Dr. Mark Drakos, Orthopedic Surgeon, Answers Your Questions about Ankle & Foot Sports Injuries

Q1. Does running on pavement increase the chances of foot injuries?

Studies have shown that there are higher stresses on your feet when running on asphalt as opposed to running on grass (reference #1). This suggests that runners who are prone to stress fractures may be at a higher risk of injury running on pavement than running on softer surfaces such as grass, a rubberized track or a treadmill. The risk of foot injuries has been correlated with an increase in miles run, foot type, runner experience, previous foot injury and certain footwear. I would recommend changing running shoes every 500 miles as after that distance the ability of the shoe to absorb the shock of running decreases and that may increase the risk of foot injuries.

Q2. Some NBA basketball players have been missing games because of sprained ankles. How long does a sprained ankle take to heal and what are preventative measure?

Ankle sprains are the most common musculoskeletal injury among NBA basketball players. In an HSS study we performed with the NBA, ankle sprains accounted for over 1600 injuries and a total of 13% of all injuries (reference #2). It was also the second most common reason for games missed by players. How much time is missed depends on the severity of the injury as well as the specific location of the sprain. For example, lateral ankle sprains are graded 1, 2 and 3 with grade 3 the most severe. Grade 1 usually takes only a week or two before the player can return to play while grade 3 may take 4-6 weeks. In addition, a “high” ankle sprain, which is more severe involving the ligaments higher up in the ankle, may take 8-12 weeks for recovery.

One of the major risk factors for ankle sprains is whether or not the athlete has had a prior sprain, which indicates a more likely change of experiencing another. To prevent further sprains try taping up the ankle before engaging in any sport or wearing a supportive ankle brace. Studies have shown that certain ankle braces can prevent future sprains and you should consult a health care professional to determine the best brace for you. Focus on strengthening the muscles and tendons around the foot and ankle to prevent a sprain.

Q3. I usually run 4-5 times a week and don’t have any foot pain. A few days ago I ran up a steep hill, then 5 miles the following day and afterwards I was in so much pain that I couldn’t walk. The pain is on the outside of both of my feet below my ankle. What could be wrong with my feet?

If you have recently increased the distance or the intensity of your training you may be developing a stress fracture. If you truly cannot walk I would recommend seeing a medical professional to make sure that you do not have a fracture. Tendinitis is also a common problem with runners. Tendinitis usually resolves with proper treatment including rest, ice, compression and elevation. Occasionally physical therapy may be appropriate. It is best to consult with an orthopedic specialist.

Q4. I play soccer once a week and every now and then I have pain on the bottom inner part of my feet near the heel. I think I have plantar fasciitis- how should I treat it and prevent it from happening again?

Plantar fasciitis is the most common cause of heel pain and is very common in athletes. It is often associated with a tight achilles tendon. Both the achilles tendon and the plantar fascia insert on the heel bone. So if the achilles is tight it can pull on the heel bone more and can affect the plantar fascia. Plantar fasciitis can usually be treated conservatively with achilles and plantar fascia stretching 2-3 times a day. To stretch the plantar fascia you can roll a tennis or golf ball, or frozen water bottle on the bottom of your foot 20 times, three times a day. It is important that before you play soccer to allow adequate time for stretching and wear the appropriate shoes. Sometimes a gel heel pad can be placed inside the cleats to take pressure off this area. It is best to be evaluated by a physician to determine if that is the source of your pain before starting any regimen of treatment.

Q5. I have a recurrent problem with sesamoiditis. I am not a serious athlete but participate in martial arts and I try to walk at least a couple miles a day. I have been to a podiatrist and had a couple of cortisone injections. They do provide temporary relief. Is anyway to manage the condition without further injections? I try to stretch the area but I am not really sure how or if I even should. There are no breaks in the sesamoid and the podiatrist sees nothing unusual in the foot structure. It can be very painful and frustrating.

Sesamoiditis can be a difficult problem to treat. The sesamoids are two small bones underneath the big toe that help normal toe function and push-off during running. These bones can become irritated because they are exposed to 3-8 times the body weight of an individual when running. If acutely irritated rest and apply ice. Orthotics are also an option. To prevent it from happening again make sure that you are wearing the appropriate footwear.

Q6. When I walk my foot rolls a lot and I tend to be prone to ankle sprains. What can I do to prevent injury?

Work on strengthening the muscles and tendons around the foot and ankle, specifically, the peroneal tendons that run along the outside of your ankle and assist in ankle stability. You should also consider wearing an ankle brace or high top sneakers when performing activities that may cause ankle sprains. These interventions can help prevent recurrent sprains in the future. If despite these treatments you still have pain and recurrent sprains you should see a health care professional to make sure that there is not a more serious ankle problem.

