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Athletic Foot and Ankle Problems:
Advice for Athletes: ‘Don’t Play With Foot Pain’
Athletes and Parents Should Monitor Seemingly ‘Normal’ Foot and Ankle Pain
As the Fall sports season reaches its conclusion, many adult, adolescent and child athletes are playing with seemingly normal but persistent foot pain that could be a sign of a more serious injury.
Playing with pain often is viewed as a badge of honor among athletes, but they must be aware that the persistent pain they dismiss as normal exercise-related stress could be something far more serious.
Athletes of all ages with foot pain due to overuse injuries from repetitive loading of the foot and ankle during running and aerobics. When athletes overdo their workouts, it may be normal to experience some temporary discomfort. But if pain continues longer than a few days with continued redness, warmth or swelling, the athlete should see a podiatric foot and ankle surgeon for proper diagnosis and advice on treatment options.
Athletes who ignore persistent foot pain and inflammation and continue to train risk potential complications that could sideline them for months. Among possible injuries associated with persistent foot and ankle pain are stress fractures, muscle strains, tendonitis and subtle fractures after inversion ankle sprains.
Stress fractures sometimes aren’t debilitating and some athletes might continue their normal training despite the injury. But continual rigorous activity can worsen the problem. An examination and diagnosis by a foot specialist can determine whether the pain is from overuse or subtle trauma, requiring only a few days of rest, or something that may require surgical intervention.
Heel pain in children often is caused by injuries to the growth plate and secondary growth centers in which tendons pull at the top and bottom of the growth plate of the heel. Boys and girls ages 8 to 14 are susceptible to this problem, and its major symptom is pain on either side of the heel.
Growth-plate trauma is common in soccer and other sports that involve a lot of running. Parents should make sure that their children stretch before playing and apply ice to the back of the heel after the game or practice. In some cases, anti-inflammatory drugs and shoe inserts or lifts are recommended, but the potential for recurrent injury exists until the growth plate closes, he explained.
Podiatric foot and ankle surgeons provide many forms of treatment to keep children pain-free and participating in sports activities. When treating athletes of any age, they will evaluate several factors that could be the underlying cause of foot pain. They include:
- Running or playing surfaces: Athletes who train on asphalt or cement are more prone to stress injuries than those who run on cushioned tracks or natural grass fields.
- Shoes: Footwear should be appropriate for the sport and match the biomechanics of the individual’s foot. For example, those who engage in one sport more than three times a week should wear athletic shoes designed for the sport, and shoe technology has advanced to allow for variances in foot characteristics that require stability cushioning.
- Training: Injuries often result when athletes fail to build up to a desired training goal. Accordingly, a runner shouldn’t set a goal of 20 miles a week without gradually progressing to that goal.
- Behavioral factors: In children, overuse injuries sometimes occur from excessive parental pressure to achieve in sports.
- Nutrition: Stress fractures can occur in athletes with poor nutritional habits.
- Over-training: Sleeping problems and resultant irritability and fatigue are common among some athletes who exercise aggressively.
- Physical characteristics: Variations in bone structure and muscle development are evidenced in individuals who are bow-legged or have malalignment problems.
Foot Health: Selecting the Right Athletic Shoe
From running to aerobics, the feet bear much of the burden for carrying out leisure sports activities, and selecting the right footwear is critical to foot health and performance.
Feet are made to bear tremendous pressure. An average day of walking brings a force equal to several hundred tons to bear on the feet. Weight bearing sports like running and aerobics put even more pressure on the feet and ankles.
Selecting the right athletic footgear is important to the overall health of the feet. Depending on your sport of choice there is a shoe to meet your foot care needs.
It’s a good idea to use the correct shoe for each sport. For example, a running shoe is built to accommodate the impact that concentrates on the forefoot, while a tennis shoe is made to give relatively more support to the ankles, and permit sudden stops and turns.
