A Pro Sports Team Physician's Guide to Foot and Ankle Sports Injuries
- sarangndesai
- 1 day ago
- 22 min read
What Happens When an Athlete Goes Down
I've been on the sideline when a basketball player lands on someone's foot and crumples to the ground. I've watched a running back plant and cut, then grab the outside of his foot. I've seen a soccer player go up for a header, come down wrong, and not get up.
In those moments, the crowd goes quiet. The coaching staff looks at you. The athletic trainer is already jogging out. And you have about 60 seconds to start making decisions that will determine whether this athlete plays next week, next month, or next season.
I'm Dr. Sarang Desai, a fellowship-trained orthopedic foot and ankle surgeon in McKinney and Flower Mound, Texas. I serve as a professional sports team physician, and I've spent over 15 years treating foot and ankle injuries in athletes at every level — from middle school players in Frisco and Prosper to professional athletes on national stages.
As a former University of Texas All-American athlete, I know what it feels like to be the one on the ground. That perspective shapes every decision I make as a surgeon.
This guide is going to walk you through the foot and ankle injuries I see most often in athletes — from the sideline evaluation to the operating room to the return-to-play decision. Whether you're a patient trying to understand your injury, a parent worried about your kid, or a coach trying to plan your season, this is the information you need.
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Why Foot and Ankle Injuries Are Different in Athletes
Here's something most patients don't realize: the same injury in a professional athlete and a weekend warrior may require completely different treatment — and sometimes it shouldn't.
A 40-year-old recreational basketball player who tears his Achilles tendon and a 25-year-old professional who tears his have the same injury. But the treatment conversation is different because the demands are different, the timeline pressures are different, and the consequences of getting it wrong are different.
At the same time, some injuries don't care who you are. A Jones fracture in a high school soccer player and a Jones fracture in an NFL running back need the same surgery. The biology doesn't change because you're famous.
My job as a sports medicine foot and ankle surgeon is to know the difference — when to be more aggressive, when to be more conservative, and when the treatment is the same regardless of the level of play.
Research from a major NCAA Division I program found that foot and ankle injuries account for 27% of all musculoskeletal injuries in collegiate athletes, with the highest rates in women's gymnastics, women's cross-country, women's soccer, and men's cross-country.[1] These aren't rare injuries. They're the most common reason athletes miss time — and the most common reason they end up in my office.
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The Sideline Evaluation: What a Team Physician Is Actually Doing
When I evaluate an athlete on the sideline, I'm running through a mental algorithm in about 90 seconds. Here's what that looks like:
Step 1: Can they bear weight?
This is the single most important question. An athlete who can't put weight on the foot or ankle has a fundamentally different injury than one who can limp off the field. If they can't bear weight, I'm thinking fracture, Achilles rupture, severe ligament injury, or Lisfranc injury until proven otherwise.
Step 2: Where does it hurt?
I'm palpating specific anatomical landmarks:
- Lateral ankle (outside) → ankle sprain, high ankle sprain, peroneal tendon injury, lateral process fracture
- Medial ankle (inside) → deltoid ligament injury, medial malleolus fracture
- Lateral midfoot (outside of the foot) → Jones fracture, fifth metatarsal fracture
- Dorsal midfoot (top of the foot) → Lisfranc injury
- Posterior heel/calf → Achilles tendon rupture
- Forefoot → turf toe, sesamoid fracture, metatarsal stress fracture
Step 3: What was the mechanism?
How the injury happened tells me almost as much as the exam:
- Inversion (ankle rolls inward) → lateral ankle sprain, peroneal tendon injury, lateral process fracture
- Eversion/external rotation → high ankle sprain, syndesmosis injury, ankle fracture
- Planting and cutting → Jones fracture, Lisfranc injury, ankle fracture
- Landing on someone's foot → ankle sprain, Jones fracture, peroneal tendon subluxation
- Pushing off explosively → Achilles rupture, Jones fracture
- Hyperextension of the big toe → turf toe
Step 4: Can they return to play today?
This is the hardest question — and the one where experience matters most. The pressure to return an athlete to the game is real. But my job isn't to get someone back on the field today. My job is to make sure they can play for the rest of their career.
If there's any concern for a fracture, Achilles rupture, Lisfranc injury, or significant ligament damage, the athlete is done for the day. Period. No exceptions. The risk of turning a treatable injury into a career-threatening one is too high.
