Return to Play Foot and Ankle | UPMC Sports Medicine

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– As an athlete for most of my life, I can tell you that athletes train hard and play harder. They are dedicated to the sport they love. There is no greater reward than when a football player catches the game-winning pass in the end zone, or when a rival runner experiences a photo finish at a track meet. But what happens if you hear a pop when you land from the game-winning catch, or when you roll your ankle as you cross the finish line? Hi, I’m Charlie Batch. And I’m here with Dr. MaCalus Hogan, chief of Foot and Ankle Surgery at UPMC Sports Medicine. Dr. Hogan, thanks for joining me today.

– Charlie, it’s an honor to be here. Thanks for having me.

– What are the most common foot and ankle injuries that you treat in athletes?

– So one of the most common things that we treat in athletes are ankle sprains. As you mentioned, you know, you sprain your ankle or roll it, you roll your ankle when you come down while playing basketball, or, you know, crossing the finish line. And we also hear those pops with things like Achilles tendon injuries and a number of overuse as well as acute injuries that we can hear. And sometimes, unfortunately as well, but we also have fractures or breaks that people experience.

– Now, are these typically traumatic injuries, or overuse, or could it be both?

– So, it can be both. We have a combination of things that we see. We see acute injuries or traumatic injuries where someone can take the wrong step, or unfortunately may have impacted, particularly in contact sports such as football, hockey, etc., and they have a traumatic injury in that scenario. But we also see quite a bit of overuse. As you mentioned, athletes love what they do. And so they do it quite a bit. And from time to time, we see overuse injuries associated with that. Often, those can be either tendon injuries, muscle injuries, or sometimes even fractures or stress fractures.

– And you mentioned overuse. What is overuse in foot and ankle injuries?

– So in the foot and ankle realm, one of the most common overuse injuries we see may be stress fractures of different bones in the foot. The foot and the ankle, they take considerable amount of load, right? They’re at the end of the body, and it can take up to three to eight times of your body weight when you’re running. And so over time and repetitive activities, we may sometimes see stress fractures. Other times we also may see overuse injuries of the tendons. When the tendons and muscles are just being overworked, they become inflamed and irritated, and then individuals have pain and limitation.

– How can athletes identify some of the overuses, or can they treat themselves when that happens?

– So, it’s a great question. The beauty of athletes in general is that they know their bodies quite well. I mean, they are doing everything possible, particularly as they go from amateur all the way to professional sports, as you played, to really understand their bodies, understand when their bodies may not be right in tune, what they need to do. And so things I always advise my patients, listen to your body. Your body’s trying to tell you something. And so if they can identify those things, obviously conditioning, hydration, and also the cross-conditioning and training that they do, and doing that to try to stay ahead of the game and also to minimize injuries down the road.

– You do have athletes that are out there that are afraid to share some of these injuries ’cause they, you know, the athlete model is, “Hey, if you’re injured, you can’t play,” and then maybe somebody else will take your place. Would that, do you caution athletes by taking on that role? Or do you say, “Hey, if you feel it, say something so you can be treated.”

– Yeah, so another great question. I’m a big advocate of being proactive, right? As you sense things, having a trusting environment, the trainers, those you work with, those that are helping you condition, being able to communicate with them when you are noticing certain things that just won’t go away — you know, that nagging feeling where you say, “Well, hold on” — you’re better off actually getting ahead of it in many scenarios other than allowing it just to linger. And so what I advise a lot of my athletes, particularly professional athletes, if it does not go away with rest or when you’re having your down period between training sessions or between practices, then it’s likely worth at least having that discussion with your trainer, the transition team, just to try to maintain a close look into it. And with our care delivery team here in Sports Medicine, we have each of those phases really ready to support our athletes and our teams to stay ahead of those injuries so they can remain small, minor, and recover quickly and not become a long-term or unfortunately season-ending scenario if treatment is delayed.

– Once the injury has been diagnosed, I imagine most athletes come to you for treatment, as they’re looking to return to play.

– Absolutely. One of the most common treatments we take, initially rest, and then we want to assess — let’s really get an understanding of, “OK, what is actually happening with this injury?” I talk to my patients and athletes regarding, “Could you continue to play? Do you feel as though you can continue to play or perform? Or do you feel like this is going to limit you or that you’re putting your body further at risk?” And then, from there, we decide our next treatment steps.

– Now, how do you identify what that treatment plan looks like for each athlete?

– So, we take it very specific to the individual and obviously what they need to get back to. So what we actually may do with a skill player on a football field or basketball court, compared to a lineman or someone else, actually may be somewhat different. The most important aspects of that are fast identification of what may be going on. Get our diagnosis quickly, and then determine is that athlete actually safe to return to play? In some scenarios, that may just be providing some additional support, taping, bracing, and getting them back into the game. In other scenarios, they may need to step out or step away from that sport for a period of time for a more focused treatment and then also a more outlined, extended recovery.

– And as athletes, we all hate that “S word,” as it relates to surgery. So when you look at those traumatic injuries, what makes you identify if an athlete right there needs surgery or not?

