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Lower Leg, Ankle, and Foot Injuries

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Musculoskeletal Injuries in the Military

Abstract

Overuse and traumatic distal lower extremity conditions are common among physically active individuals, and the incidence rate is an order of magnitude greater than that reported in the general population. With frequent impact and heavy load-bearing activity, military servicemembers have unique occupational demands that may further exacerbate inherent risks of leg, ankle, and foot injuries. A thorough endocrine, nutritional, and multisystem clinical work-up is warranted to evaluate certain overuse conditions. Furthermore, mechanical alignment and soft tissue integrity should always be scrutinized when considering a range of nonoperative or surgical treatment options. Modifications in training regimen, the use of external restraints or orthotics, and physical therapy with targeted neuromuscular, strength, and/or gait interventions may be effective preventative measures in selected patients with distal lower extremity injuries.

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References

  1. Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes. A study of 320 cases. Am J Sports Med. 1987;15(1):46–58.

    Article  CAS  PubMed  Google Scholar 

  2. Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P. Rockwood and Green’s Fractures in Adults. (7th edn, Chap. 55). Philadelphia: Lippincott Williams and Wilkins; 2009.

    Google Scholar 

  3. Harrast MA, Colonno D. Stress fractures in runners. Clin Sports Med. 2010;29(3):399–416.

    Article  PubMed  Google Scholar 

  4. Milgrom C, Giladi M, Stein M, Kashtan H, Margulies JY, Chisin R, Steinberg R, Aharonson Z. Stress fractures in military recruits. A prospective study showing an unusually high incidence. J Bone Joint Surg Br. 1985;67(5):732–5.

    CAS  PubMed  Google Scholar 

  5. Knapik JJ, Graham B, Cobbs J, Thompson D, Steelman R, Jones BH. A prospective investigation of injury incidence and injury risk factors among Army recruits in military police training. BMC Musculoskeletal Disord. 2013. 14(32).

    Google Scholar 

  6. Caesar BC, McCollum GA, Elliot R, Williams A, Calder J. Stress fracturs of the tibia and medial malleolus. Foot Ankle Clin. 2013;18(2):339–55.

    Article  PubMed  Google Scholar 

  7. Armstrong DW, Rue JP, Wilckens JH, Frassica FJ. Stress fracture injury in young military men and women. Bone. 2004;35(3):806–16.

    Article  PubMed  Google Scholar 

  8. Yates B, White S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med. 2004;32(3):772–80.

    Article  PubMed  Google Scholar 

  9. Cosman F, Ruffing J, Zion M, Uhorchak J, Ralston S, Tendy S, McGuigan FE, Lindsay R, Nieves J. Determinants of stress fracture risk in United States Military Academy cadets. Bone. 2013;55(2):359–66.

    Article  PubMed  Google Scholar 

  10. Lee D. Stress fractures, active component. US Armed Forces, 2004-2010. MSMR. 2011;18(5):8–11.

    PubMed  Google Scholar 

  11. U.S. Army Research Institute of Environmental Medicine Bone Health and Military Medical Readiness. U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA; 2006.

    Google Scholar 

  12. Jones BH, Thacker SB, Gilchrist J, Kimsey CD, Sosin DM. Prevention of lower extremity stress fractures in athletes and soldiers: a systematic review. Epidemiol Rev. 2002;24(2):228–47.

    Article  PubMed  Google Scholar 

  13. Zahger D, Abramovitz A, Zelikovsky L, Israel O, Israel P. Stress fractures in female soldiers: an epidemiological investigation of an outbreak. Mil Med. 1988;153(9):448–50.

    CAS  PubMed  Google Scholar 

  14. Knapik J, Montain SJ, McGraw S, Grier T, Ely M, Jones BH. Stress fracture risk factors in basic combat training. Int J Sports Med. 2012;33(11):940–6.

    Article  CAS  PubMed  Google Scholar 

  15. Brudvig TJ, Gudger TD, Obermeyer L. Stress fractures in 295 trainees: a one-year study of incidence as related to age, sex, and race. Mil Med. 1983;148(8):666–7.

    CAS  PubMed  Google Scholar 

  16. Jones BH, Bovee MW, Harris JM, Cowan DN. Intrinsic risk factors for exercise-related injuries among male and female Army trainees. Am J Sports Medicine. 1993;21(5):705–10.

    Article  CAS  Google Scholar 

  17. Mattila VM, Niva M, Kiuru M, Pihlajamaki H. Risk factors for bone stress injuries: a follow-up study of 102,515 person-years. Med Sci Sports Exerc. 39(7):1061–6.

