Kansas City Chiefs tight end Travis Kelce suffered an ankle sprain on August 31 during practice. Fortunately, his injury is nothing but a low-grade sprain and won’t keep him from playing the regular season.
Ankle sprains are common sports injuries. A sprain occurs when the ankle rolls outward and the foot turns inward and rolls under the leg. This causes the ligaments on the outside of the ankle to stretch and tear resulting in pain, swelling and bruising. The most common injured ankle ligaments are the anterior talofibular ligament, which connects the talus to the fibula and the calcaneal fibular ligament, which connects the fibula to the calcaneus.
The severity of the ankle sprain determines the course of treatment.
- Grade 1 sprain: slight stretching of the ligament
- Grade 2: partial tearing of the ligament
- Grade 3: complete tear of the ligament
Treatment in the first 48 to 72 hours consists of following the R.I.C.E guidelines
- Ice for 20 minutes every 2-3 hours
- Compression with an ACE wrap
- Elevate leg above the level of the heart
- Depending on the severity of the sprain and the degree of ankle instability, you may need a cast or walking boot to immobilize your ankle so that it can heal properly. In rare cases of severe ligament tears, you may require surgery to repair the damage.
Based on reports Kelce suffered a low grade sprain and will make a full recovery and return to normal activities. To prevent future ankle sprains or ankle instability it is important for Kelce to restore his ankle’s flexibility, range of motion and strength.
Skin grafts are commonly used for ulcers, burns, wound dehiscence, amputation, and surgical excision. The best types of skin graft are those that come directly from the patient. These grafts are known as autografts, auto meaning self. These grafts are safest to use and heal faster than other types of grafts. The only pitfall with using an autograft is that a second wound is created when harvesting the graft from a different site.
There are split thickness grafts and full thickness grafts. Split thickness grafts contains the epidermis and dermis where as a full thickness graft contains more layers of the skin. Split thickness grafts are more commonly used because they are less likely to form a contracture over time. The thickness of a skin graft depends on what area of the body is harvested. For example the skin of the outside of the thigh is thicker than the inside of the thigh.
Types of Split Thickness Grafts
Thin: 0.008-0.011 inches
Intermediate: 0.012-0.014 inches
Thick: 0.015-0.024 inches
Graft healing occurs in 4 phases:
- Plasmatic Stage (24-48hrs): the graft adheres to the bed
- Inosculation (end of 48hrs): vascular network forms connecting the vessels to the new graft to restore blood flow. The graft will turn a pink hue color
- Capillary Ingrowth: capillary network penetrates into the graft
- Maturation: lymphatic channels and nerves develop
Most grafts fail within the first 72 hours as a result of inadequate adherence that disrupts the blood supply from establishing. A hematoma and seroma can separate the graft from the bed and disrupt ingrowing vessels. It is important to have a compression dressing applied and to leave it intact for a week and limit motion to the area. Infection can also result in graft failure.
For more information on grafts and how they are harvested come see us at Foot & Ankle Doctors, Inc
Foot drop is not a disease, rather a sign of an underlying neurological or muscular condition. Foot drop is defined as the inability to dorsiflex the foot. It is further characterized by numbness and loss of function. Individuals with foot drop have a unique tiptoe walk. During the gait cycle some may drag their toes along the ground and others raise the leg higher than normal and slightly bend the knee to prevent the foot from dragging or slapping against the ground.
The classic foot drop is caused by damage to the common peroneal nerve that weakens the anterior and lateral muscle groups. Other causes include: nerve compression from a lumbar disc herniation, injury to the sciatic nerve, gunshot wounds, crush injuries, tumors or lower motor neuron diseases such as poliomyelitis and Charcot-Marie-Tooth disease.
Our physicians at Foot & Ankle Doctors, Inc. will perform an extensive workup before diagnosing a patient with foot drop. A compressive history and physical examination will be performed. We ask our patient to walk so we can examine leg muscles for weakness and observe how the patient is compensating for the muscle imbalance. Imaging test such as: x-ray, CT and MRI can help pinpoint various causes. A nerve conduction test called an electromyography (EMG) measure electrical activity in the muscles and nerves and are useful in determining where and which nerve is damaged.
Treatment options include:
- Braces or splits – these will fit into the shoe and help hold the foot up assisting with ambulation
- Physical therapy – exercises can strengthen the muscles and maintain range of motion
- Nerve stimulation – stimulating the nerve can help recondition the nerve and improve the severity of foot drop
- Surgery – a physician may recommend nerve grafting, nerve transfer or tendon transfers depending on the cause of the foot drop
A Schwannoma is a benign tumor arising for the covering of nerve sheath. These tumors do not invade the nerve, but rather simply lie on top of the nerve sheath. The cause of it is unknown and can elicit a variety of symptoms. Some patients experience no symptoms at all, and only notice a lump on the bottom of their foot. Other patients experience shooting pain and numbness to the area, and symptoms worsen as the tumor grows.
Imaging modalities can be used to help identify the lesion. MRI will reveal cystic fluid collection in the affected area.
The lesion must be surgically excised and sent to pathology for evaluation. After surgery symptoms should subside. Early diagnosis of this lesion is important in preventing long-term nerve damage.
If you questions or concerns about an abnormal lump or bump on your feet come see us at Foot & Ankle Doctors, Inc
Kinesio taping techniques have become popular among athletes in both treating and preventing injuries. David Beckham, Serena Williams, Tiger Woods and Lance Armstrong have all been spotted wearing kinesio tape. Athletes like it because it is lightweight and there are no harsh chemicals in it. Kinesio tape is an elastic latex free tape that can stretch up to 50-60% of its length. It is heat-activated and can withstand excessive sweat staying in place for up to one week without causing irritation to the skin.
Kinesio tape is lightweight and comfortable to wear and provides similar support to wearing a brace but without the bulk. It is applied along muscles, ligaments and tendons and can be used to treat Achilles tendonitis, shin splints, ankle sprains and plantar fasciitis.
Benefits of Kinesio tape:
- Limits motion
- Removes edema by directing fluid towards lymph ducts
- Reduces inflammation and pain
- Increase circulation to the damaged area
Kinesio tape has to be applied properly to be effective. If you have an injury and would like to learn more about Kinesio tape come see us at Foot & Ankle Doctors, Inc.
Stepping on a thumbtack, nail or piece of glass is something that shouldn’t be taken lightly. Most people try to treat themselves at home, however any object that penetrates the skin can lead to an infection especially if the object is not clean.
A puncture wound can lead to cellulitis, an infection caused by streptococcus or staphylococcus bacteria. Cellulitis will cause swelling and redness to the skin. The infected area will be warm and painful to the touch and you may develop a fever. If the bacteria enter the bloodstream the infection can spread to the rest of the body and sometimes lead to a life threatening infection know as necrotizing fasciitis.
If you step on a nail, seek medical attention immediately. If your tetanus shots are not up to date, your physician will administer a tetanus shot to protect you against lockjaw, an infection that can cause your muscles to painfully contract.
Come see us at the Foot & Ankle Doctors, Inc. within 24 hours after injury. We will remove the foreign object and take x-rays to ensure no pieces remain in the foot. We will clean the wound and monitor your progress during healing. In some cases antibiotics may be prescribed.
Infection is always a concern after a puncture wound. Signs of infection include warmth, redness, swelling, soreness and sometimes drainage. If the object penetrated to bone, a bone infection may occur. In some cases a painful scar or hard cyst may develop.