– As a foot and ankle surgeon, my approach is to provide the conservative, but as you mentioned, up to that point, surgery is sometimes indicated. And so my approach, and the approach of our Sports Medicine Institute is, if surgery is actually going to give them the best opportunity to return to play in a safe and effective and also efficient manner, then we want to have that discussion up front. In some scenarios, some injuries are season-ending, or they’re essentially going to keep the individuals out for a period of time. And when that decision needs to be made, we put our care team around them, our therapists, trainers, and then plan for that. The best aspect of having surgery is that, we usually don’t recommend that — we definitely don’t recommend it, unless it’s absolutely indicated. And surgery is often indicated when return without surgery could put them at further risk. And that’s when you’re talking about impacting someone’s career, in their sport, particularly if they’re professional, but also impacting their lifelong functionality. And so that’s what we really want to strive for, lifelong sustainability and safety.

– And as everybody talks about the surgery, of course, that’s, you know, on the far end and nobody wants that. How can an athlete work with you as it relates to making sure that they are treated for just overuse, knowing that it’s overuse versus possible surgery?

– What we try to do, essentially, put individuals in the best position to not get injured. And sometimes, particularly in the foot and ankle environment, the type of shoewear they’re playing in, the type of supports they may have — are they using an ankle brace, or taping, or certain things such as strapping and taping that can assist them in preventing injury? And I’m a big advocate for that, of essentially the appropriate foot type, the appropriate shoes, and all the appropriate equipment they need to help prevent injury is the most ideal. And that can also help minimize overuse injuries from developing.

– And I know we just went over surgical and nonsurgical procedures and those type of things, but what is the benefit that you see for athletes coming to the UPMC Sports Medicine Clinic?

– Our comprehensive care model, without question. From our primary sports team physicians, all the way through our athletic trainers, our physical therapists, how we partner with our respective teams and liaisons, all the way to the subspecialty consultants, such as myself as a foot and ankle orthopaedic surgeon. That comprehensive communication and pathway, it’s unmatched. I mean, it’s second to none, and we actually pride ourselves on working together to provide the best care to our athletes across the spectrum of care.

– After an athlete recovers from surgery or completes their rehabilitation, I imagine they’ll be anxious to get back on to their sport.

– Absolutely. Most of our athletes, everyone wants to get back to what they love and what they’re passionate about. And we work closely with them and really set out timelines. And those sometimes are adjusted, but the goal is to get them back safely, quickly, and also to get them back to where they do not have a reinjury immediately following returning. So, that’s our main focus.

– Now, how do you identify when the right time for that athlete to return to play?

– So, we work very closely with our therapy program, and with our therapists, with the trainers, essentially trying to identify can that athlete return to that activity with minimal risk to reinjury? That’s the most important thing. And so our return to play activities and our return to play training and protocols are really what we follow. And we individualize those to the patient, to the sport they’re trying to return to, or the activity, and then taking that constant feedback. We’re constantly collecting outcomes on patients, functional outcomes, and trying to assess, “Is this individual ready to go back?” Not just partially way back, right? At the highest level. Because that allows them to minimize their risk of reinjury, as well as to really enjoy getting back out there.

– And there’s two types of phases to recover. You have the physical aspect, but then there’s also mental. What are some of the tips that you give to athletes to let them know that they’re ready to return to play?

– The confidence building. And that’s the beauty of working with our training program, UPMC Rehabilitation Institute outpatient rehabilitation, and within Sports Medicine; really focusing on, OK, it’s the physical, but also the mental. The confidence that they develop with whatever treatment we provided for them, whether they be nonsurgical or surgical, and recognizing that they’ve met those appropriate metrics to return back to their sport, back to their activity, at a high level. And that is key. I mean, without that, individuals are not as confident. You know, you have to be confident to perform well.

– And you doing- you talk about confidence, and you deal with thousands of athletes throughout the year. What is the most rewarding part of your job?

– When patients get better, they’ve gotten back to their sport, and really, when they come to see us in the office or see me in the office, and they really only came to say, “Hey, I’m doing great.” I mean, that is a phenomenal feeling. You realize you’ve helped someone, they’ve taken time out of their day, even while doing well, to come let you know how they appreciate that. And then seeing and hearing about their performance, even from a distance, whether it be on TV or reports from the community, that’s, I really enjoy it. And so that’s one of the best aspects of my job.

– And I would imagine when you see those athletes coming back and they just pop up in your office, those thank yous go a long way.

– Absolutely. I mean, the value of a thank you and an appreciation that I have for them, ’cause they put it a lot of the work to get back, but it definitely, it’s a highlight to the day.

– Dr. Hogan, thank you for your time today. From sprains and strains, to fractures and breaks, foot and ankle injuries require proper diagnosis and treatment for proper healing and return to play. If you are experiencing foot and ankle discomfort, or become suddenly injured, seek the care you need at UPMC Sports Medicine. To learn more about common foot and ankle injuries and how the team of experts can get you back on your feet, and back in the game, visit

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