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The Injuries That End Seasons — and the Ones That Don't
Not all foot and ankle injuries are created equal. Here's how I think about them as a team physician:
Season-Ending Injuries (Typically Require Surgery)
These are the injuries that take an athlete out for months, not weeks:
1. Achilles Tendon Rupture — 4-6 months minimum
2. Lisfranc Injury (Unstable) — 4-6 months
3. Jones Fracture — 2-3 months
4. Ankle Fracture (Surgical) — 2-4 months
5. Osteochondral Lesion of the Talus (Large/Symptomatic) — 4-6 months
6. Chronic Ankle Instability Requiring Reconstruction — 3-6 months
Injuries That May Not End the Season
These can often be managed to allow continued play — or require only a few weeks out:
1. Grade I-II Lateral Ankle Sprain — days to 3 weeks
2. High Ankle Sprain (Stable) — 4-6 weeks
3. Turf Toe (Grade I-II) — 1-3 weeks
4. Peroneal Tendon Subluxation (First Episode) — may play with taping/bracing, but recurrence is common
5. Stress Reaction (Pre-Fracture) — 4-6 weeks if caught early
The key word is "may." Every injury is individual. A Grade II ankle sprain in a lineman is different from a Grade II ankle sprain in a wide receiver. The demands of the position, the time of the season, and the athlete's history all factor into the decision.
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The Big Seven: Foot and Ankle Sports Injuries I Treat Most Often
1. Achilles Tendon Rupture
The scenario: A basketball player pushes off for a fast break and feels like someone kicked him in the back of the leg. He turns around — nobody's there. A pickleball player lunges for a shot and feels a pop in the calf. A runner accelerates and suddenly can't push off.
Why it happens: The Achilles tendon is the strongest tendon in the body, but it has a vulnerable zone of poor blood supply about 2-6 cm above where it attaches to the heel bone. This is where most ruptures occur. The typical patient is a 30-50 year old male in a sport that requires explosive push-off — basketball, tennis, pickleball, soccer, and running are the most common.
The critical decision — surgery vs. no surgery: This is one of the most debated topics in sports medicine. The evidence shows that return-to-play rates are high with both operative and nonoperative treatment.[2] However, for athletes and active individuals, surgical repair offers specific advantages: improved strength outcomes, better functional recovery, and a shorter timeline to return to sport.[3][4] A systematic review of elite male athletes found that 61-100% return to play after operative repair, though sports with explosive plantarflexion demands like basketball may see greater performance decrements.[4]
My approach: for athletes and active adults, I recommend surgical repair. For older, sedentary patients, nonoperative treatment with functional rehabilitation is a reasonable option.
Recovery: Athletes should expect to miss a full season — typically 4-6 months to return to sport.[5] Immediate weight-bearing and early ankle motion after repair have shown good results with low re-rupture rates.[6]
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2. Jones Fracture (Fifth Metatarsal Fracture)
The scenario: A football player plants his foot and pushes off — and feels a crack on the outside of his foot. A basketball player lands from a jump and can't bear weight. A dancer has had a nagging ache on the outside of her foot for weeks, and it suddenly gets much worse.
Why it happens: The Jones fracture occurs at the base of the fifth metatarsal in a "watershed" zone of poor blood supply. This is why it's notorious for not healing — and why it almost always needs surgery in athletes.
The evidence is overwhelming: A meta-analysis of 646 Jones fractures in athletes found a return-to-play rate of 98.8% with surgery versus 71.6% without surgery, with faster return times (9.6 weeks vs. 13.1 weeks) and higher union rates (97.3% vs. 71.4%) in the surgical group.[5]
What most people don't know: Screw size matters enormously. Research shows that using a small-diameter screw increases the risk of bone union disorder by nearly 5 times. The screw needs to "fit and fill" the medullary canal. This is one of the reasons it matters who does your surgery.
Recovery: Most athletes return to sport in 8-12 weeks after surgery. The refracture rate is approximately 10%, which is why postoperative orthotics and addressing underlying foot mechanics (especially cavovarus alignment) are critical.
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3. Chronic Ankle Instability
The scenario: A volleyball player sprains her ankle for the fourth time this season. A basketball player's ankle "gives way" every time he cuts. A soccer player can't trust her ankle on uneven ground anymore.
