Kategoriarkiv: Adults injuries

Inguinal hernia

21. juni 2011Groinurtehave_com

INGUINAL HERNIA

Diagnosis:

Anatomy: The various muscles of the abdominal wall are penetrated by the inguinal canal, which contains nerves (N ilioinguinalis and the genital branch of N genitofemoralis) and in men the spermatic cord (funilicus spermaticus). In women the inguinal canal instead contains a small fibrous ligament. Where the inguinal canal penetrates the abdominal wall weak spots arise (anulus inguinalis superficialis and anulus inguinalis profundus).

M. recti abdominis
Funiculus spermaticus
Ligamentum inguinale
Spina iliaca anterior superior
M. obliquus externus abdominis

INGUINAL CANAL

Anulus inguinalis superficialis
Crus mediale
Funiculus spermaticus et m. cremaster
V. femoralis
Hiatus saphenus
Lig. lacunare
Anulus femoralis
Margo falciformis (cornu superius)
Lig inguinale
Fibrae intercrurales
M. obliquus externus abdominis

RIGHT INGUINAL CANAL

Cause: If the abdominal wall becomes too weak, the intestines can be pressed through the weak spots in the abdominal wall causing a hernia.

Symptoms: Pain in the groin, aggravated when coughing. Sometimes a swelling in the groin is visible. Usually the swelling (containing intestine) can be pushed into place. If the swelling is painful and cannot be pressed into place the hernia may be strangulated (which requires acute medical assistance).

Examination: In obvious cases with visible swelling in the groin the diagnosis is easy to make. With lack of swelling in the groin the diagnosis is naturally difficult. (article 1) A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis a MRI-scan or a dynamic ultrasound scan, where weaknesses in the abdominal wall can be detected while increasing the pressure in the abdominal cavity by applying pressure can be performed (article 2) (article 3).

Treatment: With modest discomfort, you can primarily attempt training of the abdominal muscles (article). If discomfort continues, surgery is advised. If strangulated hernia is suspected you should seek acute medical assistance to evaluate the indication for acute surgery, as there is a risk of lasting damage to the intestine. With uncomplicated surgery, a relief period of approx. two months should be expected before maximal sports activity can be resumed (very dependent on the sport in question).

Rehabilitation: INSTRUCTION

GENERAL STEP1 STEP2 STEP3 STEP4

Complications: If progress is not smooth (even after operation) it should be considered whether the diagnosis is correct or whether complication have arisen. In particular the following should be considered:

Inflammation of the heel fat pad

21. juni 2011Foot, heelurtehave_com

INFLAMMATION OF THE HEEL FAT PAD

Diagnosis:

Anatomy: Under the heel bone (calcaneus) there is a shock absorbing fatty pad (corpus adiposum) which protects the heel bone and the hollow foot tendon (aponeurosis plantaris) which fastens on the heel bone under the heel.

Corpus adiposum
M. flexor digitorum brevis
M. flexor hallucis longus
Aponeurosis plantaris

HEEL PAD, SOLE OF THE FOOT

Cause: Inflammation of the heel pad occurs often after repeated, vigorous, overload (for example landing after jumping). The injury is often seen in gymnasts.

Symptoms: Pain when walking as well as when applying pressure on the edges of the heel pad. In some cases, it will be possible to see haemorrhaging in the heel pad (article).

Acute treatment: Click here.

Examination: Medical examination is not always necessary in light cases with minimal tenderness and no pain when walking. If satisfactory progress is not made, or if there is a sense of a “snap”, or sudden shooting pains, medical attention should be sought as soon as possible to make the diagnosis. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed.

Treatment: Rest from the painful activity (running). The injury can in some cases heal within a few weeks if treatment is commenced at an early stage. It is imperative that footwear is in order, with a suitably tight heel cap to hold the heel pad in place under the heel, and with shock absorbing soles.

Rehabilitation: Treatment is primarily rest. The principles under rehabilitation, general can be followed until the pain has gone, after which running and jumping can be cautiously resumed.

Bandage: Taping to relieve problems with inflammation of the heel pad is of questionable significance, but can be attempted as the tape will not invoke further injury if applied in the correct manner (tape-instruction).

Complications: If there is not a steady improvement in the condition, x-ray or an ultrasound scan should be performed to exclude:

Shock absorbing shoes or inlays will reduce the risk of inflammation of the heel pad.