    Google Scholar 

  18. Pester S, Smith PC. Stress fractures in the lower extremities of soldiers in basic training. Orthop Rev. 1992;21(3):297–303.

    CAS  PubMed  Google Scholar 

  19. Protzman RR, Griffis CG. Stress fractures in men and women undergoing military training. J Bone Joint Surg Am. 1977;59(6):825.

    CAS  PubMed  Google Scholar 

  20. Wentz L, Liu PY, Haymes E, Ilich JZ. Females have a greater incidence of stress fractures than males in both military and athletic populations: a systemic review. Mil Med. 2011;176(4):420–30.

    Article  PubMed  Google Scholar 

  21. Kaufman KR, Brodine S, Shaffer R. Military training-related injuries: surveillance, research, and prevention. Am J Prev Med. 2000;18(3):54–63.

    Article  CAS  PubMed  Google Scholar 

  22. Bell NS, Mangione TW, Hemenway D, Amoroso PJ, Jones BH. High injury rates among female Army trainees: a function of gender? 2000. AJPM. 2000;18(3):141–6.

    CAS  Google Scholar 

  23. Hauret KG, Jones BH, Bullock SH, Canham-Chervak M, Canada S. Musculoskeletal injuries description of an under-recognized injury problem among military personnel. Am J Prev Med. 2010;28(1):61–70.

    Article  Google Scholar 

  24. Finestone A, Milgrom C, Evans R, Yanovich R, Constantini N, Moran DS. Overuse injuries in female infantry recruits during low-intensity basic training. Med Sci Sports Exerc. 2008;40(11):630–5.

    Article  Google Scholar 

  25. Yeung SS, Yeung EW, Gillespie LD. Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database Syst Rev. 2011;6(7).

    Google Scholar 

  26. Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin D supplementation decreases incidence of stress fractures in female Navy recruits. J Bone Miner Res. 2008;23(5):741–9.

    Article  CAS  PubMed  Google Scholar 

  27. Rome K, Handoll HH, Ashford R. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev. 2005;18(2).

    Google Scholar 

  28. Fraipont MJ, Adamson GJ. Chronic exertional compartment syndrome. J Am Acad Orthop Surg. 2003;11(4):268–76.

    PubMed  Google Scholar 

  29. Fronek J, Mubarak SJ, Hargens AR, Lee YF, Gershuni DH, Garfin SR, Akeson WH. Management of chronic exertional anterior compartment syndrome of the lower extremity. Clin Orthop Relat Res. 1987;220:217–27.

    PubMed  Google Scholar 

  30. Detmer DE, Sharpe K, Sufit RL, Girdley FM. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med. 1985;13:162–70.

    Article  CAS  PubMed  Google Scholar 

  31. Edmundsson D, Toolanen G, Sojka P. Chronic compartment syndrome also affects nonathletic subjects: a prospective study of 63 cases with exercise-induced lower leg pain. Acta Orthop. 2007;78(1):136–42.

    Article  PubMed  Google Scholar 

  32. Wilder RP, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 2004;23(1):55–81.

    Article  PubMed  Google Scholar 

  33. Ovarfordt P. Intramuscular pressure in vascular disease and compartment syndromes. Bulletin of the department of surgery. Lund: University of Lund; 1983.

    Google Scholar 

  34. Styf JR, Korner LM. Microcapillary infusion technique for measurement of intramuscular pressure during exercise. Clin Orthop Relat Res. 1986;207:253–62.

    PubMed  Google Scholar 

  35. Tzortziou V, Maffulli N, Padhiar N. Diagnosis and management of chronic exertional compartment syndrome (CECS) in the United Kingdom. Clin J Sport Med. 2006;16(3):209–13.

    Article  PubMed  Google Scholar 

  36. Waterman BR, Laughlin M, Kilcoyne K, Cameron KL, Owens BD. Surgical treatment of chronic exertional compartment syndrome of the leg. J Bone Joint Surg. 2013;95:592–6.

    Article  PubMed  Google Scholar 

  37. Pedowitz RA, Hargesn AR. Acute and chronic compartment syndromes. In: Garret WE, Speer KP, Kirendall DT, editors. Principles and practice of orthopaedic sports medicine. Philadelphia: Lippincott Williams & Wilkins; 2001. pp. 87–97.

    Google Scholar 

  38. Waterman BR, Liu J, Newcomb R, Schoenfeld AJ, Orr JD, Belmont PJ. Risk factors for chronic exertional compartment syndrome in a physical active military population. Am J Sports Med. 2013;41(11):2545–9.

