Categorized | Health

The Athlete’s Foot: Healthy Performance From The Bottom Up

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footbackgroundFor professional athletes, healthcare starts at the bottom. Athletes are on their feet throughout a game, match, or performance, whether they’re running, jumping, kicking, dancing, sprinting, skating, or skiing.

Their feet not only bear their full body weight, but the stress on them during a game can reach as much as 20 times the person’s body weight.

If there’s a problem with their feet, their performance will suffer. Worse yet, if they injure a foot, they will miss games and may even end their career.

Yet the demands they constantly place on their feet are likely at some point to lead to injuries such as stress fractures, ankle sprains, torn ligaments, neuromas or tendonitis. They may have blisters, bunions, shin splints, corns, calluses or, of course, athlete’s foot. Improper foot care can also lead to lower back pain and other joint or muscle problems.

In basketball, as one example, where players put an extraordinary amount of stress on their feet, well-known players such as Yao Ming, Bill Walton, and Greg Oden missed plenty of playing time because of fractures in their navicular bone, which is in the top, front of a person’s foot. During a 13-year career, Walton played in just 44 percent of his team’s regular-season games.

In football, Lisfranc fractures made the news in 2012 when three NFL players were affected in one week—the New York Jets’ star receiver Santonio Holmes was out for the season, Green Bay Packers running back Cedric Benson was placed on injured reserve, and Carolina Panthers center Ryan Kalil required surgery.

Named for a French surgeon, a Lisfranc fracture takes place when one or more metatarsal bones are displaced (i.e., moved out of alignment). The metatarsals are the five bones in the middle part of the foot that connect the toes to the tarsus. Lisfranc fractures cannot be prevented, but early diagnosis can prevent a season-ending injury.

We could cite similar examples of foot injuries in everything from baseball to ballet. So what can athletes do to prevent foot injuries? And if an injury takes place, what can they do to recover?

Know Your Feet

It helps for athletes to be aware of their foot structure, because different types of feet are prone to certain injuries.

Foot structure affects how a foot pronates. Pronation and supination are the rotation that takes place in your feet when you run. When your foot pronates, it becomes more flexible, which helps it absorb the shock from your body weight as it hits the ground and also helps your feet adjust to the contours of the running surface. When your foot supinates, it becomes more rigid, which allows it to more effectively push the body forward. If you’re standing and turn your torso and hips to the right, your left foot will pronate and your right foot will supinate. Turning to the left will have the opposite effect.

Athletes whose feet have low arches or who have flat feet tend to “overpronate,” which means they rotate their feet too much when they run. Their feet are too flexible, which places a lot of stress on certain structures in the foot; their feet don’t lock up the way they should.

Those whose feet have high arches tend to “oversupinate” or “underpronate,” meaning they don’t rotate their feet enough. Athletes who supinate have rigid feet, so their feet lack shock absorption.

Athletes who know their feet are better able to prevent injuries, as they can compensate with supportive footwear, tape, or orthotic devices, which are corrective shoe inserts designed to help support muscles, bones, and joints, and relieve stress. Those who use tape should wear footwear that is loose enough to compensate for the tape.

Footwear with extra support in the arch area can help those who overpronate. Footwear with more cushion can help those who oversupinate, absorbing the shock that takes place when their feet hit a hard surface. Athletes with a normal arch typically have an optimal amount of pronation and should wear footwear that provides stability.

It’s also important to wear footwear that fits properly; it should be neither too tight, nor too loose. You should have enough space at the front of your shoe so that your foot can slide forward a little when you walk without your toes rubbing against the front of your shoe. You also should be able to spread your toes.

Footwear should be designed not only for the sport, but also for the surface you’re playing on. It also helps to wear high-quality cotton socks and to keep your feet clean.

Athletes, fortunately, are typically in good physical shape, as being overweight places added stress on the feet. Stretching before and after a workout or a game can also help prevent injuries.

Common Foot Injuries for Athletes

Feet are complex and contain almost a quarter of the body’s bones. The injuries they encounter are also complex. Consider a few of the foot injuries most common to athletes:

Stress fractures

Stress fractures are microfractures in the architecture of the bone that cause pain, swelling and redness. They are relatively benign, but they can become more serious if ignored. Athletes are driven and may try to “work through” their injuries, which may ultimately result in the bone breaking completely.

Bones constantly break down and build themselves back up in response to stress. Exercise and sports make the bones stronger and denser, but bones need a chance to work their way up in strength. Stress fractures occur when athletes do more than their bones can tolerate.

Stress fractures often take place after sudden increases in exercise, use of improper training techniques, or a change in the surface on which training takes place. Running uphill, or on a treadmill with a steep incline, or training in footwear that is worn out can also cause stress fractures.