Rupture of the hollow foot tendon

21. juni 2011Foot, heelurtehave_com

Diagnosis:

(Ruptura aponeurosis plantaris)

Anatomy: The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. The calf muscles are attached to the rear of the heel bone (calcaneus) via the Achilles tendon. The hollow foot tendon (aponeurosis plantaris) runs from the heel bone under the sole, and is attached to all five toes. The hollow foot tendon is instrumental in maintaining the arch running the length of the foot (Photo).

Aponeurosis plantaris
Tuber calcanei

SOLE OF THE FOOT

Cause: Rupture of the hollow foot tendon occurs after sudden, forceful overload (for example landing after jumping). In a number of cases, a rupture of the hollow foot tendon is preceded by inflammation of the tendon (fasciitis plantaris). Since the hollow foot tendon is a functional extension of the Achilles tendon, the provoking factors which are instrumental in injuries due to overload of the hollow foot tendon and the Achilles tendon are often the same.

Symptoms: In light cases, a localised tenderness can be felt at the point of attachment of the hollow foot tendon under the heel bone, or under the arch of the foot after strain or load (“sprain”, “threatening muscle pull”). In more severe cases, sudden shooting pains can be felt in the tendon (“partial rupture”, “pulled muscle”) and at the worst a sensation of feeling and hearing a “crack” after which it is impossible to run and pain is felt whilst walking (“total tendon rupture”), where it is often possible to feel a defect in the hollow foot tendon. Total ruptures are very rare.

Acute treatment: Click here.

Examination: In all cases when there is a sense of a “crack”, or sudden shooting pains in the tendon, medical attention should be sought as soon as possible to make the diagnosis. Ultrasound scanning (or MRI examination) is used to advantage for making a swift and correct diagnosis, as injuries requiring treatment will often be overlooked under normal clinical examination (article).

Treatment: The chosen treatment will usually be relief until the pain disappears (article), and surgical intervention if the rehabilitation does not proceed satisfactorily (article). If a tender lump of cicatricial tissue develops after several months of rehabilitation (inflamed granuloma), treatment can be supplemented in medicinal form by rheumatic medicine (NSAID) or injection of corticosteroid in the area surrounding the inflamed lump of cicatricial tissue. Ultrasound guided injection increases the effect of the injection, as well as reduces the risks involved (article). As the injection of corticosteroid is always an element in the long term rehabilitation of a very serious, chronic injury, it is vital that the rehabilitation period lasts over several months in order to reduce the risk of a relapse or (further) rupture. The tendon is naturally unable to accommodate maximum strain or load after a prolonged injury period after only a short rehabilitation period. If the diagnosis is made by use of ultrasound scanning, the injections are performed under guidance of ultrasound, and the rehabilitation is progressed in accordance with the guidelines mentioned, then the treatment involving corticosteroid injections has very few risks connected (article-1) (article-2). It is not unusual for a rehabilitation period of six months before maximum strain or load in the form of jumping is permitted. It is vital for safety that injections are performed under guidance of ultrasound when treating chronic hollow foot tendon injuries.

Rehabilitation: INSTRUCTION

GENERAL STEP1 STEP2 STEP3 STEP4

Bandage: Taping to relieve problems with the hollow foot tendon is of questionable significance, but can be attempted as the tape will not invoke further injury if applied in the correct manner (tape-instruction).

Prevention: As inflammation of the hollow foot tendon is extremely difficult to treat, it is important to prevent the injury from arising or recurring. The principles in rehabilitation, general should be followed to ensure that quickly increasing training loads at the season start, or after an injury period, are avoided. It is important that running shoes fit well (tight heel cap, shock absorbing soles). It is vital that the first signs of tenderness or pain are reacted upon, to enable the training to be adapted before the injury reaches the stage where continuing the sports activity may be at risk.

Complications: If there is not a steady improvement in the condition an ultrasound scan should be performed to exclude:

In the severe, chronic cases, all treatment and rehabilitation attempts will often result in permanent inability to continue the sports activity.

Special: As there is a risk that the injury can cause permanent disability, all cases should be reported to your insurance company.

Inflammation of the hollow tendon

21. juni 2011Foot, heelurtehave_com

INFLAMMATION OF THE HOLLOW FOOT TENDON

Diagnosis:

(Fasciitis plantaris)

Anatomy: The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. The calf muscles are attached to the rear of the heel bone (calcaneus) via the Achilles tendon. The hollow foot tendon (aponeurosis plantaris) runs from the heel bone under the sole, and is attached to all five toes. The hollow foot tendon is a functional extension of the Achilles tendon, and is instrumental in maintaining the arch running the length of the foot (Photo).