    Article  PubMed  Google Scholar 

  39. Brennan FH, Kane SF. Diagnosis, treatment options, and rehabilitation of chronic lower leg exertional compartment syndrome. Curr Sports Med Rep. 2003;2(5):247–50.

    Article  PubMed  Google Scholar 

  40. Glorioso J. Exertional leg pain. In: O’Connor FG, Wilder RP, Nirschl R, editors. Textbook of running medicine. New York: McGraw-Hill; 2000. pp. 188–9.

    Google Scholar 

  41. Kirby RL, McDermott AG. Arch Phys Med Rehabil. Arch Phys Med Rehabil. 1983;54(7):296–9.

    Google Scholar 

  42. Tsintzas D, Ghosh S, Maffulli N, King JB, Padhiar N. The effect of ankle position on intracompartmental pressures of the leg. Acta Orthop. 43(1):42–8.

    Google Scholar 

  43. Diebal AR, Gregory R, Alitz C, Gerber JP. Effects of forefoot running on chronical exertional compartment syndrome: a case series. Int J Sports Phys Ther. 2011;6(4):312–21.

    PubMed Central  PubMed  Google Scholar 

  44. Fallat L, Grimm DJ, Saracco JA. Sprained ankle syndrome: prevalence and analysis of 639 acute injuries. J Foot Ankle Surg. 1998;37(4):280–5.

    Article  CAS  PubMed  Google Scholar 

  45. Ferran NA, Maffulli N. Epidemiology of sprains of the lateral ankle ligament complex. Foot Ankle Clin. 2006;11(3):659–62.

    Article  PubMed  Google Scholar 

  46. Waterman BR, Belmont PJ Jr, Cameron KL, et al. Epidemiology of ankle sprain at the United States military academy. Am J Sports Med. 2010;38(4):797–803.

    Article  PubMed  Google Scholar 

  47. Cordova ML, Sefton JM, Hubbard TJ. Mechanical joint laxity associated with chronic ankle instability: a systematic review. Sports Health. 2010;2(6):452–9.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Bridgman SA, Clement D, Downing A, et al. Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK ew. Sports Health. 2010;2(6):452–9.

    Article  Google Scholar 

  49. Soboroff SH, Pappius EM, Komaroff AL. Benefits, risks, and costs of alternative approaches to the evaluation and treatment of severe ankle sprain. Clin Orthop Relat Res. 1984. 183:160-8. practice for severe ankle sprains. Emerg Med J. 2003;20(6):508–10.

    Article  Google Scholar 

  50. Holmer P, Sondergaard L, Konradsen L, et al. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int. 1994;15(2):72–4.

    Article  CAS  PubMed  Google Scholar 

  51. Waterman BR, Owens BD, Davey S, et al. The epidemiology of ankle sprain in the United States. J Bone Joint Surg Am. 2010;92(13):2279–84.

    Article  PubMed  Google Scholar 

  52. Lillywhite LP. Analysis of extrinsic factor associated with 379 injuries occurring during 34,236 military parachute descents. JR Army Med Corps (London). 1991;137:115–21.

    Article  CAS  Google Scholar 

  53. Knapik JJ, Spiess A, Swedler DI, Grier TL, Darakjy SS, Jones BH. Systematic review of the parachute ankle brace: injury risk reduction and cost effectiveness. Am J Prev Med. 2010;38(1):182–8.

    Article  Google Scholar 

  54. Luippold RS, Sulsky SI, Amoroso PJ. Effectiveness of an external ankle brace in reducing parachuting-related ankle injuries. Inj Prev. 2011;17(1):58–61.

    Article  PubMed  Google Scholar 

  55. Williams JG. Aetiologic classification of sports injuries. Br J Sports Med. 1971;4:228–30.

    Article  Google Scholar 

  56. Beynnon BD, Murphy DF, Alosa DM. Predictive factors for lateral ankle sprains: a literature review. J Athl Train. 2002;37(4):376–80.

    PubMed Central  PubMed  Google Scholar 

  57. Cameron KL. Time for a paradigm shift in conceptualizing risk factors in sports injury research. J Ath Train. 2010;45(1):58–60.

    Article  Google Scholar 

  58. Gwinn DE, Wilckens JH, McDevitt ER, et al. The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy. Am J Sports Med. 2000;28(1):98–102.

    CAS  PubMed  Google Scholar 

  59. Beynnon BD, Renstrom PA, Alosa DM, et al. Ankle ligament injury risk factors: a prospective study of college athletes. J Orthop Res. 2001;19(2):213–20.

