Whenever you experience a sprained foot, one or more of the ligaments have been injured or damaged. Such an injury could occur in any part of the foot, although when one speaks of sprain, it is more often than not a ligament in the middle part of the foot that’s involved. An injury to a ligament in the forefoot is most often referred to as a sprained toe, while an injury to the back portion of your foot is often termed an ankle injury, whether the ankle joint has been directly involved or not. This makes sense since the ligaments in the back part that attach to the bones are rarely injured, while ankle sprains are much more common.
A brief look into the anatomy of the human foot can help to shed some light on where sprains are likely to occur and what they might involve. The difference between a sprain and a strain is also touched upon as these two types of injury are often confused. The discussion then turns to five things you should know, should you have the misfortune to experience a sprained foot.
Anatomy of the Foot 101
The focus here is on the bones, joints, and ligaments of the feet. A study of the tendons and muscles is not necessary to understand the places where a sprained foot would most likely occur.
The bones of the feet can be placed into three groups or categories. Knowing these can help you to navigate through the various joints and ligaments, a few of which have lengthy or unfamiliar names. Once you are familiar with the anatomy of the feet’s bones, understand where two bones meet to form a joint, and appreciate the fact that the ligaments are there to protect the joints by keeping the bones and other tissues where they belong, understanding the complete anatomy of the feet should be less challenging. There are three categories of foot bones:
The tarsals are the bones of the rear of the feet. These bones include the heel bone and six bones on the top of each foot near the ankle.
The metatarsals are the long bones of the feet. They are located in the middle part of one’s foot and extend from four of the tarsal bones to the first joint of the toes.
The phalanges are located in the front part of the feet. These are your toe bones. There are two bones in your big toe and three in each of the other four toes.
Although not technically part of each foot, the ankle joint consists of one of the foot bones and the two lower leg bones. The ankle joint is where that part of the foot known as the hindfoot begins.
The hindfoot is the region of the foot between the ankle joint and the calcaneocuboid joint, which connects the heel bone to the cuboid bone, the main bone in the mid-foot. One of the joints in the hindfoot is the subtalar joint, which lies between the talus bone in the ankle and the calcaneus or heel bone. The subtalar joint moves in combination with the two other joints in the hindfoot – the talonavicular joint, located at the top of each foot near the ankle, and the calcaneocuboid joint.
The mid-foot begins with the calcaneocuboid joint and ends where the metatarsal joints begin. This part of the foot has very little mobility. Three of five metatarsal joints connect three of the metatarsal bones to the middle and lateral cuneiform bones, and the other two of the metatarsal joints connect the metatarsal bones to the cuboid bone.
The forefoot consists of two sets of joints: the five metatarsophalangeal joints plus the proximal and distal interphalangeal joints in the toes. The metatarsophalangeal joint that is most frequently injured is the first metatarsophalangeal joint. This is the joint at the base of the big toe, which sometimes suffers a sprain when the toe has been bent too far backwards. This particular injury is commonly known as a turf toe.
There are a number of ligaments that serve to stabilize the ankle joint and hold the tibia and fibula together where they meet at the ankle. The cervical ligament, which is located in the subtalar joint, could be considered either a foot or an ankle joint. Aside from the cervical ligament, the ligaments in the foot consist of the Lisfranc ligaments, the intermetatarsal ligaments, and the joint capsule of the big toe.
The Lisfranc ligaments stabilize the small bones in the foot. These are very strong ligaments, but they are also ligaments that if injured tend to take a long time to heal. Lisfranc ligaments are most apt to be damaged if the middle part of the foot becomes trapped and twisted.
The intermetatarsal ligaments connect the neck of one metatarsal bone to the neck of its neighbor, effectively binding the metatarsal bones together. The result is that all five metatarsal bones move together in synchronization, which is what you would want to happen when you are walking or running. It is possible to sprain these ligaments, but experiencing a sprained intermetatarsal ligament is fairly uncommon.
The joint capsule of the big toe is so named because that is the shape the ligament takes in surrounding the big toe joint. The primary function of this ligament is to stabilize the inside of the big toe and keep the big toe from moving out to the side.
The Difference between a Sprain and a Strain
Sprains and strains are among the more common types of injuries, second only to scratches, bumps, and bruises. Sprains involve injuries to ligaments. Ligaments are tough bands of fibrous tissue that connect one bone to another and will therefore be present in the body’s joints. Strains involve muscles and/or tendons. Muscles and tendons also connect bones but serve to move a bone, making up one part of a joint to a different position relative to another bone that makes up the same joint. Ligaments serve to keep the bones and muscles in a joint in place and therefore perform a stabilizing function. A foot strain can involve one or more of the muscles or tendons. You will in most cases recover from a foot strain quickly if it happens to be a mild one. A severe strain can be another story however since a muscle or tendon that is badly torn or has ruptured usually requires medical treatment and the recovery time can be lengthy.
Ligaments are not meant to be stretched. They are slightly elastic, but only to the extent that while they hold the bones in a joint in place, they also act as shock absorbers. If placed under heavy stress, they may stretch, but only slightly. If the stress is too great however, or is applied too quickly, a ligament tends to tear. That is what a sprain consists of. Like strains, sprains can be mild, moderate, or severe. In general, a sprain will take longer to recover from than a strain of comparable severity. A severe sprain can often require weeks of recovery time and a surgical repair.
How Sprains Happen
Sprains most often occur when a joint is subjected to sudden trauma to the extent that the bones in the joint are knocked out of position. In some instances, the bones may return to their natural position, thanks to the muscles, tendons, and ligaments that will naturally try to return them to that position. In other cases however, the movement may be so violent that a ligament in the joint can be overstretched or even ruptured. Sprains, particularly to the ankle or foot, tend to occur more commonly in athletic endeavors and happen when the ankle or foot is being forced to move into an unnatural position. Baseball (sliding into a base) and skiing (bindings failing to release properly during a fall) are two sports where a sprain is always a possibility. When you twist your ankle, the pain you feel is usually the result of a sprain. Fortunately, most twisted ankles do not cause serious sprains.