Aponeurosis plantaris
Tuber calcanei

SOLE OF THE FOOT

Cause: Occurs after repeated overload in the form of running or jumping. Since the hollow foot tendon is a functional extension of the Achilles tendon, the provoking factors which are instrumental in injuries due to overload of the hollow foot tendon and the Achilles tendon are often the same.

Symptoms: Pain when running and jumping, as well as when applying pressure at the attachment point of the hollow foot tendon directly under the heel bone. The pain is often most pronounced slightly on the inner side of the attachment.

Acute treatment: Click here.

Examination: Medical examination is not necessarily required in slight, early cases where the tenderness is slowly increasing without sudden worsening. A normal medical examination is usually sufficient in order to make the diagnosis, and in all cases when there is a sense of a “crack”, or sudden shooting pains in the tendon, medical attention should be sought as soon as possible to exclude a (partial) rupture of the hollow foot tendon and bone fracture. This situation is best determined by use of ultrasound scanning (or MRI examination), as a number of injuries requiring treatment can easily be overlooked during a clinical examination. In cases where satisfactory progress is not in evidence, an ultrasound examination should be performed as early as possible. Ultrasound scanning enables an evaluation of the extent of the change in the tendon; inflammation of the tendon (tendinitis), development of cicatricial tissue (tendinosis), calcification, inflammation of the tissue surrounding the tendon (peritendinitis), inflammation of the bursa (bursitis), as well as (partial) rupture (article) (Ultrasonic image).

Treatment: Rest from the painful activity (running). The injury can in some cases heal within a few weeks if treatment is commenced at an early stage (article). If the pain has been present for several months, and especially if ultrasound scanning reveals thickening and change in the tendon, a rehabilitation period of several months must be anticipated. Special emphasis is laid upon strengthening exercise where the calf muscle is activated simultaneously with being stretched (eccentric training). It is imperative that the footwear is in order, with good running shoes including shock absorbing heels. Pressure on the hollow foot tendon can be relieved by walking in shoes with an arch support. Treatment with ice can be repeated every time the hollow foot tendon becomes tender during the rehabilitation phase. If satisfactory progress is not made in the training, medical treatment can be considered in the form of rheumatic medicine (NSAID) or injection of corticosteroid in the area around the thickened part of the tendon. Ultrasound guided injection increases the effect of the injection, as well as reduces the risks involved. Research has shown that ultrasound guided injections of corticosteroid are extremely effective in reducing the extent of the thickened tendons, to enable more active rehabilitation to commence (article). As the injection of corticosteroid is always an element in the long term rehabilitation of a very serious, chronic injury, it is vital that the rehabilitation period lasts over several months in order to reduce the risk of a relapse or rupture. It is not unusual for a rehabilitation period of six months before maximum strain or load in the form of jumping is permitted. The tendon is naturally unable to accommodate maximum strain or load after a prolonged injury period after only a short rehabilitation period. If the diagnosis is made by use of ultrasound scanning, the injections are performed under guidance of ultrasound, and the rehabilitation is progressed in accordance with the guidelines mentioned, then the treatment involving corticosteroid injections has very few risks connected (article). During recent years, different types of experimental treatment have been seen such as shock-wave (ultrasound treatment). However, there is no sure or clear documentation for the effect of the treatment. If the rehabilitation and conservative treatment does not yield progress, surgical intervention can be attempted. The long term results of operations are often disappointing (article-1), (article-2), (article-3).

Rehabilitation: INSTRUCTION

GENERAL STEP1 STEP2 STEP3 STEP4

Heel spur: Inflammation of the hollow foot tendon is occasionally connected to a heel spur. A heel spur is a new bone development which is seen in connection with a prolonged inflammation at the point of attachment of the hollow foot tendon on the heel bone due to overload. A heel spur is thus a consequence of an injury due to overload, and not the cause. If a heel spur has developed, it will never disappear. Heel spurs have no practical significance, and require no treatment. Many symptom free athletes have heel spurs without having had symptoms from the point of attachment of the hollow foot tendon. Surgical removal of heel spurs as performed in earlier days is now virtually no longer used

Complications: If there is not a steady improvement in the condition an ultrasound scan should be performed to exclude:

Few sports injuries carry as large a risk of chronic, permanent sporting disability as inflammation of the hollow foot tendon. In the severe, chronic cases, all treatment and rehabilitation attempts will often result in permanent inability to continue the sports activity.