    Article  CAS  PubMed  Google Scholar 

  60. Hosea TM, Carey CC, Harrer MF. The gender issue: epidemiology of ankle injuries in athletes who participate in basketball. Clin Orthop. 2000;372:45–49.

    Article  PubMed  Google Scholar 

  61. Frank C, Amiel D, Woo SL, Akeson W. Normal ligament properties and ligament healing. Clin Orthop 1985;196:15–25.

    PubMed  Google Scholar 

  62. Ekstrand J, Gillquist J. Soccer injuries and their mechanisms: a prospective study. Med Sci Sports Exerc. 1983;15(3):267–70.

    Article  CAS  PubMed  Google Scholar 

  63. McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001;35(2):103–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  64. Milgrom C, Shlamkovitch N, Finestone A, et al. Risk factors for lateral ankle sprain: a prospective study among military recruits. Foot Ankle. 1991;12(1):26–30.

    Article  CAS  PubMed  Google Scholar 

  65. Malliaropoulos N, Ntessalen M, Papacostas E, et al. Reinjury after acute lateral ankle sprains in elite track and field athletes. Am J Sports Med. 2009;37(9):1755–61.

    Article  PubMed  Google Scholar 

  66. Tyler TF, McHugh MP, Mirabella MR, et al. Risk factors for noncontact ankle sprains in high school football players: the role of previous ankle sprains and body mass index. Am J Sports Med. 2006;34(3):471–5.

    Article  PubMed  Google Scholar 

  67. Sitler MR, Ryan J, Wheeler B, McBride J. The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball: a randomized clinical study at West Point. Am J Sports Med. 1994;22(4):454–61.

    Article  CAS  PubMed  Google Scholar 

  68. Freeman MA, Dean MR, Hanham IW. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br. 1965;47(4):678–85.

    CAS  PubMed  Google Scholar 

  69. Leanderson J, Eriksson E, Nilsson C, Wykman A. Proprioception in classical ballet dancers. A prospective study of the influence of an ankle sprain on proprioception in the ankle joint. Am J Sports Med. 1996;24(3):370–4.

    Article  CAS  PubMed  Google Scholar 

  70. Leanderson J, Wykman A, Eriksson E. Ankle sprain and postural sway in basketball players. Knee Surg Sports Traumatol Arthrosc. 1993;1(3–4):203–5.

    Article  CAS  PubMed  Google Scholar 

  71. Perrin PP, Bene MC, Perrin CA, Durupt D. Ankle trauma significantly impairs posture control. a study in basketball players and controls. Int J Sports Med. 1997;18(5):387–92.

    Article  CAS  PubMed  Google Scholar 

  72. McGuine TA, Greene JJ, Best T, Leverson G. Balance as a predictor of ankle injuries in high school basketball players. Clin Sports Med. 2000;10(4):239–44.

    Article  CAS  Google Scholar 

  73. Trojian TH, McKeag DB. Single leg balance test to identify risk of ankle sprains. Br J Sports Med. 2006;40(7):610–3.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  74. Stecco C, Macchi V, Porzionato A, et al. The ankle retinacula: morphological evidence of the proprioceptive role of the fascial system. Cells Tissues Organs. 2010;192(3):200–10.

    Article  PubMed  Google Scholar 

  75. Riemann BL. Is there a link between chronic ankle instability and postural instability? J Athl Train. 2002;37(4):386–93.

    PubMed Central  PubMed  Google Scholar 

  76. McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part II. Is balance training clinically effective? J Athl Train. 2008;43(3):305–15.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Mohammadi F, Roozdar A. Effects of fatigue due to contraction of evertor muscles on the ankle joint position sense in male soccer players. Am J Sports Med. 2010;38(4):824–8.

    Article  PubMed  Google Scholar 

  78. Fong DT, Hong Y, Chan LK, et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73–94.

    Article  PubMed  Google Scholar 

  79. Arnason A, Gudmundsson A, Dahl HA, et al. Soccer injuries in Iceland. Scand J Med Sci Sports. 1996;6(1):40–5.

    Article  CAS  PubMed  Google Scholar 

  80. Chomiak J, Junge A, Peterson L, Dvorak J. Severe injuries in football players: influencing factors. Am J Sports Med. 2000;28(5 Suppl):S58–68.

    Article  CAS  PubMed  Google Scholar 

  81. Kujala UM, Taimela S, Antti-Poika I, et al. Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data. BMJ. 1995;311(7018):1465–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  82. Sullivan JA, Gross RH, Grana WA, et al. Evaluation of injuries in youth soccer. Am J Sports Med. 1980;8(5):325–7.

