All too common today is the misuse of the word “injury.”
When it comes to the majority of foot and ankle issues people experience, these ailments should not be called “injuries,” unless of course they really are an injury.
But why does it matter?
It is critical in the cause and effect part of diagnosis, and therefore the treatment, to not use this word incorrectly. In other words, be careful and accurate how you describe your presenting problem because it really matters.
About 3 out of 4 people who come to me with foot or ankle pain are experiencing what is an acquired inflammatory disorder of mechanical imbalance, yet the description of how it started almost always includes some “traumatic event.”
Actual acute foot and ankle trauma results in such problems as turf toe, ankle sprain, 5th metatarsal tuberosity fracture, lisfranc midfoot sprain, ankle fractures, acute metatarsal shaft fracture, as a few examples. You can think of an actual injury as the scenario in which you have a split second, acute force (blunt force, twisting, bending, etc.), and you have the immediate pain and likely swelling that comes with that force.
Trauma vs. Non-Trauma: Why it Matters
When people experience pain that comes with a second MTP synovitis, midfoot osteoarthritis, plantar fasciitis or a posterior tibialis tendon rupture—these do not have such trauma associated with them…ever. These are examples where someone might say, “I don’t know how I hurt it.” If you really are unable to pinpoint the exact time when you had to be carried off the field, or when you “went down” with the injury and had swelling right after and the next day, it really is not an injury!
Why would one even describe a non-traumatic problem as traumatic? Because generally speaking ALL orthopaedic problems in our minds are trauma generated, right? Wrong, but this assumption is prevalent and understandable.
How can your story make a difference?
Just the other day I saw a 54-year-old female with an obvious diagnosis of second MTP synovitis, which is never caused by trauma. Yet I was the 5th doctor she had seen.
She told me this problem began when she was involved in an auto accident seven months ago in which she broke her left wrist and “injured her right foot.”
Right after the accident, the broken wrist took precedence and the foot was ignored until about six weeks later. She then presented to doctor #1 for a foot injury from the accident.
It is a reasonable assumption and the doctor took her at face value as did doctors #2 through #4. Unfortunately, the last four doctors treated any number of trauma-related problems, but not her real problem.
On closer questioning, she said that the pain in her foot did not start until about five weeks following the accident. Again, a reasonable belief that the foot problem resulted from an injury.
She ended up having a second MTP synovitis diagnosed accurately by doctor #5, me.
It comes down to trauma vs. non-trauma, which is really about cause and effect.
This difference is crucial information to know when it comes to treating whatever problem it is that brought you into the doctor. Think of it this way: there are basically two avenues to orthopaedic related pain: one of those is trauma (an injury), and the other is non-traumatic: it just starts for no known reason.
And why is this important for you, the patient, to know the difference? When you visit your doctor for a foot and ankle complaint, your description of the problem will almost always impact the diagnosis, which will impact your recommended course of action. When you call it an injury when it is not an injury, you’re starting off on the wrong path when it comes to your diagnosis, because all too often, your doctor takes you at your word.
Do You Really Have an Injury…Or Is It a Non-Traumatic, Acquired Foot and/or Ankle Problem?
In the majority of these cases of acquired problems in the foot and ankle, tight calves are to blame! In fact, in at least 3 out of 5 people who come into my office, tight calves are the cause of their problem. If you think about your foot and heel pain, and one morning it “just started,” that’s exactly what I’m talking about. There’s no clear-cut, true history of a traumatic event…even if we try to make one up on our own!
Another reality is that these ailments tend to creep up on us in our 40s, 50s, 60s and 70s. These problems are not “injuries” and this distinction is very important for the proper and accurate treatment from the start.
This is a simple example of an algorithm for a few foot and ankle diagnostic problems for illustrative purposes. Similar appearing problems often have vastly different treatments depending on the origin.
Orthopedically speaking, think of it this way: there are true injuries, and then there are imbalance inflammatory problems—and it’s essential that people know which of these categories they fall under. It’s true that pain may be associated with both, which could be why you’re using the word “injury,” but now you know: pain doesn’t mean your foot was actually injured.
Hopefully, if doctors ask more questions, and people become increasingly educated about the use of the word injury, we can stop treating an “injury” the wrong way…at least if people want to get better!
When you start stretching your calves, you fix the problem.
The 9-Minute Challenge: Just Do It
The #SaveYourFeet Challenge we have for you is this: just do the stretching described here for 3 minutes, 3 times a day (or look to get 9 minutes total a day). After 4 months, come back and tell us how it works. (We say 4 months because while some people see improvement in two weeks, others may need upwards of 5-6 months to break through a through a long-standing calf contracture.)
We’re not even saying you have to use the One Stretch. What we’re saying is stretch your calves, save your feet!