Dr. Mark Drakos is an orthopedic surgeon specializing in disorders of the foot and ankle as well as sports-related injuries. He did his undergraduate work in biomedical engineering at Harvard University and received his medical degree from SUNY Stony Brook. Dr. Drakos is the author of more than 50 peer-reviewed articles, book chapters and presentations involving orthopedics. He has directly provided care for high school, collegiate, professional, and Olympic athletes.




1) In-shoe plantar pressure distribution during running on natural grass and asphalt in recreational runners. Tessutti V, Trombini-Souza F, Ribeiro AP, Nunes AL, Sacco Ide C. J Sci Med Sport. 2010 Jan;13(1):151-5. Epub 2008 Oct 31.

2)? Injury in the National Basketball Association: A 17-Year Overview. Mark C. Drakos, MD; Benjamin Domb, MD; Chad Starkey, PhD, ATC; Lisa Callahan, MD; Answorth A. Allen, MD. Sports Health: A Multidisciplinary Approach. July/August 2010; 2(4): 284-290.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. I’ve got accident 2 years ago.. I didn’t go hospital for check up.
    Now i have foot swelling. And the x-ray show my my 3rd toe hairline is fracture.
    Is it possible now to make surgery?

  2. I have a sprained ankle and I’m not sure what grade but I’m sure it’s not 1st degree. This is the third time in 10 years that I have sprained the same ankle. I was told by the ortho doc that I tore all the ligaments. What I want to know is if I might need surgery? Obviously you don’t have my X-rays but what are the indications for surgery with multiple ankle sprains? The first incident was severe for sure. I actually fell down my staircase and landed on my right ankle. Six months later I rolled it inward stepping off a sidewalk. Now ten years later I missed my footing coming off a curb and twisted inward again. It’s been a week and it is still very sore. It’s in a cast and I can put a little weight on it but if I turn a certain way it is very painful. Any input would be appreciated!

    1. Hi Natalie, thank you for reaching out. Dr. Mark Drakos, Orthopedic Surgeon, says: “Ankle sprains are extremely common. There are over 30,000 ankle sprains every day in the United States and it is one of the most common reasons for a visit to the emergency room. This often involves an injury to the outside ligaments of the ankle. Most (> 90%) get better within 6 weeks if treated properly. This includes the RICE protocol (Rest, Ice, Compression, Elevation) and often a rehabilitation or proprioception program as guided by a physical therapist. Once a patient sustains an ankle sprain, that patient is more likely to have a second ankle sprain. If the sprains become more common including difficulty with uneven ground, episodes of giving way or routinely spraining the ankle, surgery can be indicated to tighten the ligaments. However, a trial of rehabilitation is often indicated before proceeding to an operation. I would also recommend following up with your orthopedist.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  3. Hi, I currently run 1-5 miles a week for work (USMC) and I was due for a shoe upgrade due to getting older and pain starting a little bit in my body. I ran in the Nike Free’s for a while and then the running store told me that I have over pronation so they sold me a pair of Asics Gel Kayano 21’s. I am 5’7, male, and weigh 175 lbs. My shoes wear on the outsides and I strike with my heel when I run. Doing more research I think they sold me the wrong type of shoe. I have ran 20+ miles in these shoes and still feel like they have not been broken in. Every day after I run I still seem to be mildly sore. Am I correct in the fact they did indeed sell me a shoe not designed for my style of running?

    1. Hi Robert, thank you for reaching out. Michael Silverman, Physical Therapist, says: “If you are in face an over-pronator, those shoes are designed for runners with neutral feet as well as runners who have mild to moderate pronation. From what you are describing, it sounds like the proper fit, but that’s just with knowing your strike pattern and the statement that you are an over-pronator. My recommendation would be to take them back and find something you’re comfortable wearing. Many of the running stores video you running and can check to see if you are in fact an over-pronator there.”

    1. Hi Debbie, thank you for reaching out. Dr. Mark Drakos, Orthopedic Surgeon, says: “If it is a stress fracture, it most likely can be treated again. If you are getting recurrent stress fractures, there may be an underlying cause for this. Potential causes include improper footwear, poor foot alignment and vitamin D deficiency. If you are having recurrent issues with your foot, you should be evaluated by a foot and ankle specialist to see if further workup is needed to determine if you have one of these predisposing conditions.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  4. Hi, soooo im 16 and about a year ago I sprained my right ankle during basketball. Stupid me never let it heal and only took a 1 week break from practice. Also during the time I rarely applied ice, heat, or elevation to my foot. The only thing that kept it from alot of pain was an ankle brace I bought but, every time I took it off it would swell even bigger. Also during swim activities of even walking, my ankle constantly pops and is still slightly bigger than my other foot. Soo im wonder if I caused more damage and can it still heal properly, after all this time? PLEASE HELP my ankle hurts from time to time severely.

    1. Hi Destinee, thank you for reaching out. Unfortunately, we are not able to answer your question because you are under the age of 18. It is best for you to consult with your treating physician with a parent.

