Serena Williams to Miss Next Few Weeks for Foot Surgery
Reports are that Serena Williams injured her right foot at a restaurant, sustaining a cut to the top her foot. She will need surgery and will miss the next few tournaments.
A cut to the top of the foot, particularly at the junction of the foot and ankle, can be very concerning. In this area, vital structures can be damaged, including: nerves, blood vessels, tendons, ligaments, and muscles. An injury two tendons, the anterior tibial tendon and the extensor hallucis longus, or an injury to the artery, are particularly worrisome. The anterior tibial tendon (ATT) runs from the front, inner part of the shin to the foot. It helps the foot to move up and in (a motion known as inversion). The extensor hallucis longus (EHL) runs from the front of the shin bone to the big toe. It helps to move the big toe up. The artery on the top of the foot is one of two major arteries that provides blood supply to the foot. Injury to this structure is bloody, but no devastating.
A cut to the top of the foot is usually due to a sharp piece of glass, metal, or plastic falling on the foot. Depending on the size, weight, and depth of the injury. any of the structures on the top of the foot can be injured.
All cuts will lead to some amount of pain, swelling, and bleeding. One may notice a loss of the ability to raise the lesser or big toes to the ceiling or the inability to move the ankle upwards. This is concerning for a tear or laceration of a tendon.
WHEN TO SEEK MEDICAL CARE
If you think you may have cut a tendon, ligament, nerve, or blood vessel, you should seek medical attention within a few hours to days.
The treatment for a cut on the top of the foot depends on the depth of the cut and other structures involved with the cut. If the cut has not gone deep enough to injure any other structures, an athlete is usually kept out of play for a week or so with local wound care. If deeper, an a tendon such as the EHL or ATT is cut, then conservative care or surgery may be needed.
Conservative care would include a non-weight bearing cast for 6 weeks, where the toes or ankle is casted in an upward position. This will allow the two ends of the torn tendon to be close enough together to heal.
In the competitive athlete or someone who has pain or loss of function even after a cast, surgery is needed. The surgery involves the repair of the torn tendon. The ends of the tendon are found and sewn end-to-end. The patient is usually made non-weight bearing in a cast for 8 weeks. Intensive physical therapy is then needed.
OUTCOMES AND RETURN TO ACTIVITIES
If the cut is superficial, the wound will heal with little long-term issues. These players are back to competitive sports within 1-2 weeks. If a tendon is torn, the athlete is not allowed to return to play for 8 to 12 weeks. Physical therapy is needed to rehabilitate the tendon and restore range of motion and strength to the tendon.
In the next few days, we will learn more about Serena’s surgery, the injury, and when she will be returning to tennis. Early reports suggest that she will be ready to play in the US Open on August 30, 2010.
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