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Sprained Foot

Written by Tele Demetrious

Updated:

(Also known as Foot Sprain, Midtarsal Joint Sprain)

What is a sprained foot?

A sprained foot is a condition characterized by damage or tearing of the connective tissue (such as ligaments, cartilage and joint capsule) of one or more joints of the foot.

The rear foot comprises of 7 bones collectively known as the tarsals. The mid foot comprises of 5 long bones known as the metatarsals. The toes each comprise of several small bones known as the phalanges (figure 1). Each bone within the foot attaches to the adjacent bones forming joints. Each of these joints comprises of strong connective tissue wrapping around the bony ends and cartilage which lies between the joint surfaces, cushioning the impact of one bone on another during activity.

Sprained Foot Anatomy
Figure 1 – Anatomy of a Sprained Foot

During certain movements of the foot or activities such as landing from a jump (particularly on an uneven surface or with the foot in an awkward position) or rolling an ankle, stretching or compression forces are placed on the joints of the foot. If these forces are excessive due to too much repetition or high force, injury to the joints may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. When this occurs, the condition is known as a sprained foot and may affect one or more joints.

Causes of a sprained foot

A sprained foot typically occurs due to a specific incident involving a forceful twisting or bending movement of the foot (normally during weight bearing). This may occur during activities such as jumping (especially following an awkward landing), running (especially with change of direction or on uneven surfaces), gymnastics and contact sports such as football (often due to a collision). Foot sprains are also relatively common in windsurfers who have their feet strapped in and suddenly move forward over one foot. They may also occur in association with a rolled ankle.

Occasionally, a sprained foot will occur due to repetitive strain associated with overuse. This may be the case in patients who perform repetitive activities involving end of range movements of the foot and are more common in patients with unstable foot types such as flat feet.

Signs and symptoms of a sprained foot

Patients with a sprained foot often experience a sudden onset of pain during the causative activity. However, patients may also experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms may be felt on the top, bottom or sides of the affected joint. Occasionally pain may be referred into the toes or ankle on the affected side. Symptoms are generally exacerbated with activities that place pressure on the affected joint such as standing, walking or running (especially up or down hills, on uneven surfaces or with change of direction), kicking, jumping or standing on tip toes. It is also common for patients to experience pain on firmly touching the affected region. In more severe cases, bruising or swelling may be present and in some cases, the patient may walk with a limp.

Diagnosis of a sprained foot

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a sprained foot and to determine the likely structures affected. Investigations such as an X-ray, MRI or CT scan may be required to confirm diagnosis and rule out other injuries (particularly fractures).

Treatment for a sprained foot

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Prognosis of a sprained foot

In cases of a minor to moderate foot sprain, return to sport or normal activity can usually occur in 2 – 6 weeks with appropriate management and treatment. Patients with a more severe injury will usually require a longer period of rehabilitation to gain optimum function.

Contributing factors to the development of a sprained foot

Although a large number of foot sprains are unavoidable, there are some factors which can increase a patients’ likelihood of experiencing a sprained foot or suffering a recurrence. These factors need to be assessed and corrected with direction from a physiotherapist and may include:

Physiotherapy for a sprained foot

Physiotherapy for a sprained foot can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:

Other intervention for a sprained foot

Despite appropriate physiotherapy management, a small percentage of patients with this condition do not improve adequately and may require other intervention. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, CT scan or MRI, pharmaceutical intervention, corticosteroid injection, the use of a protective boot (cam walker) or referral to a specialist who can advise on any procedures that may be appropriate to improve the condition. A review with a podiatrist for the prescription of orthotics and appropriate footwear advice may also sometimes be indicated.

Exercises for a sprained foot

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.

Initial Exercises

Foot and Ankle Up and Down

Move your foot and ankle up and down as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 2). Repeat 10 – 20 times provided there is no increase in symptoms.

Exercises for a Sprained Foot - Foot & Ankle Up and Down
Figure 2 – Foot and Ankle Up and Down (left leg)

Foot and Ankle In and Out

Move your foot and ankle in and out as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 3). Repeat 10 – 20 times provided there is no increase in symptoms.

Exercises for a Sprained Foot - Foot & Ankle In and Out
Figure 3 – Foot and Ankle In and Out (right leg)

Foot and Ankle Circles

Move your foot and ankle in a circle as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 4). Repeat 10 times in each direction provided there is no increase in symptoms.

Exercises for a Sprained Foot - Foot and Ankle Circles
Figure 4 – Foot and Ankle Circles

Intermediate Exercises

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Advanced Exercises

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Other Exercises

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Rehabilitation Protocol for a Sprained Foot

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Physiotherapy products for a sprained foot

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:

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