    1. Hi Fiona, thank you for reaching out. It is best for your boyfriend to consult with his treating physician so that he can get a better diagnosis. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  5. I had hammer toe correction surgery on second toe right foot and also straightening of third toe. Both toes had pins inserted. The stitches were taken out after two weeks. The pins out after six weeks. Is it unusual to have intravenous sedation for this procedure? Every article I have read states the pin removal is done in the office without sedation. Do I need to take off work for awhile after this? Any pain involved?

    1. Hi John, thank you for reaching out. It is best to consult with your treating physician. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  6. Hi,
    I’m 20 year old I met with an accident in July! and left leg talus was dislocated with fracture! And even after 6-7 weeks of physiotherapy, I’m struggling to walk,lateral bone is protruded it makes me feel uncomfortable. When will i be back to normal?will I get full ankle movements? Can I run and jog like before? please reply asap!I’m really worried about it 🙁

    1. Hi Chaitanya, thank you for reaching out. Dr. Mark Drakos, Orthopedic Surgeon, says: “A talus fracture is one of the more difficult fractures to treat as an orthopedist. Your recovery not only depends on the nature of the fracture but also whether or not there was any damage to the joint surfaces of the ankle. Furthermore, the blood supply to the talus can be tenuous so depending on damage to the blood vessels at the time of your injury, the recovery may take a year or longer. Full motion and return to activitiy is dependent on the joint damage and how the talus is healing after the injury.” It is best for you to consult with your treating physician. If you are interested in care at HSS, please contact our Physician Referral Service at 877-606-1555.

  7. I have a case of Tendinitis and Calcium Deposits in my right foot. If it gets any worse, I’ll have to get a brace put on it. have Physical Education two times a week until January 17th and after that I have it three times a week. How many weeks of Physical Education would I miss if I have a brace on my foot/ankle as an Estimate?

    1. Hi Haleigh, thank you for your question. Dr. Mark Drakos, Orthopedic Surgeon, says: “Tendinitis can take several weeks to resolve. Physical therapy may help to expedite the healing process. Depending on the nature of the calcium deposits the recovery can take longer or require more aggressive intervention. You should follow up with your health care provider if there is no improvement within several weeks.” If you are interested in care at HSS, please contact our Physician Referral Service at 877-606-1555 for assistance.

  8. Trauma, disease and injuries are the most likely causes of foot pain. Poor biomechanical alignment and the type of footwear can also cause pain or discomfort. Shoes that fit tight or are tied too tightly can cause pain on the top of the foot. High heels can cause pain around the ball of your foot just below your toes.

  9. My boyfriend had a TKR on 4/9/13. Since the surgery, he has had some complications, including a DVT. We had to go to an ER to have an ultrasound done, because his surgeon and his partners didn’t seem to listen to him, since he had a prior one 8 years ago, and knew how it felt. They just said it was inflammation and shrugged it off. My question is….how do we go about finding another orthopedic Dr. so that we can finish his aftercare. Not too trusting with the one we have. Thank you.

  10. Two months ago I sprained my ankle now when I walk on treadmill my ankle hurts for two days I was wondering should I wear hi top gym shoes I never went to doctor to have it checked I just let it heal I”m a big guy

    1. Hi Christopher, We?re sorry to hear about your ankle. Orthopedic surgeon Dr. Mark Drakos says, ?Most ankle sprains heal in 6-8 weeks with conservative management. Wearing a high-top sneaker or a lace-up ankle brace will help give your ankle more stability, particularly if there is any residual looseness from your injury. However, if this pain persists you should get evaluated by a physician to rule out any other damage to the ankle.? If you?d like to make an appointment with an HSS physician, please contact our Physician Referral Service at +1.877.606.1555 or https://www.hss.edu/secure/prs-appointment-request.asp?pageid=6463.

  11. Hello Doctor. I am an avid runner and in the last year I started getting foot pains. As I fix one I get another. However my most recent is my ankle seems unstable when I run and I get like burning fire balls above my outside ankle bone on both legs. Thes balls swell to a big knot, and usually the pain subsides after a mile and starts back after 3 miles. What can I do? I do not want to stop running. I wear ankle elastic braces that helps a little.

      1. Thank you so much. I will see if they accept Tricare or BluecrossBlueshield. I have both.


  12. Hi doc, my 21 year old daughter we think stress fractured her lateral sesamoid bone earlier this year. Orthotics, boot, bone stimulator has not helped. Its very painful. MRI today showed a normal medial sesamoid, but fragmented and Av Nec of the lateral ses. We are seeking an experienced surgical consult at HSS. What do you think?

    1. That”s great news! If she does seem to have any lingering problems, please feel free to reach out to our Patient Referral Service at 877-606-1555.

  13. My grand daughter twisted her anklle about two weeks or so ago. She did not have it x-rayed and after about a week she went back to figure skating. Now she says the ankle is turning bluish although it does not hurt. Does sthat sound normal?

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