ANKLE EXOSTOSIS |
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General Information
DEFINITION--A piling up of bone at the site of a new or repeat injury, usually caused by direct trauma.
BODY PARTS INVOLVED
Lower part of the tibia (lower-leg bone).
Heel and other foot bones.
Other areas of the foot (sometimes).
Blood vessels, nerves, periosteum (covering of bone), and other soft tissue close to the exostosis.
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SIGNS & SYMPTOMS
Loss of "push" or "drive" (the ability to push off rapidly and forcefully in running).
Inability to run, cut or jump at full speed.
Low level of ankle pain with activity. Sometimes no pain exists.
No tenderness or pressure with a physical examination. Sometimes pain and tenderness in the ankle and top of the heel bone can be detected only by special examination from a trained medical professional.
Change in ankle-bone contours. This begins as a small irregular bump that progresses to a large calcified spur (1cm or more in length). In the worst cases, the exostosis may break away and appear on the X-ray as a calcified foreign body.
"Locking" if the tendon catches on the exostosis during exercise.
CAUSES
Repeated ankle or foot injury, even mild injury.
Participation in sports that require "pushing off" or "springing" from a position with the foot bent upward.
RISK INCREASES WITH
Medical history of repeated ankle injury.
Vitamin and mineral deficiency, which makes complications following injury more likely.
Poor muscle strength or conditioning, which fosters improper movement and allows undue stress on the ankle and foot bones.
Improper or inadequate strapping prior to participation in contact sports.
If surgery is necessary, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Engage in vigorous muscle strengthening and conditioning prior to regular participation in sports.
Allow full healing time after an ankle or foot injury before resuming any sport that requires you to push off and run.
Warm up adequately before competition or workouts.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis and care.
Surgery to remove the exostosis (sometimes).
Self-care during recovery.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of the foot, ankle and knee.
POSSIBLE COMPLICATIONS
Disability severe enough to diminish an athlete's competitive ability if the exostosis is untreated. Because mild exostosis is not readily apparent, coaches and other athletes often attribute the decline in performance to emotional causes or a loss of competitive drive in the athlete, rather than understanding that it is caused by a physical disability (exostosis).
Proneness to repeated injury.
Degenerative arthritic changes in the ankle joint and cartilage in later life.
Pressure on or injury to nearby nerves, ligaments, tendons, blood vessels or connective tissue.
PROBABLE OUTCOMEExostosis usually causes no disability with proper treatment, including rest of the injured ankle, heat treatments, corticosteroid injections, and protection against additional injury. In a few cases, surgery is necessary. No surgical treatment is required for mild conditions that do not interfere with performance.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDNone. The problem develops gradually.
CONTINUING CARE
Apply heat frequently. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Gentle massage will frequently provide comfort and decrease swelling.
MEDICATIONMedicine usually is not necessary for this disorder. For minor discomfort, you may use non-prescription drugs such as aspirin or ibuprofen.
ACTIVITYRest the injured ankle for 2 to 4 weeks. Use splints or crutches, if necessary, to prevent weight-bearing. Elevate the foot when sitting or lying down. Resume your normal activities gradually.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity. Your doctor may suggest vitamin and mineral supplements to promote healing.
REHABILITATION
Begin daily rehabilitation exercises when pain subsides and you have clearance from your doctor.
Use ice massage for 10 minutes before and 10 minutes after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
Your ability to push off with the foot and ankle diminishes for no apparent reason.
Any of the following occurs after surgery:
Numbness or discoloration of the toes when the walking cast is in place.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Increased pain, swelling, redness, drainage, or bleeding in the surgical area.
New, unexplained symptoms. Drugs used in treatment may cause side effects.
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