Why it happens: About 20% of patients who suffer an acute ankle sprain go on to develop chronic ankle instability.[7] The lateral ankle ligaments — particularly the anterior talofibular ligament (ATFL) — stretch or tear and never heal properly. The ankle becomes mechanically loose and functionally unreliable.
The hidden problem: One in three patients with chronic ankle instability has a cartilage lesion (osteochondral defect) inside the ankle joint.[8] This is why chronic instability isn't just an inconvenience — it's a pathway to arthritis if left untreated.
Surgical treatment: The modified Broström procedure — a repair and tightening of the native ligaments — remains the gold standard. A meta-analysis of 1,384 patients found that 95% returned to some sport, 83% returned to their preinjury level, and 87% returned to competitive sport after surgery, with a mean time to return of 12.5 weeks.[9] For patients with poor tissue quality or very high demands, augmentation with suture tape (internal brace) or anatomic reconstruction with a graft may be used.[10][11]
What I tell athletes: If you've sprained your ankle more than twice and it still gives way despite physical therapy and bracing, it's time to talk about surgery. Every additional sprain damages the cartilage inside the joint a little more — and that damage is much harder to fix.
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4. Lisfranc Injury
The scenario: A football lineman gets his foot stepped on while it's planted. A soccer player's foot gets caught in the turf while she's tackled. A dancer lands from a jump and feels a pop in the top of the midfoot.
Why it matters: Lisfranc injuries are the most commonly misdiagnosed foot injury in sports. They're often dismissed as "midfoot sprains" — and that misdiagnosis can be career-ending. The Lisfranc joint complex is the keystone of the midfoot arch. When it's disrupted, the entire biomechanical foundation of the foot is compromised.
Diagnosis is the challenge: The 2024 International Foot and Ankle Sports Consensus reached unanimous agreement that the mechanism involves axial compression or twisting through a plantarflexed foot, and that key exam findings include midfoot tenderness, pain with the squeeze test, and inability to bear weight.[12] Bilateral weight-bearing radiographs are the initial imaging study, with CT or MRI for subtle injuries.
Treatment depends on stability: Stable, nondisplaced injuries with intact ligaments on MRI can be managed nonoperatively, with most athletes returning to sport within 6-10 weeks.[12] Unstable injuries require surgery. For ligament injuries in elite athletes, the 2024 consensus recommends fixation (not fusion), with suture button fixation showing lower complication rates and fewer secondary procedures than traditional screw fixation.[13] Over 90% of athletes successfully return to sport, typically within 4-6 months.[14]
The bottom line: Any midfoot injury that prevents weight-bearing needs to be evaluated by a foot and ankle specialist. A missed Lisfranc injury is one of the worst outcomes in sports medicine.
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5. High Ankle Sprain (Syndesmosis Injury)
The scenario: A football player gets rolled up on from behind. A soccer player's foot is planted and externally rotated during a tackle. A basketball player lands awkwardly with the foot turned outward.
Why it's different from a regular ankle sprain: A regular ankle sprain tears the ligaments on the outside of the ankle. A high ankle sprain tears the syndesmosis — the ligaments that hold the tibia and fibula together above the ankle joint. It's a completely different injury with a completely different recovery timeline.
The telltale sign: The squeeze test — squeezing the calf at mid-leg level — reproduces pain at the ankle. External rotation of the foot with the knee bent at 90 degrees also reproduces pain. If these tests are positive, it's a high ankle sprain until proven otherwise.
Return to play: A meta-analysis of 440 elite athletes with syndesmosis injuries found a 99% return-to-sport rate.[15] Nonoperatively managed athletes returned in about 29 days; surgically managed athletes returned in about 50 days. Suture button fixation was used in 96% of surgical cases, with a mean return to sport of 7 weeks and a 9.1% complication rate.[15]
What I tell athletes: High ankle sprains take 2-3 times longer to heal than regular ankle sprains. If you try to come back too early, you'll re-injure it. Patience here saves you time in the long run.
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6. Ankle Cartilage Injuries (Osteochondral Lesions)
The scenario: An athlete has persistent deep ankle pain and swelling months after an ankle sprain that "should have healed by now." The ankle catches or locks. It aches after activity and sometimes swells overnight.