Special: As prolonged overload or strain on the hollow foot tendon has a large risk of developing in to chronic inflammation, which is extremely difficult to treat, it is important to prevent the injury from arising or recurring. The principles in “Rehabilitation, general” should be followed to ensure that quickly increasing training loads at the season start, or after an injury period, are avoided. It is important that running shoes fit well (tight heel cap, shock absorbing soles ). It is vital that the first signs of tenderness or pain are reacted upon, to enable the training to be adapted before the injury reaches the stage where continuing the sports activity may be at risk.

Degenerative arthritis

21. juni 2011Foot, fronturtehave_com

SLIDGIGT

Diagnosis:

(Osteoarthritis)

Anatomy: The surfaces of the joints are lined with a cartilage covering of a few millimetre’s thickness which serves to reduce the load or strain on the joint surfaces.

Phalanx media
Tuberositas ossis metatarsalis V
Os cuboideum
Calcaneus
Talus
Os naviculare
Os cuneiforme laterale
Os cuneiforme intermedium
Os cuneiforme mediale
Os metatarsalei
Os sesamoideum
Phalanx proximalis
Phalanx distalis

THE FOOT FROM ABOVE

Cause: Degenerative arthritis occurs with repeated (over) load when first the cartilage takes damage, and then the bone under the cartilage. Degenerative arthritis can in some instances cause an irritation of the synovial membrane which will result in concentration of fluid, swelling, reduction in mobility and pain in the joints. Degenerative arthritis in the ankle joint is often seen after repeated ligament injuries (outer ankle joint ligaments, inner ankle joint ligaments), where cartilage lesions in the ankle joint have occurred at the same time.

Symptoms: Pain in the joint with movement under load. Occasionally swelling in the joint.

Examination: Normal clinical examination is often sufficient. However, it is also often necessary to perform an x-ray (or ultrasound scan or MRI examination) to make the diagnosis. Ultrasound scanning will often reveal inflammation surrounding new bone development at the joint surfaces.

Treatment: Treatment comprises relief from the painful activities until the swelling has gone down, after which training can commence with the primary aim to strengthen the muscles surrounding the joint and retain joint mobility. There is no treatment which can restore the damaged cartilage (and bone). Cartilage transplants are, as yet, not suitable for general degenerative arthritis. In cases of swelling in the joint, and with inflamed new bone development at the joint surfaces, inflammation of the synovial membrane can be attempted subdued by using rheumatic medicine (NSAID), or by draining the fluid and injecting corticosteroid. The injections can be performed to advantage by utilising an ultrasound guided method. Pain without swelling of the joints is best treated with paracetamol. In severe cases of degenerative arthritis where there is pain when resting (at night), it may be necessary to fix the joint by operation.

Rehabilitation: Rehabilitation is completely dependent upon the degree of the degenerative arthritis and in which joints it is located.
Also read rehabilitation, general.

Bandage: A supportive tape (Hollywood bandage) can be attempted to aid degenerative arthritis in small joints (toes) (tape-instruction). Tape provides no help to attacks in the ankle joint.

Complications: Degenerative arthritis which sits on the weight bearing parts of the joint is one of the most serious sports injuries, and often results in a termination of active sport. It is usually possible to continue sport activities with light strain on the joints (cycling, swimming), whereas it is advisable to participate in activities with great strains on the joint (running, ball games) with restraint. The diagnostic considerations in connection with degenerative arthritis include:

Special: Shoes with shock absorbing inlays will reduce the discomfort of degenerative arthritis.

Stiff toe syndrome

21. juni 2011Foot, fronturtehave_com

STIVHED AF STORETÅEN

Diagnosis:

(Hallux rigidus functionalis)

Anatomy: The flexing tendons of the big toe (musculus flexor hallucis longus & brevis) run under the sole of the foot and are attached to the bones of the big toe.

M. flexor hallucis brevis
M. flexor hallucis longus

MUSCLES IN THE SOLE OF THE FOOT

Cause: The stiffness is due to an irritation in the flexing tendons under the toe (M flexor hallucis). It occurs with repeated overloading of the flexing tendons (jumping, handball).