Classes of Sprains
There are three degrees or classes of sprains: mild, moderate, and severe. You can normally tell the degree of a sprain by its symptoms. In general, the more severe the sprain is, the more severe or intense the symptoms will be.
A Class I sprain is a mild sprain. In a Class I sprain, a ligament has been overstretched. While the initial pain that is felt may be sharp, it tends to subside fairly quickly, although not completely. There may be some mild swelling about the joint that’s been injured, and the joint may feel a little unstable for a time and a certain amount of stiffness may set in. You can usually walk on a foot that has experienced a mild sprain, but running or jumping could be uncomfortable or even painful.
A Class II sprain is a moderate sprain. In a Class II sprain, a ligament has been partially torn, though not ruptured. It is accompanied by what could be described as moderate pain, and the amount of swelling that would be experienced will often be quite significant. Bruising is one of the symptoms of a Class II sprain. Some motion may be lost in the joint involved, and depending upon which joint has been affected, walking could be a problem.
A Class III sprain is a severe sprain and is one in which a ligament has been completely torn. The pain to be experienced will generally be quite severe, as will the swelling. The joint involved will become unstable and, for all practical purposes, unusable until the injury has been allowed to heal. If a joint other than the ankle joint is where the injury has occurred, walking may be possible, but would usually be quite painful.
Treating a Sprained Foot
Although it’s always advisable to err on the side of caution, if you should sprain your foot and the symptoms appear to be mild, you can usually treat the injury at home. If you can walk on your feet and there is only mild pain or discomfort involved, you’ll still want to avoid strenuous activities such as hiking, jogging, or playing sports until the pain has subsided. If any activity, including walking, seems to be making matters worse however, it’s probably a good time to see your doctor or visit a podiatrist. If the pain is severe enough to make walking difficult or if any bruising is apparent, you should definitely seek medical attention – and seek it quickly!
Home treatment primarily involves rest, ice, compression, and elevation, or RICE. Rest is the best medicine as far as healing a sprained foot is concerned. Ice, when applied as soon as possible after the injury has occurred, will often keep both swelling and inflammation at a minimum. It is important to keep in mind however that ice should not be applied directly to the skin. An icy-cold compress is most effective when applied for about 30 minutes at a time. Placing ice against your skin for more than 30 minutes could not only damage the skin tissue but also make your injury worse. A suggested approach, that is, a good one, is to wrap a towel around a package of frozen vegetables (frozen peas are an excellent choice) and use that for your ice treatment. Keeping your foot elevated when you lie down will generally reduce any swelling. Sometimes you will see the acronym PRICE used instead of RICE. The P stands for protection. Protection doesn’t necessarily mean wearing a special boot or a cast. High-ankle hiking boots laced tighter than normal will often provide protection enough for a mild to moderate sprain. Ordinary shoes laced tightly may suffice for a sprain that has occurred in the mid-foot or forefoot, although, as mentioned previously, an injury to the Lisfranc ligaments, even a mild sprain, may take more than the usual amount of time to heal.
Resting your foot as much as possible will usually allow a mild sprain to heal. If the sprain should be a moderate to severe one, rest becomes imperative. That usually means immobilization and the use of a soft cast, a boot, and/or crutches. While having your foot immobilized may seem to be a bother at first, the alternative is usually unacceptable, since not only significant pain would be involved in your recovery but also your foot could be injured even more. The real issue is whether a ligament has been stretched a little too far or if it’s been torn. Even a slight tear takes more time to heal than an overstretched ligament does. A severe tear or rupture not only will be immobilizing from the beginning but also will likely require surgical repair and can take a long time to heal.
Recovering from a Foot Sprain
Recovery time can vary widely depending on the severity of the sprain and on the involved joint or ligament. As noted earlier, recovery from a mild sprain may take only a few days to a week or two, and you primarily have to be careful not to re-injure your foot or make the injury worse while it is healing. A moderate to severe sprain can take from 4 to 6 weeks to heal, and a sprain that requires surgical repair will sometimes take months before it will heal completely.
One of the challenges you will likely face when recovering from a severe sprain is learning how to exercise the muscles in the ankle and foot to keep them from becoming weakened while giving the ligament the protection and rest it needs. This is an area where assistance or advice from a therapist will often be beneficial. There are a number of physiotherapy treatments that can be called into play to help the healing process without re-injuring yourself. These include electrotherapy or ultrasound; hydrotherapy; the use of a special orthotic; exercises to improve strength, flexibility, and balance; and protective taping.
Prevention of Foot Sprains
One way to help prevent foot sprains would of course be to watch where you are going and pay attention to what you are doing at all times, which is clearly impossible. Accidents can happen no matter how careful a person is. This is particularly true in sporting activities where, if you are overly cautious, your overall performance will very likely suffer. While you would want to be paying attention to your surroundings, the best way to prevent foot or ankle sprains from occurring is to get into the habit of doing exercises that serve to improve your balance, strengthen the muscles in your feet and ankles, and keep the feet and ankle joints flexible.
Neither having knowledge of the anatomy of the feet nor knowing the difference between a sprain and a strain is essential, but knowing how to treat a sprained foot is. Even more important is knowing when it’s time to call on professional help. Knowing what to do and what not to do during the recovery process is important as well. As far as preventing this type of injury is concerned, keeping oneself in good physical condition will help prevent the injury and may serve to lessen the severity if one should occur.