Why it happens: When the ankle sprains, the talus (the bone that sits inside the ankle joint) can slam against the tibia or fibula, damaging the cartilage surface. In athletes with acute ankle ligament injuries, the prevalence of cartilage and osteochondral lesions is approximately 14% on 3-T MRI.[16] In patients with chronic ankle instability, that number rises to 32%.[8] Most lesions occur on the medial (inside) talar dome.
The diagnostic challenge: These injuries often don't show up on X-rays. MRI is the gold standard for detection — it can identify cartilage damage, bone marrow edema, and the size and location of the lesion.[17][18] CT is useful for surgical planning.
Treatment options: Small, stable lesions may respond to a period of immobilization and activity modification. Larger or symptomatic lesions typically require arthroscopic surgery. Microfracture (drilling small holes in the bone to stimulate a healing response) remains the most common first-line surgical approach.[7][17] For larger lesions, osteochondral autograft transfer (OATS) or other cartilage restoration procedures may be needed.
The connection to instability: This is critical — if the ankle is unstable, the cartilage will continue to get damaged no matter what you do to treat the lesion. Addressing instability and cartilage damage together is essential for a good long-term outcome.
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7. Peroneal Tendon Injuries
The scenario: A runner has chronic pain behind the outside ankle bone that won't go away. A basketball player feels a snapping sensation on the outside of the ankle every time he pushes off. A hiker's lateral ankle pain has been misdiagnosed as "chronic ankle sprains" for two years.
Why it's missed: Peroneal tendon injuries are one of the most underdiagnosed conditions in foot and ankle sports medicine.[19] The peroneal tendons run behind the fibula (the outside ankle bone) and are responsible for stabilizing the ankle during push-off and lateral movements. They can tear, become inflamed, or subluxate (slip out of their groove) — and all three conditions produce lateral ankle pain that mimics other injuries.
The two main problems:
- Peroneal tendon tears: These are often degenerative, developing over time from repetitive stress. Surgical treatment depends on the extent of the tear — tears involving less than 50% of the tendon can be repaired directly, while tears involving more than 50% require tenodesis (connecting the damaged tendon to the healthy one). A systematic review of 336 patients showed significant improvements in pain and function after surgery, with AOFAS scores improving from 69.6 to 88.8.[19][20]
- Peroneal tendon subluxation/dislocation: The tendons slip out of the groove behind the fibula, usually after a forceful dorsiflexion injury. In athletes, surgery is often indicated for recurrent subluxation. The best outcomes come from combining groove deepening with repair of the superior peroneal retinaculum — this combination produces significantly higher return-to-sport rates than retinaculum repair alone.[21]
What I tell patients: If you've been told you have "chronic ankle sprains" but the outside of your ankle still hurts despite treatment, ask about your peroneal tendons. They're frequently the real problem.
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Other Important Foot and Ankle Sports Injuries
Beyond the Big Seven, there are several other injuries I see regularly in athletes:
Ankle Fractures in Athletes
Ankle fractures are among the most common surgical fractures, and in athletes, the stakes are high. A study of unstable malleolar fractures found that 69.7% of patients returned to sport without limitations, but bimalleolar fractures, trimalleolar fractures, associated dislocations, and osteochondral injuries were all associated with worse outcomes and lower return rates.[22] The key is anatomic reduction — restoring the joint surface perfectly — and appropriate fixation to allow early rehabilitation.
Stress Fractures
Stress fractures of the foot are the third most common foot and ankle injury in collegiate athletes.[1] The navicular, the metatarsals, and the calcaneus are the most common locations. Some stress fractures (like navicular stress fractures) are "high-risk" — meaning they have a poor blood supply and a high rate of nonunion, similar to Jones fractures. These often require surgery.
The most important thing about stress fractures is catching them early. A stress reaction (the precursor to a stress fracture) can be managed with rest and activity modification. A complete stress fracture may need surgery and months of recovery.
Turf Toe
A hyperextension injury of the big toe metatarsophalangeal joint, most common in football players on artificial turf. Grade I and II injuries can usually be managed with taping, a stiff-soled shoe, and activity modification. Grade III injuries (complete plantar plate tears) may require surgery and 3-4 months of recovery.
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The Return-to-Play Decision: How a Team Physician Thinks About It
This is the part of sports medicine that doesn't get talked about enough. The decision to clear an athlete to return to play is not just about whether the bone has healed or the ligament has been repaired. It's about whether the athlete can perform the demands of their sport safely and effectively.
