Common Ankle and Foot Injuries from Childhood Sports

By Kimberly H. Burrer, PMAC, PRAC, RMA

This article was published in the 2021 ASPMA 2nd Quarter Journal. ASPMA is the American Society of Podiatric Medical Assistants. Kim is our office manager and currently serving on the board of directors of the ASPMA.

It’s back-to-school season! For many students, this means finally returning to the classrooms 
and participating in physical education classes and extracurricular sports. With this return to 
more physical activity for students after having many months of less active lifestyles due to the 
COVID-19 pandemic and quarantining, more injuries are likely to occur this autumn.


Ankle Sprains


Ankle sprains comprise nearly 25% of sports-related injuries, making them the 
most common foot and ankle injuries. Typically, activities involving twisting 
actions increase the likelihood of sprains, like basketball, football, soccer, and tennis. 
The ankle is flexed or inverted when a sprain happens, causing the ligaments to 
over-stretch or even tear. The posterior talofibular ligament, anterior talofibular 
ligament, and calcaneofibular ligaments are most affected by sprains. 


Fractures

Foot and ankle fractures are other common injuries seen due to sports. Movements 
like sudden stops or turns typically cause fractures. Sports that involve running 
or jumping, like baseball, volleyball, and gymnastics, are frequently associated with 
ankle fractures. Foot fractures mainly occur in the phalanges and metatarsals as closed 
fractures, which do not break through the skin. Stress fractures develop over some time 
and are not usually trauma-caused. Typically, the overuse that occurs from 
competitive training in sports, such as basketball, running, dancing, tennis, 
and gymnastics, causes microtraumas that the weight-bearing bones of the 
feet can no longer handle. Pain and inflammation mimicking the symptoms of 
shin splints may lead to a stress fracture diagnosis. Female adolescents experience 
stress fractures more often than male adolescents.

Toenail Trauma

Toenail trauma is a frequent occurrence in P.E. class or sports, such as soccer and football, 
when children’s feet repeatedly kick into the top of their shoes or a ball. Toenails may become 
painful and bruised and be susceptible to irritation or infection. The pressure from bleeding 
and swelling that builds up under the toenail may cause the toenail to turn a dark color, called 
a subungual hematoma. The nail may separate from the nail bed or be prone to tearing.
Ingrown toenails may be another outcome of toenail injury or poorly fitting shoes. Many 
soccer players and runners experience ingrown toenails as repetitive pressure pushes the sides 
of the toenails into the surrounding skin, usually from the tight-fitting toe box of cleats or running shoes. The toenails and surrounding areas may become painful, swollen, or infected. 


Sever’s Disease and Heel Injuries

Sever’s Disease, or calcaneal apophysitis, is a leading cause of many juvenile heel injuries, 
specifically during ages 8-14 years, when the body begins to experience adolescent growth 
spurts. The body’s bones, tendons, and muscles grow at differing rates, which may cause 
additional strain or repetitive stress on the growth plate or apophysis near the calcaneus 
and Achille’s tendon. The area around the calcaneus may become inflamed, swollen, stiff, 
and painful. Sever’s Disease commonly affects children who are active and involved in sports 
played on hard surfaces, such as basketball, gymnastics, and running.

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