Here is a rundown of sports and recommended shoe type:
- Tennis: Proper tennis shoes give enough to allow for side-to-side sliding. In addition, tennis shoes need to have padded toe boxes to prevent injuries.
- Cycling: Select a cycling-specific shoe that is right for you among models designed for racing and mountain biking. The casual rider without known foot problems can use cross training shoes (i.e. combination cycling hiking shoes), which provide the necessary support across the arch and instep in a shoe as well as the heel lift that cycling shoes give.
- Golf: No longer driven by fashion, today’s golf shoes are constructed using basic principles of athletic footwear. Advanced technological innovations keep golf shoes light and add strength.
- Running: A good pair of running shoes is the most important piece of equipment for a runner. Shoe choice should be determined by weight, foot structure, and running regimen. Keep in mind that all shoes have a different shape, and sizes are not uniform from shoe to shoe. It’s a good idea for a beginning runner to see a foot care specialist before starting a running regime.
Children’s Athletic Shoes: It’s not the brand name or price tag of an athletic shoe that makes the difference in a child’s foot health. Foot care specialists agree it’s often better to buy a child two pairs of less expensive shoes than a single expensive pair.
The reason that two pairs are better than one is so the shoes can be rotated, to avoid rapid wear deterioration. Excessive wearing of the out-sole, loss of shoe counter support, or wearing out in the mid-sole indicate it’s time to replace the shoes. Proper fit is key.
If you have a preexisting foot condition, your foot care specialist can make recommendations for appropriate shoes.
Comfort, fit and support are the key drivers in selecting shoes and recommends these general shoe buying tips:
- Have your feet measured while you’re standing
- Always try on both shoes, and walk in the shoes before buying them
- Buy for the larger foot; feet are rarely the same size
- Shoes should feel comfortable immediately, not needing a break-in period
- Shop for shoes later in the day; feet swell during the day
- Be sure that the widest part of your foot corresponds to the widest part of the shoe
- Try on shoes while you’re wearing the same type of sock you’ll be wearing with the shoe
- Because children’s feet are constantly growing, allow at least one finger’s width from the end of the longest toe when buying shoes
Golfers: Don’t be Handicapped with Foot Pain!
As millions of avid golfers get ready for another season of pars and bogeys, they should be aware of potentially serious foot problems that can result from years of playing the game.
Although golf is not considered a rigorous sport, the physical act of repeatedly swinging a golf club in practice and on the links can lead to a condition known as hallux limitus, a jamming and deterioration of the big toe joint. The movement and weight transfer that occur during the swing’s follow through can cause this problem and other chronic foot ailments.
When golfers follow through on their swing, they can overextend the big toe joint on the back foot. Those who have played the game avidly for several years eventually can wear out the cartilage or jam the big toe joint. The likely outcome, if left untreated, is painful arthritis in the big toe, which would make it very difficult to continue playing golf.
Golfers who have pain and swelling around the big toe joint or have less mobility in this area than other parts of the foot should visit a podiatric foot and ankle surgeon for an examination and appropriate treatment. A history of trauma to the big toe area and bone structure also can precipitate the condition. Individuals with a long first metatarsal bone (big toe), for example, are more susceptible to joint compression and hallux limitus.
If golfers experience pain in the big toe area when playing, they should consider it a warning sign that intervention is necessary before the joint becomes arthritic. In most situations, orthotics can be prescribed to provide relief, but others with advanced cases may require surgery.
Another foot problem that is common in golfers is a neuroma or pinched nerve at the bottom of the foot. The weight transfer to the front foot that occurs in the follow through applies pressure that, over time, can cause a pinched nerve. Also, golfers are advised not to wear shoes that have a spike located directly beneath the ball of the foot. The pressure from that single spike, magnified by the several thousand steps taken during an average round, can cause intense pain and swelling in the ball of the foot. Any pair of golf shoes can be made more foot friendly without sacrificing traction by removing the poorly located spikes.