What I'm Evaluating Before Clearance
1. Structural healing — Has the fracture united? Has the tendon healed? Has the ligament repair matured? This is assessed with imaging (X-rays, sometimes MRI or CT).
2. Functional strength — Can the athlete perform a single-leg heel raise? Can they hop? Can they cut? Strength testing — often with isokinetic dynamometry — should show at least 80-90% of the uninjured side.
3. Sport-specific function — Can they perform the movements their sport demands? A basketball player needs to cut, jump, and land. A soccer player needs to sprint, change direction, and kick. A runner needs to sustain repetitive loading over distance.
4. Confidence — This is underrated. An athlete who doesn't trust the ankle will compensate, and compensation leads to other injuries. Psychological readiness is part of the clearance process.
5. Risk of reinjury — Some injuries have high refracture or re-rupture rates. Jones fractures have a 10% refracture rate. Achilles re-rupture rates are 2-5% after surgery. These numbers factor into the timeline.
The Pressure to Return Early
I'll be honest about this: the pressure to return athletes to play before they're ready is real. It comes from coaches, agents, parents, and often the athletes themselves. As a team physician, my job is to be the voice of reason — to protect the athlete from the short-term thinking that can cause long-term damage.
I've had conversations where I've told a player, "I know you feel ready. I know the team needs you. But your bone isn't healed yet, and if you go back now and refracture, you're looking at 6 months instead of 6 weeks." That conversation is never easy. But it's the right one.
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Sport-by-Sport Injury Patterns
Different sports produce different injury patterns. Understanding this helps athletes, parents, and coaches know what to watch for.
Basketball
Basketball is the highest-risk sport for foot and ankle injuries requiring surgery. The combination of jumping, landing, cutting, and contact creates a perfect storm.
- Most common injuries: Ankle sprains (leading to chronic instability), Achilles tendon ruptures, Jones fractures, osteochondral lesions
- Unique risk: Landing on another player's foot is the most common mechanism for ankle sprains in basketball. Jones fractures in basketball players have the lowest return-to-play rate of any sport (91.1%)
- Key prevention: Ankle bracing after a first sprain, proper landing mechanics, and neuromuscular training
Football
Football produces the widest variety of foot and ankle injuries due to the diversity of positions and mechanisms.
- Most common injuries: High ankle sprains (syndesmosis), Jones fractures, Lisfranc injuries, ankle fractures, turf toe
- Unique risk: Linemen are at highest risk for Lisfranc injuries (getting stepped on while the foot is planted). Skill position players are at highest risk for Jones fractures and Achilles ruptures
- Key prevention: Proper cleat selection, ankle taping/bracing for players with prior sprains
Soccer
Soccer combines the running demands of cross-country with the cutting demands of basketball — on a surface that can be uneven.
- Most common injuries: Ankle sprains, Jones fractures, Achilles tendon injuries, stress fractures
- Unique risk: Shooting (the kicking motion) loads the fifth metatarsal and the Achilles tendon. Cleats with a narrow toe box increase lateral forefoot pressure
- Key prevention: Ankle strengthening programs (like the FIFA 11+), proper cleat fitting
Running
Runners are the stress fracture population. The repetitive, high-volume loading of distance running makes the foot vulnerable to overuse injuries.
- Most common injuries: Metatarsal stress fractures, navicular stress fractures, Jones fractures (stress type), Achilles tendinopathy, plantar fasciitis
- Unique risk: The "terrible too's" — too much, too fast, too soon. Rapid increases in mileage are the number one risk factor
- Key prevention: The 10% rule (increase weekly mileage by no more than 10%), proper footwear, vitamin D optimization
Pickleball
Pickleball has exploded in DFW — and so have the injuries. The typical pickleball player is older (40-70), which means slower healing, lower bone density, and less tolerance for surgical complications.
- Most common injuries: Achilles tendon ruptures, ankle sprains, Jones fractures, plantar fasciitis
- Unique risk: The lateral lunge on a hard court surface is the classic mechanism for Achilles ruptures and ankle sprains in pickleball. Many players are deconditioned and playing at an intensity their bodies aren't prepared for
- Key prevention: Proper warm-up, court-specific shoes (not running shoes), gradual ramp-up of playing frequency
Tennis
Similar injury patterns to pickleball but with more running and higher-intensity demands.