    Article  CAS  PubMed  Google Scholar 

  83. Chomiak J, Junge A, Peterson L, Dvorak J. Severe injuries in football players: influencing factors. Am J Sports Med. 2000;28(5 Suppl):S58–68.

    Article  CAS  PubMed  Google Scholar 

  84. Peterson L, Junge A, Chomiak J, et al. Incidence of football injuries and complaints in different age groups and skill-level groups. Am J Sports Med. 2000;28(5 Suppl):S51–7.

    Article  CAS  PubMed  Google Scholar 

  85. Arnason A, Gudmundsson A, Dahl HA, et al. Soccer injuries in Iceland. Scand J Med Sci Sports. 1996;6(1):40–5.

    Article  CAS  PubMed  Google Scholar 

  86. Dvorak J, Junge A, Chomiak J, et al. Risk factor analysis for injuries in football players: possibilities for a prevention program. Am J Sports Med. 2000;28(5 Suppl):S69–74.

    Article  CAS  PubMed  Google Scholar 

  87. Ekstrand J, Gillquist J, Moller M, et al. Incidence of soccer injuries and their relation to training and team success. Am J Sports Med. 1983;11(2):63–7.

    Article  CAS  PubMed  Google Scholar 

  88. Olsen OE, Myklebust G, Engebretsen L, et al. Exercises to prevent lower limb injuries in youth sports: clustered randomized controlled trial. BMJ. 2005;330(7489):449.

    Article  PubMed Central  PubMed  Google Scholar 

  89. Frey C, Feder KS, Sleight J. Prophylactic ankle brace use in high school volleyball players. A prospective study. Foot Ankle Int. 2010;31(4):296–300.

    Article  PubMed  Google Scholar 

  90. Saxena A, Eakin C. Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sports Med. 2007;35(10):1680–7.

    Article  PubMed  Google Scholar 

  91. Leontaritis N, Hinojosa L, Panchbhavi VK. Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg. 2009;91(2):333–9.

    Article  PubMed  Google Scholar 

  92. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 2004;86(6):1336.

    PubMed  Google Scholar 

  93. Stone JW. Osteochondral lesions of the talar dome. J Am Acad Orthop Surg. 1996;4(2):63–72.

    PubMed  Google Scholar 

  94. Orr JD, Dawson LK, Garcia EJ, Kirk KL. Incidence of osteochondral lesions of the talus in the United States military. Foot Ankle Int. 2011;32(10):948–54.

    Article  PubMed  Google Scholar 

  95. O’Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med. 2010;38(2):392–404.

    Article  PubMed  Google Scholar 

  96. DiGiovanni BF, Fraga CJ, Cohen BE, Shereff MJ. Associated injuries found in chronic lateral ankle instability. Foot Ankle Int. 2000;21(10):809–15.

    CAS  PubMed  Google Scholar 

  97. Komenda GA, Ferkel RD. Arthroscopic findings associated with the unstable ankle. Foot Ankle Int. 1999;20(11):708–13.

    Article  CAS  PubMed  Google Scholar 

  98. Schafer D, Hintermann B. Arthroscopic assessment of the chronic unstable ankle joint. Knee Surg Sports Traumatol Arthrosc. 1996;4(1):48–52.

    Article  CAS  PubMed  Google Scholar 

  99. Taga I, Shino K, Inoue M, Nakata K, Maeda A. Articular cartilage lesions in ankles with lateral ligament injury: an arthroscopic study. Am J Sports Med. 1993;21:120–7.

    Article  CAS  PubMed  Google Scholar 

  100. Chew KT, Tay E, Wong YS. Osteochondral lesions of the talus. Ann Acad Med Singapore. 2008;37(1):63–8.

    PubMed  Google Scholar 

  101. Bosien WR, Staples OS, Russell SW. Residual disability following acute ankle sprains. J Bone Joint Surg. 1955;1(37):1237–43.

    Google Scholar 

  102. Shearer C, Loomer R, Clement D. Nonoperatively managed stage 5 osteochondral talar lesions. Foot Ankle Int. 2002;23(7):651–4.

    Article  PubMed  Google Scholar 

  103. Tol JL, Strujis PA, Bossuyt PM, Verhagen RA, van Dijk CN. Treatment strategies in osteochondral defects of the talar dome a systematic review. Foot Ankle Int. 2000;21(2):119026.

