Dr Waryasz is triple fellowship-trained orthopedic surgeon who specializes in injuries and conditions of the foot and ankle. Dr. Waryasz’s goal is to improve the quality of life of his patients by integrating his unique background in sports medicine, strength and conditioning and foot/ankle training. He enjoys seeing patients of all ages, with a variety of activity levels.
Summary:
Injuries to the foot and ankle in youth soccer are common and responsible for lost time to training and match play. Dr. Waryasz from Mass General Brigham explains the major categories of traumatic and overuse style injuries and what to expect from each.
Common Traumatic Injuries
Ankle Sprain
Ankle sprains are the most common injury and luckily most are treated with conservative care. Rest, Ice, Elevation and Compression (RICE) are important early parts of treatment. Early physical therapy can improve outcomes and get players back on the pitch quicker. Imaging studies like x-rays are helpful when the athlete is having trouble with bearing weight or with any symptoms that persist. Only a small percentage of patients will not improve and may require further work up and potentially surgery for a cartilage injury, tendon tear, or chronic instability of the joint. These injuries are more common in teenagers closer to full growth maturity.
Growth Plate Fracture/ Injuries (Younger Patients)
A growth plate injury refers to a specific type of injury/fracture involving the portion of the bone responsible for growth. These injuries can vary from a nondisplaced issue to a potential surgical issue. These injuries occur in athletes that are still growing (i.e., elementary, middle school and early high school typically). It is important to seek medical attention to ensure alignment is acceptable to prevent any changes to normal growth. These injuries can be treated in a boot or cast depending on the issue.
Traumatic Fractures/Dislocations
Fractures can occur from a variety of methods while playing soccer. Common areas include ankle and toes from trauma. Any deformity needs to seek care. Midfoot sprains and dislocations (known as Lisfranc) injuries can occur from a twisting injury to the foot. Some of these injuries may need surgery so it is worth getting an evaluation if there is any concern.
Atraumatic Injuries
Achilles Tendonitis/Sever’s Disease
Back of the heel pain along the tendon or bone can be a debilitating condition for a young athlete. Achilles tendonitis tends to occur if teenagers while Sever’s disease or irritation of the achilles/calcaneal growth plate peaks around ages 8-12. Treatment for achilles tendonitis starts with rest, NSAIDs, and physical therapy. Treatment for Sever’s Disease is similar with the condition, typically resolving within 1.5 to 3 months.
Stress Fractures
Overuse, poor nutrition intake and poor footwear can lead to stress fractures. Sudden increases in training intensity/volume or inadequate rest can be the culprit. These can be common in the female athlete with some studies showing up to a 3x increase in risk compared to males. Stress fractures of the tibia(shin), navicular, 5th metatarsal and sesamoids are some of the more common injuries seen in soccer players and often require surgery. These typically present with a dull ache and tenderness over the area. X-rays are often not revealing for fractures and some patients will need advanced imaging.
Return to Play
Rest is an important part of recovery when an athlete is dealing with an injury, with a return to play guided by a clear reduction in pain and symptoms. In many cases, working with a physical therapist can help ensure a safe and appropriate progression back to agility and conditioning. Returning too quickly or at too high an intensity can increase the risk of a new injury, which is why missing an extra game or practice now may help prevent weeks or even months of missed time later due to a more serious or chronic issue. Keeping an eye on the long-term health of the athlete is key. I also recommend cross-training during the season and incorporating a variety of training methods to build a well-rounded fitness foundation that supports both performance and injury prevention.