- Most common injuries: Ankle sprains, Achilles tendinopathy, stress fractures, peroneal tendon injuries
- Key prevention: Court-specific shoes, ankle strengthening, calf flexibility
CrossFit
CrossFit athletes are a unique population — they combine heavy lifting, gymnastics, and high-intensity cardio, often with high volume and limited rest.
- Most common injuries: Achilles tendinopathy, stress fractures, ankle sprains (from box jumps and rope climbs)
- Unique risk: Box jumps are the number one mechanism for Achilles injuries in CrossFit. Rope climbs and pistol squats stress the ankle in extreme ranges of motion
- Key prevention: Scaling movements appropriately, step-downs instead of rebounding box jumps, proper warm-up
Dance and Gymnastics
These sports place extreme demands on the foot and ankle — particularly in positions of maximal plantarflexion (pointing the foot).
- Most common injuries: Fifth metatarsal stress fractures, Achilles tendinopathy, ankle impingement (anterior and posterior), os trigonum syndrome, sesamoid injuries
- Unique risk: En pointe and relevé positions concentrate enormous force through the forefoot and posterior ankle. Female athletes in these sports are also at higher risk for the relative energy deficiency in sport (RED-S) spectrum, which impairs bone health
- Key prevention: Adequate nutrition and energy availability, gradual progression of pointe work, ankle strengthening
Golf
Golf is low-impact but not zero-impact. The rotational forces of the swing load the lead foot significantly.
- Most common injuries: Plantar fasciitis, Achilles tendinopathy, ankle sprains (on uneven terrain)
- Key prevention: Supportive golf shoes, calf stretching, orthotics for arch support
Volleyball
Jumping and landing are the primary mechanisms. Volleyball players share many injury patterns with basketball players.
- Most common injuries: Ankle sprains, Achilles tendinopathy, stress fractures
- Key prevention: Landing mechanics training, ankle bracing after first sprain
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When to See a Foot and Ankle Specialist vs. an Urgent Care or ER
This is practical advice that can save you time, money, and — most importantly — a misdiagnosis.
Go to the ER if:
- You have an obvious deformity (the foot or ankle looks crooked)
- You have an open wound with a fracture (bone visible or suspected)
- You can't feel your toes or your foot is cold and pale (vascular emergency)
- You have severe pain and swelling after a high-energy injury (car accident, fall from height)
See a foot and ankle specialist (not urgent care) if:
- You were told you have a "fifth metatarsal fracture" — you need to know which zone
- You have persistent lateral foot pain that's been going on for more than a week
- You sprained your ankle and it's still unstable after 4-6 weeks of rehab
- You have midfoot pain after a twisting injury — Lisfranc injuries are frequently missed at urgent care
- You felt a pop in your calf or heel — Achilles ruptures are missed about 20-25% of the time on initial evaluation
- You have chronic ankle pain that hasn't responded to rest, bracing, or physical therapy
The most commonly misdiagnosed injuries I see:
1. Lisfranc injuries — dismissed as midfoot sprains
2. Jones fractures — lumped in with Zone 1 avulsion fractures and undertreated
3. Achilles tendon ruptures — missed on initial evaluation and diagnosed late
4. Osteochondral lesions — attributed to "chronic ankle sprain" when the real problem is cartilage damage
5. Peroneal tendon tears — diagnosed as "lateral ankle pain" without further workup
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The Role of Imaging in Sports Injuries
X-Rays
Still the first-line imaging for most acute injuries. Fast, inexpensive, and excellent for identifying fractures and dislocations. Weight-bearing X-rays are critical for Lisfranc injuries and ankle instability — they show how the bones behave under load, which non-weight-bearing films can miss entirely.