Heel Pain Epidemic Afflicts Weekend Athletes
Heel pain among weekend sports participants, runners and those beginning exercise programs is reaching epidemic proportions.
We’re seeing a lot of heel pain these days, and much of it can be traced to preventable causes, such as stress from excessive athletic activity and poorly designed footwear.
If an athletic shoe bends in the middle, it may not provide the required stability and protection against heel pain. The shoe should bend in the area in which the toes bend and not at the arch. Heel pain is a very common ‘overuse’ sports injury and weekend athletes should wear well designed athletic shoes specific for the shape of their feet.
When heel pain occurs, it’s best to decrease and sometimes eliminate strenuous athletic activity until the pain subsides and seek treatment if symptoms persist.
It is estimated that 15 percent of all adult foot complaints involve plantar fasciitis, the type of heel pain caused by chronic inflammation of the connective tissue extending from the heel bone to the toes. Conservative treatment is effective in most cases and surgery, such as removal of heel spurs, often is the best option in severe and persistent cases.
Runners: Fit Feet Finish Faster
Both long-distance runners and casual joggers can improve their performance by keeping their feet in top condition and taking steps to control foot problems common in runners.
The human foot is a biological masterpiece that amazingly endures the stresses of daily activity. For runners, the feet are more vulnerable to injury than any other part of the body, and these athletes should be on the alert for signs of foot problems that can slow them down if not treated promptly. The most common complaint from runners is heel pain caused by inflammation of the ligament that holds up the arch, a condition known as plantar fasciitis. In athletes, heel pain can result from faulty mechanics and over pronation in which pressure is unequally applied to the inside of the foot. It also can be caused by wearing running shoes that are worn out or too soft.
At the first sign of heel pain do stretching exercises, wear sturdier shoes and use arch supports. In some cases, icing and anti-inflammatory drugs, such as ibuprofen, are helpful. Should heel pain continue, custom orthotics, injections and physical therapy might be required. Surgery normally isn’t considered unless heel pain persists for more than a year and conservative treatment has failed to bring relief.
Neuromas and tendonitis are other common foot problems that affect runners. A neuroma is a pinched nerve between the toes that can cause pain, numbness and a burning sensation in the ball of the foot. Overly flexible shoes often are the cause and padding, orthotics or injections usually are effective. Sometimes surgery is the answer if pain between the toes continues for more than six months.
Serious runners can be sidelined with tendonitis if they ignore the warning signs of this overuse-related condition. There are several forms of tendonitis that affect the Achilles and other areas, and all are treated with rest, icing, stretching and anti-inflammatory medications, and sometimes with orthotics and physical therapy. Over-zealous training usually causes tendonitis, especially among beginners who try to do too much too soon.
A common myth among athletes, is that it’s not possible to walk or run if a bone in the foot is fractured. often surprised patients say ‘It can’t be broken, I can walk on it. That’s dead wrong, especially with stress fractures when pain and swelling might not occur for a few days. If a fracture or sprain is suspected, runners should remember the word RICE as an abbreviation for Rest-Ice-Compression-Elevation. Should pain and swelling continue after following this procedure for three or four days, you should see a podiatric foot and ankle surgeon for an x-ray and proper diagnosis.
Other common foot ailments runners should watch for are:
- Athlete’s Foot: This fungal skin disorder causes dry, cracking skin between the toes, itching, inflammation and blisters. It can be prevented and controlled by washing the feet regularly and carefully drying between the toes; switching running shoes every other day to allow them to dry; wearing socks made with synthetic material instead of cotton; and applying over-the-counter ointments.
- Toenail Problems: Ingrown nails can cause inflammation and possible infection and usually are treated by cutting the corner of the nail with sterile clippers. Black toenails happen when a blood blister forms under the nail from trauma, and it’s best to let the nail fall off by itself. Fungal toenails are yellow, brown or black and sometimes are irregularly shaped and thick. They are best treated with oral anti-fungal medications.