    Google Scholar 

  104. Philbin TM, Landis GS, Smith B. Peroneal tendon injuries. J Am Acad Orhrop Surg. 2009;17(5):306–17.

    Google Scholar 

  105. Geller J, Lin S, Cordas D, Vieira P. Relationship of a low-lying muscle belly t otears of the peroneus brevis tendon. Am J Orthop. 2003;32(11):541–4.

    PubMed  Google Scholar 

  106. Sobel M, Hashimoto J, Arnoczky SP, Bohne WH. The microvasculature of the seasmoid complex: its clinical significance. Foot Ankle. 1992;13(6):359–63.

    Article  CAS  PubMed  Google Scholar 

  107. Hyer CF, Dawson JM, Philbin TM, Berlet GC, Lee TH. The peroneal tubercle: description, classification, and relevance. Foot Ankle Int. 2005;26(11):947–50.

    PubMed  Google Scholar 

  108. Manoli A, Graham B. The subtle cavus foot, “the underpronator.” Foot Ankle Int. 2005;26(3):256–63.

    PubMed  Google Scholar 

  109. Injuries T. Basic science and clinical medicine. Edited by Maffulli N, Renstrom P, Vayne B. Leadbetter.

    Google Scholar 

  110. Hess GW. Achilles tendon rupture: a review of etiology, population, anatomy, risk factors, and injury prevention. Foot Ankle Spec. 2010;3(1):29–32.

    Article  PubMed  Google Scholar 

  111. Jarvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005;10(2):255–66.

    Article  PubMed  Google Scholar 

  112. Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of achilles tendon ruptures. Am J Sports Med. 2002;30(4):565–75.

    PubMed  Google Scholar 

  113. Raikin SM, Garras DN, Krapchev PV. Achilles tendon injures in a United States population. Foot Ankle Int. 2013;34(4):475–80.

    Article  PubMed  Google Scholar 

  114. Davis JM, Mason KT, Clark DA. Achilles tendon ruptures stratified by age, race, and cause of injury among active duty US military members. Mil Med. 1999;164(12):872–3.

    CAS  PubMed  Google Scholar 

  115. Maffulli N, Tallon C, Wong J, Peng Lim K, Bleakney R. No adverse effect on early weight bearing following open repair of acute tears of the Achilles tendon. J Sports Med Phy Fit. 2003;43(3):367–79.

    CAS  Google Scholar 

  116. Clark SC, Jones MW, Choudhury RR, Smith E. Bilateral patellar tendon rupture secondary to repeated local steroid injections. J Accid Emerg Med. 1995;12(4):300–1.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  117. Newnham DM, Douglas JG, Legge JS, Friend JA. Achilles tendon rupture: an underrated complication of corticosteroid treatment. Thorax. 1991;46(11):853–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  118. Stinner DJ, Orr JD, Hsu JR. Fluoroquinolone-associated bilateral patellar tendon rupture: a case report and review of the literature. Mil Med. 2010;175(6):457–9.

    Article  PubMed  Google Scholar 

  119. Wise BL, Peloquin C, Choi H, Lane NE, Zhang Y. Impact of age, sex, obesity, and steroid use on quinolone-associated tendon disorders. Am J Med. 2012;125(12):1228–38.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  120. Owens B, Mountcastle S, White D. Racial differences in tendon rupture incidence. Int J Sports Med. 2007;28(7):617–20.

    Article  CAS  PubMed  Google Scholar 

  121. Kvist M. Achilles tendon injuries in athletes. Sports Med. 1994;18:173–201.

    Article  CAS  PubMed  Google Scholar 

  122. Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001;9(1):42–7.

    Article  CAS  PubMed  Google Scholar 

  123. Silbernagel KG, Thomee R, Thomee P, Karlsson J. Eccentric overload training for patients with chronic Achilles tendon pain—a randomized controlled study with reliability testing of the evaluation methods. Scan J Med Sports Sci. 2001;11(4):197–206.

    Article  CAS  Google Scholar 

  124. Jonsson P, Alfredson H, Sunding K, Fahlstrom M, Cook J. New regimen for eccentric calf-muscle training in patients with chronic insertional achilles tendinopathy: results of a pilot study. Br J Sports Med. 2008;42(9):746–9.

    Article  CAS  PubMed  Google Scholar 

  125. Singh D, Angel J, Bentley G, Trevino SG. Fortnightly review. Plantar fasciitis. BMJ. 1997;315(7101):172–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  126. Gill LH. Plantar fasciitis: diagnosis and conservative management. J Am Orthop Surg. 1997;5(2):109–17.