MRI
The workhorse of sports medicine imaging. MRI shows soft tissue (ligaments, tendons, cartilage) and bone marrow edema (the earliest sign of a stress injury). Essential for:
- Stress fractures that don't show on X-ray
- Osteochondral lesions
- Achilles tendon injuries (partial vs. complete tears)
- Lisfranc ligament integrity
- Peroneal tendon tears
CT Scan
Best for bony detail. I use CT for:
- Preoperative planning for fracture surgery
- Evaluating osteochondral lesions (size and depth)
- Complex fracture patterns
- Jones fracture screw sizing
Ultrasound
Increasingly used for dynamic evaluation — watching tendons move in real time. Useful for:
- Peroneal tendon subluxation (you can see the tendon slip out of the groove)
- Achilles tendon evaluation
- Guided injections
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Prevention: What Every Athlete Should Know
After 15 years of treating sports injuries, here's what I wish every athlete, parent, and coach understood:
1. The Best Surgery Is the One You Never Need
Most sports injuries are preventable — or at least their severity can be reduced. Neuromuscular training programs (like the FIFA 11+ for soccer) have been shown to reduce ankle sprain rates by 30-50%. Ankle bracing after a first sprain reduces the risk of recurrence. Gradual training progression prevents stress fractures.
2. Pain Is Information
Athletes are taught to play through pain. That's fine for muscle soreness. It's not fine for bone pain, joint pain, or tendon pain that persists for more than a few days. A stress reaction caught at 2 weeks of symptoms is a 4-week problem. A stress reaction ignored for 2 months is a surgical problem.
3. Vitamin D Matters
I check vitamin D levels in every athlete I treat for a bone injury. Deficiency is remarkably common — especially in indoor athletes (basketball, volleyball, dance, gymnastics) and in the general DFW population. Adequate vitamin D (and calcium) is essential for bone healing and injury prevention.
4. Shoes Matter
Wearing running shoes for court sports, or court shoes for running, increases injury risk. Sport-specific footwear exists for a reason. And if you have a high-arched (cavovarus) foot — which is a risk factor for Jones fractures, peroneal tendon injuries, and lateral ankle sprains — custom orthotics can make a meaningful difference.
5. Rehabilitation Is Not Optional
Surgery fixes the structural problem. Rehabilitation restores function. Skipping rehab — or cutting it short — is the most common reason athletes re-injure themselves. A full rehabilitation program after any significant foot or ankle injury should include range of motion, strengthening, proprioception (balance training), and sport-specific conditioning.
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Why It Matters Who Does Your Surgery
I want to be direct about this — not because I'm trying to sell you on my practice, but because it genuinely affects outcomes.
Foot and ankle surgery is a subspecialty. An orthopedic surgeon who specializes in foot and ankle injuries has completed an additional year of fellowship training beyond the 5 years of orthopedic surgery residency. That fellowship year
References
Incidence and Epidemiology of Foot and Ankle Injuries in Elite Collegiate Athletes. Hunt KJ, Hurwit D, Robell K, et al. The American Journal of Sports Medicine. 2017;45(2):426-433. doi:10.1177/0363546516666815.
Return to Play and Functional Outcomes Following Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-Analysis. Bak BM, Seow D, Teo YZE, Hasan MY, Pearce CJ. The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons. 2024 May-Jun;63(3):420-429. doi:10.1053/j.jfas.2023.12.008.
Achilles Tendon Ruptures and Repair in Athletes-a Review of Sports-Related Achilles Injuries and Return to Play. Mansfield K, Dopke K, Koroneos Z, et al. Current Reviews in Musculoskeletal Medicine. 2022;15(5):353-361. doi:10.1007/s12178-022-09774-3.
Return-to-Play and Performance After Operative Treatment of Achilles Tendon Rupture in Elite Male Athletes: A Scoping Review. LaPrade CM, Chona DV, Cinque ME, et al. British Journal of Sports Medicine. 2022;56(9):515-520. doi:10.1136/bjsports-2021-104835.
Optimizing Return to Play for Common and Controversial Foot and Ankle Sports Injuries. Allahabadi S, Amendola A, Lau BC. JBJS Reviews. 2020;8(12):e20.00067. doi:10.2106/JBJS.RVW.20.00067.
Immediate Weightbearing and Ankle Motion Exercise After Acute Achilles Tendon Rupture Repair. Won Lee K, Bae JY, Ho BC, Kim JH, Seo DK. The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons. 2022 May-Jun;61(3):604-608. doi:10.1053/j.jfas.2021.10.021.
Surgical Treatment Paradigms of Ankle Lateral Instability, Osteochondral Defects and Impingement. Pereira H, Vuurberg G, Spennacchio P, et al. Advances in Experimental Medicine and Biology. 2018;1059:85-108. doi:10.1007/978-3-319-76735-2_4.