- Foot Odor: There are more than 250,000 sweat glands in the foot and daily hygene plus regular changing of shoes and socks are best for controlling sweat and odor. Runners should avoid wearing cotton socks and running without socks. Foot powders, aerosols antiperspirants and vinegar soaks also are helpful.
- Blisters, corns and calluses: Never pop blisters unless they are larger than a quarter or are painful or swollen. Use a sterile instrument to lance the corner, leave the top as a biological dressing, wash, apply antibiotic ointment, and cover with a Band-aid. Corns and calluses are caused by repeated friction, and should be treated by aseptically trimming the dead skin and eliminating the underlying cause.
Summer Games Can Cause Foot and Ankle Pains
With the summer recreation season in full swing, many weekend athletes are experiencing foot and ankle injuries for which prompt treatment is the key to avoiding long-term complications.
From pick-up basketball participants to over-the-the-hill softball players at the company picnic, weekend athletes are vulnerable to foot and ankle problems, which account for 27 percent of all sports injuries. Overuse and insufficient stretching and warm-ups often cause such injuries.
At one time or another most athletes suffer sprained ankles and/or heel pain and these conditions should be promptly evaluated and treated to restore strength, range of motion and balance. As a precaution, anyone who has had more than one sprain on the same ankle should brace it whenever engaging in athletic activity. Those with heel pain lasting more than a month should seek treatment.
Any sport that requires side-to-side motion, involves several participants in a confined area, or is played on uneven surfaces, presents a significant risk for ankle injuries. Players who have experienced previous ankle sprains that have been inappropriately evaluated and treated may have persistent ankle pain, weakness and instability. Proper evaluation is critical to establish an accurate diagnosis and initiate the right treatment for the injury.
If symptoms persist, ankle surgery may be necessary to allow the athlete to continue to compete at the desired level. Performing ankle surgery though a conventional incision or though a small puncture incision with an arthroscope enables the podiatric foot and ankle surgeon to look inside the joint and assess the specific problem. He added that arthroscopic surgery, though best known for repairing knee injuries, also is used to repair the ankle joint and lessen or eliminate the effects of arthritis that might be present. It’s a viable procedure that should be considered to treat chronic ankle pain symptoms when conservative measures have failed.
Tendonitis occurs from overuse and is common among weekend athletes who try to do too much too soon. While muscle pain is the result of the body’s inability to control swelling, it isn’t normal for tendons to swell. Tendonitis in the Achilles, ankle or foot, therefore, should be examined and treated without delay.
headded that pain in the Achilles tendon should be evaluated at the first sign of trouble. If the Achilles is strained or stretched, it should be examined right away to help prevent a possible rupture that will require surgery and a lengthy rehab.
Blisters and neuromas also can be an annoying source of forefoot pain from sports activity. Blisters occur from excessive moisture and friction, and athletes can be predisposed to this problem by wearing cotton socks instead of the preferred acrylic socks. Poor fitting, constricting athletic shoes also produce blisters as well as neuromas (pinched nerves of the foot), which cause severe pain and numbness of the inner toes.
Certain types of foot and ankle injuries are more common in various sports:
- Tennis: Quick stops and starts and lateral movements can cause ankle joints to become unstable, and Achilles tendon pain also is common among tennis players.
- Softball: Sliding on the base paths can cause serious ankle sprains and fractures.
- Basketball: On hard outdoor surfaces, players are vulnerable to ankle sprains, Achilles pain, stress fractures and heel pain.
- Golf: Players who fail to stretch before a round can experience muscle pain from walking up and down hills and from climbing in and out of deep sand traps. Avid golfers also are at risk for neuromas and hallux rigidus, a jamming and deterioration of the big-toe joint.
- Running: Injuries occur most frequently when runners fail to stretch and warm up and over do it when training for marathon races. Common foot and ankle problems for runners are heel pain, neuromas, tendonitis and stress fractures.
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