Symptoms: Pain in the metatarsophalangeal toe joint when walking. The pain is aggravated when the big toe is flexed backwards (extension). Often seen in girls in the 14-18 year age group.

Examination: Medical examination is not necessarily required in slight cases with minimal tenderness and no discomfort when walking. Examination is required in cases of more pronounced pain in order to confirm the diagnosis. The examination will show that the big toe can not be flexed upwards (extension), when the ankle joint is flexed 90 degrees, whilst the big toe can flex upwards when the ankle joint is stretched (flexion). In some instances it will be necessary to perform an x-ray or ultrasound scan, possibly supplemented with MRI examination (article).

Treatment: Treatment comprises relief with the aid of shoes with stiff soles (article). The treatment can be combined with rheumatic medicine (NSAID) (gel or crème). Furthermore, increased mobility of the joint is aimed at by active and passive movement of the big toe (hallux) within the pain threshold. Operations have been attempted, but have not yielded satisfactory results (article).

Rehabilitation: Load or strain within the pain threshold is allowed. Shoes with stiff soles are recommended. The guidelines under rehabilitation, general should be followed. Passive and active movement of the big toe within the pain barrier.

Bandage: Taping which supports the metatarsophalangeal toe joint can be used to reduce the pain from sports activity and walking (tape-instruction). If this is not sufficient, special soles can be manufactured to support the big toe.

Complications: If there is not a steady improvement in the condition, medical assistance should be sought to determine whether the diagnosis is correct or whether complications have arisen:

Imflammation of the bursa

21. juni 2011Foot, fronturtehave_com

Diagnosis:

(Bursitis)

Anatomy: There are numerous bursas around the foot for the purpose of reducing the pressure on the muscles, tendons and ligaments which lie close to bone projections. The bursas at the achilles tendon are those which most often give rise to symptoms.

Cause: The bursas can become inflamed, produce fluid, swell and become painful with repeated over-load or due to blows.

Symptoms: Pain when applying pressure to the bursa, which sometimes, but far from always, can give the impression of being swollen.

Acute treatment: Click here.

Examination: Medical examination is usually not required in light cases with only minimal tenderness. With more pronounced pain, or lack of improvement, medical examination should always be performed for confirm the diagnosis and commencement of treatment if required. The diagnosis is best made using ultrasound examination.

Treatment: Treatment is primarily concentrated on providing rest. If the provoking factor is known (i.e. tight shoes), this should naturally be corrected. Treatment can be supplemented with rheumatic medicine (NSAID) or injection of corticosteroid in the bursa preceded by draining, which can be best performed if ultrasound-guided.

Rehabilitation: Treatment is completely dependent upon which bursa is inflamed, but the sports activity can be cautiously resumed when the pain has diminished, especially if the provoking factor has been identified and removed.
Also read rehabilitation, general.

Bandage: In some cases a ring of felt (for example) can be taped around the tender bursa which will reduce the pressure from shoes. It is naturally important that the hole in the ring is positioned directly above the bursa.

Complications: If there is not a steady improvement in the condition consideration must be given as to whether the diagnosis is correct, or if complications have arisen:

In rare cases, the bursa can be infected with bacteria. This is a serious condition if the bursa becomes red, warm and increasingly swollen and tender. This condition requires immediate examination and treatment.

Fracture of the sesamoid bone under the toe

21. juni 2011Foot, fronturtehave_com

FRACTURE OF THE SESAMOID BONE UNDER THE TOE

Diagnosis:

Anatomy: Sesamoid bones are located in several places in the foot, embedded in tendons and ligaments. The sesamoid bones protect the tendons and ligaments against over load. There are almost always two sesamoid bones embedded in the flexing tendon of the big toe (musculus flexor hallucis brevis) under the metatarsophalangeal joint of the big toe.

Ossa sesamoidea
Talus
Calcaneus

THE FOOT FROM BELOW

Cause: Fracture of the seamoid bones can either occur acutely after sudden forceful strain/load, or in the form of a stress fracture subsequent to repeated, monotonous activity (running).

Symptoms: Pain just below the metatarsophalangeal joint of the big toe which is aggravated when the big toe is flexed backwards.

Acute treatment: Click here.

Examination: Clinical examination is usually necessary in order to make the diagnosis. The fracture can often be seen on x-rays, MRI examination (article), or ultrasound scanning.

Treatment: Treatment of a fracture of the sesamoid bone comprises relief, possibly in the form of shoes with a fixed sole.