Athletes whose feet have high arches are more prone to stress fractures. Wearing footwear or orthotics can help, especially for those who repeatedly have stress fractures.

A podiatrist can usually diagnose stress fractures by manipulating the bone. They will commonly not show up on an x-ray for a few weeks after the symptoms start. An MRI or bone scan can be ordered to help with the diagnosis.

When stress fractures are detected, it is important to decrease activity for a period of time, then resume activity incrementally. Professional athletes may prefer not to rest, but stress fractures heal quickly. It’s better to miss a week or two of play than to miss a whole season.

Plantar Fasciitis

Plantar fasciitis, also known as a heel spur syndrome, is inflammation on the bottom of the heel, which results in heel and arch pain. The name derives from plantar fascia, the ligament that stretches from the base of the toes across the arch of the foot and attaches to the bottom of the heel.

If you have a pronated foot type, as you push forward, your foot will not supinate enough and lock up, causing an increase in tension on the plantar fascia. Shoes that help lessen the amount of pronation can often decrease this effect.

In most cases, plantar fasciitis can be treated successfully using anti-inflammatory medications, such as cortisone shots. Ice packs, stretching exercises and physical therapy will also help. In certain individuals, orthotic devices can help treat and prevent plantar fasciitis.

Chilles Tendonitis

While the Achilles tendon, which inserts in the back of the heel bone, is the largest tendon in the body and can withstand forces of more than 1,000 pounds, it is also the tendon most frequently ruptured.

Achilles tendonitis often begins with mild pain, but the pain gradually worsens. Other symptoms may include swelling, stiffness, and tenderness. The tendon may also develop longitudinal tears.

Like pronation, the amount of contraction that takes place in an athlete’s calf muscles varies greatly. Those with tight calf muscles are more prone to develop Achilles tendonitis.

Causes of Achilles tendonitis may include running on hills or stairs or on a treadmill with a steep incline, over-exercising, a rapid increase in the amount of running or speed when running, improper footwear or trauma caused by a contraction of the calf muscle when overexerting. Athletes who fail to keep in shape during the off-season and start strenuous workouts too quickly are prone to Achilles tendonitis.

Anti-inflammatory medication, ice, rest, massage, and ultrasound treatment are also effective, as is stretching the calf muscle and Achilles tendon. Those who have tight calf muscles should wear splints on their feet at night.

Bunions

Bunions are not caused by athletic activity. About one in three Americans has a bunion, a bone deformity caused by a deviation of the metatarsophalangeal joint, which is at the base and side of the big toe.

Bunions are not inherited, but foot structures are, and if one family member has bunions, the odds are higher that other family members will as well. Those who overpronate are more susceptible to bunions. Foot injuries and neuromuscular problems may contribute to their formation.

As a bunion becomes enlarged, it causes friction and pressure as it rubs against footwear. The big toe sometimes twists as it moves toward the second toe, causing a condition known as hallux abducto valgus. Over time, the big toe crowds in and may alter the position of the second toe. Bunions can also lead to hammertoe and other toe deformities. Eventually, if nothing is done about the bunion, it may become arthritic.

The first step in treating bunions is to wear carefully fitted footwear that accommodates the bunion without contributing to its growth. Protective padding may be added to reduce friction and inflammation. Orthotic devices can help stabilize the joint and hold the foot in the correct position.

When conservative treatment is inadequate, a bunionectomy may be performed to correctly align the joint and remove the bunion.

Neuroma

A neuroma is an enlarged growth of nerve, most often between the third and fourth toe, created by tissue rubbing against the nerves and irritating them. A burning feeling, numbness in the toes, tinglingand pain in the ball of the foot are common symptoms.

Neuromas can be caused by shoes that are too narrow or fit poorly or by an abnormal bone structure.

Orthotics, cortisone treatments and use of corrective shoes are the most common treatments, but surgical removal of the growth is sometimes necessary.

Ankle Sprain

When an athlete twists his or her ankle, one or more ligaments on the outside of the ankle may stretch or tear. Primary symptoms include pain, swelling and bruising. If not properly treated, ankle sprains may develop into bigger problems.

Treatment includes resting, elevating the ankle and applying ice to reduce swelling. Compression bandages also may be used to support the ankle as it heals. Serious sprains may require surgery to repair and tighten damaged ligaments.

If you are a professional athlete, you are likely to have one or more of these injuries during your career. Don’t ignore the injury, as it will only get worse. Treat your feet well and they will treat you well, carrying you throughout your professional career.

 

About John A. Scheffel, D.P.M.

John A. Scheffel, D.P.M. is the owner and founder of the Scheffel Foot Center, which has offices in Worcester and Clinton, Mass. He can be reached at Drscheffel@scheffelfootcenter.com

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