One in Three Patients With Chronic Lateral Ankle Instability Has a Cartilage Lesion. Wijnhoud EJ, Rikken QGH, Dahmen J, et al. The American Journal of Sports Medicine. 2023;51(7):1943-1951. doi:10.1177/03635465221084365.
Return to Sport After Anatomic Lateral Ankle Stabilization Surgery for Chronic Ankle Instability: A Systematic Review and Meta-Analysis. Li Y, Su T, Hu Y, et al. The American Journal of Sports Medicine. 2024;52(2):555-566. doi:10.1177/03635465231170699.
Comparison of Modified Broström Procedure with or without Suture Tape Augmentation Technique for the Chronic Lateral Ankle Instability. Li J, Qi W, Yun X, et al. BioMed Research International. 2022;2022:6172280. doi:10.1155/2022/6172280.
Arthroscopic Reconstruction of the Anterior Talofibular Ligament and Calcaneofibular Ligament Using Allograft for Chronic Lateral Ankle Instability Allows Patients to Successfully Return to Their Preinjury Sports Activities With Excellent Clinical Outcome at Minimum 2-Year Follow-Up. Vilá-Rico J, Mortada-Mahmoud A, Fernández-Rojas E, Jiménez-Blázquez JL, Campillo-Recio D. Arthroscopy : The Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2025;:S0749-8063(25)00055-6. doi:10.1016/j.arthro.2025.01.037.
Diagnostic Evaluation and Nonoperative Management of Lisfranc Injuries in Athletes. Semelsberger SD, Boggiano VJ, Webber K, et al. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA. 2025;. doi:10.1002/ksa.70244.
Operative Treatment of Lisfranc Injuries in Elite Athletes: 2024 International Foot and Ankle Sports Consensus and Systematic Review. Balboni JM, Levine AR, Boggiano VJ, et al. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA. 2026;. doi:10.1002/ksa.70261.
Return to Sport Following Lisfranc Injuries in Elite Athletes-2024 International Foot and Ankle Sports Consensus and Systematic Review. Webber KJ, Balboni JM, Semelsberger SD, et al. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA. 2026;. doi:10.1002/ksa.70285.
Elite Athletes Successfully Return to the Preinjury Level of Sport Following Ankle Syndesmosis Injuries: A Systematic Review and Meta-Analysis. Bolia IK, Bogdanov J, Schoell K, et al. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2023;33(1):90-96. doi:10.1097/JSM.0000000000001019.
The Prevalence, Size, and Anatomic Location of Cartilage and Osteochondral Lesions in Athletes With an Acute Ligamentous Ankle Injury. Baltes TPA, Dalansi F, Al-Naimi MR, et al. The American Journal of Sports Medicine. 2025;53(9):2173-2180. doi:10.1177/03635465251344187.
Current Concepts in the Diagnosis and Treatment of Osteochondral Lesions of the Ankle. O'Loughlin PF, Heyworth BE, Kennedy JG. The American Journal of Sports Medicine. 2010;38(2):392-404. doi:10.1177/0363546509336336.
National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. Kaminski TW, Hertel J, Amendola N, et al. Journal of Athletic Training. 2013 Jul-Aug;48(4):528-45. doi:10.4085/1062-6050-48.4.02.
Operative Treatment for Peroneal Tendon Disorders. Heckman DS, Reddy S, Pedowitz D, Wapner KL, Parekh SG. The Journal of Bone and Joint Surgery. American Volume. 2008;90(2):404-18. doi:10.2106/JBJS.G.00965.
Clinical Outcomes of Peroneal Tendon Tears: A Systematic Review. Mercer NP, Gianakos AL, Mercurio AM, Kennedy JG. The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons. 2021 Sep-Oct;60(5):1008-1013. doi:10.1053/j.jfas.2021.03.003.
Return to Sports and Clinical Outcomes in Patients Treated for Peroneal Tendon Dislocation: A Systematic Review. van Dijk PA, Gianakos AL, Kerkhoffs GM, Kennedy JG. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA. 2016;24(4):1155-64. doi:10.1007/s00167-015-3833-z.
Unstable Malleolar Ankle Fractures: Evaluation of Prognostic Factors and Sports Return. Pina G, Fonseca F, Vaz A, Carvalho A, Borralho N. Archives of Orthopaedic and Trauma Surgery. 2021;141(1):99-104. doi:10.1007/s00402-020-03650-w.
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