Dr. Sampson, helps identify cause of injury and supervises healing and a return to activity.

Tarsometatarsal Arthritis

Tarsometatarsal arthritis occurs at the joint between the tarsals and metatarsals. Over time the cartilage wears down and causes the bones to rub together causing pain. There are many causes including wear and tear over time, trauma, infection, chronic injury, etc.

Symptoms include pain, weakness, and loss of motion.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis and guided injections in refractory cases.

Turf Toe

Turf toe is a sprain of the big toe. The injury usually results from excessive upward bending of the big toe. This can be a result of either jamming the toe or from repetitive injury when pushing off while running or jumping. This is most commonly in football, soccer, basketball, wrestling, gymnastics and dance also are at risk. The name “turf toe” comes from the fact that this injury is especially common among athletes who play on artificial turf. When playing sports on artificial turf, the foot can stick to the hard surface, resulting in jamming of the big toe.

Symptoms include pain, swelling and limited joint movement of the big toe.

Treatment often includes a period of rest, activity modification, and physical therapy. Dr. Sampson uses ultrasound for accurate diagnosis supervises a safe return to activity.