    Google Scholar 

  127. Crawford F, Atkins D, Edwards J. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2000;3:CD000416.

    PubMed  Google Scholar 

  128. Schepsis AA, Leach RE, Gorzyca J. Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature. Clin Orthop Relat Res. 1991;266:185–96.

    PubMed  Google Scholar 

  129. Hill JJ, Cutting PJ. Heel pain and body weight. Foot Ankle. 1989;9(5):254–6.

    Article  PubMed  Google Scholar 

  130. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone and Joint Surg. 2003;85(5):872–7.

    Google Scholar 

  131. Rano JA, Fallat LM, Savoy-Moore RT. Correlation of heel pain with body mass index and other characteristics of heel pain. J Foot Ankle Surg. 2001;40(6):351–6.

    Article  CAS  PubMed  Google Scholar 

  132. Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006;9(1–2):11–22.

    Article  CAS  PubMed  Google Scholar 

  133. Butterworth PA, Landorf KB, Smith SE, Menz HB. The association between body mass index and musculoskeletal foot disorders: a systematic review. Obesity Rev. 2012;13(7):630–42.

    Article  CAS  Google Scholar 

  134. Rome K, Webb P, Unsworth A, Haslock I. Heel pad stiffness in runners with plantar heel pain. Clin Biomech. 2001;16(10):901–5.

    Article  CAS  Google Scholar 

  135. Scher DL, Belmont PJ, Bear R, Mountcastle SB, Orr JD, Owens BD. The incidence of plantar fasciitis in the United States military. J Bone Joint Surg. 2009;91(12):2867–72.

    Article  PubMed  Google Scholar 

  136. Matheson GO, Macintyre JG, Taunton JE, Clement DB, Lloyd-Smith R. Musculoskeletal injuries associated with physical activity in older adults. Med Sci Sports Exerc. 1989;21(4):379–85.

    Article  CAS  PubMed  Google Scholar 

  137. Prichasuk S. The heel pad in plantar heel pain. J Bone Joint Surg. 1994;76(1):140–2.

    CAS  Google Scholar 

  138. Wearing SC, Smeathers JE, Yates B, Sullivan PM, Urry SR, Dubois P. Sagittal movement of the medial longitudinal arch is unchanged in plantar fasciitis. Med Sci Sports Exerc. 2004; 36(10):1761–7.

    Article  PubMed  Google Scholar 

  139. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. BJSM. 2002;36(2):95–101.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  140. Lapidus PW, Guidotti FP. Painful heel: report of 323 patients with 364 painful heels. Clin Orthop Relat Res. 1965;39:176–86.

    Google Scholar 

  141. Sobel M, Pavlov H, Geppert MJ, Thompson FM, DiCarlo EF, Davis WH. Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot Ankle Int. 1994;15(3):112–24.

    Article  CAS  PubMed  Google Scholar 

  142. Patel A, Digiovanni B. Association between plantar fasciitis and isolated contracture of the gastrocnemius. Foot Ankle Int. 2011;32(1):5–8.

    Article  PubMed  Google Scholar 

  143. Garrett TR, Neibert PJ. The effectiveness of a gastrocnemius-soleus stretching program as a therapeutic treatment of plantar fasciitis. J Sport Rehab. 2013;22(4):308–12.

    Google Scholar 

  144. DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, Baumhauer JF. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003;85:1270–7.

    PubMed  Google Scholar 

  145. DiGiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, Baumhauer JF. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2006;88(8):1775–81.

    Article  PubMed  Google Scholar 

  146. Pfeffer G, Bacchetti P, Deland J, et al. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int. 1999;20(4):214–21.

    Article  CAS  PubMed  Google Scholar 

  147. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow up. Foot Ankle Int. 1994;15(3):97–102.

    Article  CAS  PubMed  Google Scholar 

  148. Gross MT, Byers JM, Krafft JL, Lackey EJ, Melton KM. The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis. J Orthop Sports Phys Ther. 2002;32(4):149–57.

    Article  PubMed  Google Scholar 

  149. Seligman DA, Dawson DR. Customized heel pads and soft orthotics to treat heel pain and plantar fasciitis. Arch Phys Med Rehab. 2003;84(10):15564–7.

    Article  Google Scholar 

  150. Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Int Med. 2006;26(166):1305–10.

    Article  Google Scholar 

  151. Tong KBJW, Ng EY. Preliminary investigation on the reduction of plantar loading pressure with different insole materials. Foot. 2010;20(1):1–6.

    Article  Google Scholar 

  152. Vuori JP, Aro HT. Lisfranc joint injuries: trauma mechanisms and associated injuries. J Trauma. 1993;35(1):40–5.

    Article  CAS  PubMed  Google Scholar 

  153. Kalia V, Fishman EK, Carrino JA, Fayad LM. Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. Skeletal Radiol. 2012;41(2):129–36.

