Foot and ankle injuries

There are numerous injuries that can be sustained by the foot and ankle. Sprains and strains commonly occur.

A sprain occurs when the ligaments around a joint are overstretched or tear - most commonly the lateral/outside ankle ligaments. This is often due to a sudden wrench or twist, which causes the bones of a joint to separate unduly.

Minor sprains and strains can be treated at home, initially using the following measures:

Start treatment as soon as possible to reduce swelling and speed up recovery. The less swelling, the more blood can get to the injured part to start the repair process.

Apply the RICE method:

• Rest – even if it is only a minor sprain and use crutches for up to a week to allow the damaged tissue to unload and start to knit.
• Ice (using ice or a bag of frozen peas) for 10-15 minutes every hour for the first 24-48 hours. (Do not apply heat during the first two days, as this will only increase swelling.) Ice is shown to be more effective with compression. 
• Compression can be applied by securing the ice with a cloth, or purchasing a product at your local chemist called Tubigrip/Orthogrip.
• Elevate the ankle ABOVE your heart.

Use paracetamol for the first day of the injury, since it will reduce pain without increasing bleeding. Thereafter, ibuprofen (or other nonsteroidal anti-inflammatories) or aspirin is a good choice. Don't give aspirin to a child younger than 16 years. Be aware that  anti-inflammatories can cause more bleeding in an area where you are trying to control the bleeding.  Steer clear of anti- inflammatories for the first three days – rather take paracetamol.

•             Arnica oil works well to reduce swelling.

•             After 48 hours, start moving the limb gently, but not as to cause pain.

•             Gradually increase the range of movement – let pain be your guide.

•             Strains usually take between 3 and 6 weeks to heal.

After the initial treatment you need to see a physiotherapist for ankle strengthening rehabilitation to be able to play, perform maximally, and prevent re-injury.

If the ankle sprain is not healing as quickly as one would expect, a bone bruise or syndesmosis injury must be considered, and this is where an ankle specialist is vital. In more sever injuries the ankle may even be fractured, requiring the attention  of an orthopaedic surgeon.

Another injury to consider is posterior impingement of the ankle. This injury is characterised by pain in the region of the achilles tendon. It is caused by maximal repetitive forced plantarflexion (pointing toes), most especially when this occurs at the time of impact during bowling.

This injury classically affects the right foot (of a right-handed bowler) at back foot impact during the delivery stride. This can be aggravated by uneven surfaces, which are commonly found at the run-up at the nets. There is a “pinching” or impingement of the soft tissue at the back of the ankle.  Fast bowlers who plantar flex their front foot in their delivery stride get posterior impingement which, when present  for many years, eventually can result in a bony spur formation.  Surgery is not popular amongst the top surgeons because of all the nerves surrounding  that area, and because the bone often grows back – the body’s adaption to the bowling action and impact demands, but there are taping  techniques that I use to keep them pain free.  It does slightly change their stride length, but they adapt quickly.

Management may require surgery in a limited number of cases to reduce the impingement of tissue by bone, or to release a restricted tendon. Other management techniques would include strengthening to allow controlled landing of the foot and assessing the bowling biomechanics to prevent poor landing mechanics.  Also avoid/limit surfaces with inadequate shock absorption!

Coaches and players should be aware of the quality of the surfaces that fast bowlers practice on, and should know the acceptable levels of bowling per week for each bowler.

Content reviewed and enhanced by Dr Joe de Beer, a well-known orthopaedic specialist, and T-J Malherbe, a physiotherapist. Both are from Cape Town.