Second Opinion Needed

February 24, 2017

When student-athletes have foot and ankle injuries, it may be best to get a second opinion or further imaging. This recommendation centers on the revelation that foot and ankle injuries are occasionally misdiagnosed, leading to an increased risk of developing complications down the road.

Foot and ankle injuries are a common cause for emergency room visits, with more than three million annually. The six most common maladies include snowboarder’s fracture, Lisfranc injuries, turf toe, navicular stress fractures, os trigonum injuries, and syndesmotic injuries.

“These types of trauma are a clinically significant source of morbidity and long-term disability among patients, not just those who are elite athletes,” Jessica Reissig, DO, Orthopedic Surgery Resident at Plainview (N.Y.) Hospital, told Science Daily. “As an osteopathic physician, I view treatment of foot and ankle injuries as acute and preventative care because a mismanaged injury leads to so many future problems for patients.”


Reissig and two colleagues recently completed a clinical review related to these injuries. The study, published in the February 2017 edition of the Journal of the American Osteopathic Association discusses each of the six most common foot and ankle issues, the anatomy involved, notes on their diagnoses, and management. Researchers concluded many of the injuries may worsen with improper recognition and treatment.

For example, as the research article explains, os trigonum injuries are often confused with Achilles tendon injuries due to close anatomical proximity. Diagnosing the injury can usually be done with a physical examination of the ankle and plain radiographs, but MRIs can help rule out other issues like Achilles tendinosis. If left undiagnosed, athletes afflicted with an os trigonum injury tend to compensate by rotating their ankle and hindfoot in a varus—or inward—position. This may lead to recurrent ankle sprains, peroneal tendinitis, and sinus tarsi syndrome. There is also a high correlation of arthritis in the future for snowboarder’s fractures, Lisfranc injuries, and turf toe.

Many of the injuries examined can be resolved with proper treatment that includes rest, ice, immobilization, and medication. Some more serious injuries require surgical treatment, and athletes may choose a surgical route in order to get back on the field sooner.

“Once the diagnosis is confirmed, in many cases patients can be offered a range of treatment options from conservative to surgical,” Adam Bitterman, DO, Assistant Professor in the Hofstra Northwell School of Medicine and co-author of the study, told Science Daily. “Choosing the best treatment for the individual can prevent the injury from decreasing the patient’s future quality of life.”

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