    Article  PubMed  Google Scholar 

  154. Mantas JP, Burks RT. Lisfranc injuries in the athlete. Clin Sports Med. 1994;13(4):719–30.

    CAS  PubMed  Google Scholar 

  155. Thompson MC, Mormino MA. Injury to the tarsometatarsal joint complex. J Am Acad Orthop Sur. 11:260–7.

    Google Scholar 

  156. DeOrio M, Erickson M, Usuelli FG, Easly M. Lisfranc injuries in sport. Foot Ankle Clin. 2009;14:169–86.

    Article  PubMed  Google Scholar 

  157. Meyer SA Callaghan JJ, Albright JP, Crowley ET, Powell JW. Midfoot sprains in collegiate football players. Am J Sports Med. 1994;22:392–401.

    Article  PubMed  Google Scholar 

  158. Curtis MJ, Myerson M, Szura B. Tarsometatarsal joint injuries in the athlete. Am J Sports Med. 1993;21:497–502.

    Article  CAS  PubMed  Google Scholar 

  159. Rhim B, Hung JC. Lisfranc injury and Jones fracture in sports. Clin Podiatr Med Surg. 2011;28(1):69–86.

    Article  PubMed  Google Scholar 

  160. Ekstrand J, Van Dijk CN. Fifth metatarsal fractures among male professional footballers: a potential career-ending disease. BJSM. 2013;47(12):754–8.

    Article  PubMed  Google Scholar 

  161. Raikin SM, Slenker N, Ratigan B. The association of a varus hindfoot and fracture of the fifth metatarsal metaphyseal-diaphyseal junction: the Jones fracture. Am J Sports Med. 2008;36(7):1367–72.

    Article  PubMed  Google Scholar 

  162. Weinfeld SB, Haddad SL, Myerson MS. Metatarsal stress fractures. Clin Sports Med. 1997;12(2):319–38.

    Article  Google Scholar 

  163. Bernstein A, Stone JR. March fracture: a report of three hundred and seven cases and a new method of treatment. J Bone Joint Surg. 1944;26(4):743–50.

    Google Scholar 

  164. Fetzer GB, Wright RW. Metatarsal shaft fractures and fractures of the proximal fifth metatarsal. Clin Sports Med. 2006;25(1):139–50.

    Article  PubMed  Google Scholar 

  165. Greaney RB, Gerber FH, Laughlin RL, Kmet JP, Metz CD, Kilcheski TS, Rao BR, Silverman ED. Distribution and natural history of stress fractures in US Marine recruits. Radiology. 1983;146(2):339–46.

    Article  CAS  PubMed  Google Scholar 

  166. Boden BP, Osbahr DC, Jimenez C. Low-risk stress fractures. Am J Sports Med. 2001;29:100–11.

    CAS  PubMed  Google Scholar 

  167. Sullivan D, Warren RF, Pavlov H, Kelman G. Stress fractures in 51 runners. Clin Orthop Relat Res. 1984;187:188–92.

    PubMed  Google Scholar 

  168. Gross TS, Bunch RP. A mechanical model of metatarsal stress fracture during distance running. Am J Sports Med. 1989;17:669–74.

    Article  CAS  PubMed  Google Scholar 

  169. Milgrom C, Finestone A, Sharkey N, Hamel A, Mandes V, Burr D, Arndt A, Ekenman I. Metatarsal strais are sufficient to cause fatigue fracture during cyclic overloading. Foot Ankle Int. 2002;23(3):230–5.

    CAS  PubMed  Google Scholar 

  170. Milgrom C, Simkin A, Eldad A, Nyska M, Finestone A. Using bone’s adaptation ability to lower the incidence of stress fractures. Am J Sports Med. 2000;28:245–51.

    CAS  PubMed  Google Scholar 

  171. Drez D, Young JC, Johnston RD, Parker WD. Metatarsal stress fractures. Am J Sports Med. 1980;8:123–5.

    Article  PubMed  Google Scholar 

  172. Kadel NJ, Teitz CC, Kronmal RA. Stress fractures in ballet dancers. Am J Sports Med. 1992;20:445–49.

    Article  CAS  PubMed  Google Scholar 

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Waterman, B., Dunn, J., Orr, J. (2016). Lower Leg, Ankle, and Foot Injuries. In: Cameron, K., Owens, B. (eds) Musculoskeletal Injuries in the Military. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2984-9_11

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