Ankle and foot fractures and tendon injuries are often misdiagnosed as ankle sprains. This can lead to inadequate treatment, which increases the chance of long-term injury and reinjury.
If your foot and ankle are hurting you and you aren’t sure why, make sure you go into your doctor’s appointment understanding the many possible causes of your pain. Here are the four most common fractures and tendon injuries that are mistaken for sprains.
Fifth Metatarsal Fractures
Fifth metatarsal fractures are easily missed because they are similar to lateral ankle sprains. The chance of misdiagnosis is also high because isolated ankle radiographs don’t effectively evaluate the fifth metatarsal.
There are three different types of fifth metatarsal fractures.
Caused by the pull of the plantar aponeurosis and the peroneus brevis tendon at the tuberosity of the bone. A small piece of the bone is pulled away from the main portion by a tendon or ligament. Avulsion fractures typically happen as the result of an inversion ankle injury (rolling the ankle out so the sole faces inward).
Happens at the bases of the fourth and fifth metatarsal between the toe and shaft. Jones fractures are most often caused by excessive adductive force being applied to the forefoot on the plantar flexed ankle (when toes are pointed down) or by repeated motion, which puts stress on the bone.
Spiral or Oblique Shaft Fracture
Also known as a diaphyseal stress fracture, this occurs closer to the fifth toe and may result in displacement due to instability. The injury usually happens after a sudden increase in walking or running.
Symptoms and Treatment
People with a fifth metatarsal fracture usually have tenderness when the area of injury is palpated. Acute injuries will be accompanied by ecchymosis and edema (bruising and swelling). A doctor will diagnose the injury after a physical exam and X-rays.
Nonsurgical treatments usually include:
- Bone stimulation
The navicular bone is the bone on the top of the midfoot. The central third of the bone doesn’t have many blood vessels, making it susceptible to stress injuries during repetitive foot strikes. Track and field athletes see this type of foot injury most often.
Patients with a navicular stress fracture typically experience a gradual onset of midfoot pain while working out. An examination will frequently reveal tenderness on palpation over the top side of the navicular. While active inversion and passive eversion (rolling ankle inward) might be painful, bruising and swelling are typically absent.
A navicular fracture can be diagnosed by a physical exam and other tests, including:
- CT scan
- Bone scan
- MRI scan
This type of fracture is frequently treated through nonsurgical means, usually with a cast to hold the bones in place. In rare cases, the fracture is severe enough to call for surgery.
Talar Dome Lesions
The talus is commonly injured during an ankle sprain. This injury may cause persistent pain even after the sprain has healed. Disruption of the cartilage overlaying the talar dome is the cause of most talar injuries. Subtle talus fractures might also result from an acute ankle injury.
- Osteochondral lesions – associated with dull ankle pain deep within the area of a prior ankle injury. A physical exam of osteochondral lesions will frequently show an ankle joint effusion (fluid accumulation) with contained tenderness around the joint. An MRI is recommended for evaluating lesions as ankle radiographs often lack the sensitivity to catch them.
- Fractures of the talar dome – can be medial or lateral and are usually the result of inversion ankle injuries. Like with osteochondral lesions, radiographs may fail to identify the fracture. CT scans should be used to better evaluate the fracture.
- Tarsal coalition – incomplete separation of the bones, which occasionally involves the calcaneus and talus. You may have a tarsal coalition if you’re experiencing persistent pain after a sprain. During the physical exam, your doctor will look for decreased range of motion in the transverse or subtalar tarsal joint. While radiographs can identify the coalition, a CT or MRI scan will provide the clearest image.
Treatment depend on how severe the talar dome lesion is. If the area is stable, nonsurgical treatment options can be considered, like:
- An ankle brace
- Oral medications
- Physical therapy
Peroneal Tendon Injuries
Peroneal tendon injuries include subluxation, strains, dislocation and tears of one or both peroneal tendons. This is often caused by ankle inversion, similarly to an uncomplicated sprain. Untreated peroneal tendon injuries may cause subsequent ankle instability.
People with peroneal tendon injuries may report a “pop” at the time of injury and a “snapping” sound during athletic activities. Pain is most likely located behind the lateral malleolus and causes posterolateral ankle pain, weakness and swelling with tenderness along the peroneal tendons.
Radiographs can help doctors identify an isolated injury to the tendon. However, an MRI provides the best imaging for peroneal tendons and the stabilizing retinaculum, while a CT scan provides detailed bone anatomy when subtle fractures are suspected.
Emergency Services in Texas and Colorado Springs at Complete Care
Whether you think you have a sprain or a more serious ankle injury, the qualified medical professionals at Complete Care can help. Each of our locations is fully equipped to treat patients of all ages. Our urgent care walk-in emergency room facilities across Texas and Colorado Springs are open 24 hours for your emergency needs.
For more information, contact us online!