Rehabilitation: Load or strain within the pain threshold is allowed. Shoes with stiff soles are recommended. The guidelines under rehabilitation, general should be followed.

Complications: It is unfortunately often seen that a fracture of the sesamoid bone does not heal, and frequently results in prolonged discomfort. If there is not steady improvement in the condition, consideration must though be given as to whether the diagnosis is correct or whether complications have arisen:

Surgical intervention can be attempted in cases with persistent discomfort, where one of the most used methods entails removal of one part of the fractured sesam bone (article).

Bone mambrane tear

21. juni 2011Foot, fronturtehave_com

Diagnosis:

(Perisotael avulsion)

Anatomy: The foot bones comprise the 7 tarsal bones (ossa tarsi), the 5 metatarsal bones (ossa metatarsi) and the 14 bones in the toes (phalanx). Muscles or ligaments are attached or anchored to all the bones. The outer surface of the bone is called bone membrane (periosteum), (Ultrasonic image).

Cause: A violent twist can stretch the ligaments and tear a small piece of bone membrane (periosteum) from the ligament anchor point. In other cases, bone membrane tears can occur when the bones impact upon each other (for example if the foot is bent or flexed backwards with great force so that one of the tarsal bones (talus) impacts against the front edge of the shin bone). Bone membrane tears in the ankle joint area are common, and can be seen in most cases where the person has played football for many years (“football-ankle”). Bone membrane tears can occur on all the bones of the foot where tendons or ligaments are anchored.

Symptoms: Pain when applying pressure, and when stretching the tendon or ligament which is attached to the bone.

Acute treatment: Click here.

Examination: Normal clinical examination is often sufficient. Larger tears can be seen on an x-ray. Many lesser tears can be best seen via an ultrasound (Ultrasonic image) scan or MRI examination, (article).

Treatment: Relief from the pain inducing activities. Larger tears can require surgical operation. Lesser tears do not require treatment. Some cases can cause prolonged discomfort with pain which does not recede despite relief. This can be due to the tear causing inflammation in the tissue. In such cases, rheumatic medicine (NSAID) or injection of corticosteroid in the area surrounding the tear can be recommended.

Rehabilitation: Rehabilitation is totally dependent upon the type of tear, and the treatment (conservative or surgical).
Also read rehabilitation, general.

Complications: If there is not a steady improvement in the condition consideration must be given as to whether the diagnosis is correct, or if complications have arisen:

Bleeding under toe nail

21. juni 2011Foot, fronturtehave_com

BLEEDING UNDER TOE NAIL

Diagnosis:

(Haematoma subunguis)

Anatomy: The nail is attached to the outermost part of the toe for protection.

Cause: Bleeding under the toe nail (especially the big toe or the toe adjacent) most often occurs due to the toe repeatedly jolting against the inside of the shoe, or by the athlete having his toes trodden on. Injuries to the toe and nail are extremely frequent in sport (article). Due to the toe nail being so firmly attached to the toe, even small drops of blood collecting under the nail will cause significant pain. The bleeding can loosen the nail, resulting in the nail finally being shed (Photo).

Symptoms: Pain and dark discolouring of toe nail (“Black Toe”, “Tennis Toe”).

Examination: Medical examination is normally not necessary in cases of bleeding under the nail.

Treatment: The pain normally goes away after a few days’ resting of the toe. In cases of acute pain and discolouring under the nail, a hole can be bored in the nail to release the trapped blood and therefore reduce the pain considerably (article). If this course of treatment is followed it is recommendable to soak the foot in soap water several times a day to diminish the risk of infection under the nail. Pain can be treated with ordinary pain-killers (paracetamol), and in some cases supplemented by rheumatic medicine (NSAID). There is only minimal risk of making the injury worse by continuing sports activity, however, if the cause of the injury is due to footwear, the necessary actions should be taken to avoid repeat. The nail can be remove if loose.

Rehabilitation: Training can continue unaffected.
Also read rehabilitation, general.

Bandage: If the toe nail is loose the pain can be reduced by taping the nail to the toe (tape-instruction).

Complications: In some cases the toe nail is shed, and it can take several months for a new to grow. If there are repeated cases of bleeding under the same toe nail, an x-ray examination should be performed to ascertain whether new bone has been formed (exostose) on the toe bone under the nail (“basketball toe”). In such cases, the exostose can be surgically removed.