Sports

sports podiatry

Managing painful feet

We have a special interest in Sports Podiatry, with extensive experience in treating both acute and chronic overuse sporting injuries. With the repetitive nature of exercise and sport on the feet and lower limbs, small inefficiencies or errors in your alignment and movement can lead to the development of overuse injuries, including:

Heel Pain – also referred to as Plantar Fasciitis, Plantar Fasciitis (or fasciopathy) is a condition of pain and tissue damage at the attachment of the plantar fascia to the underside of the calcaneus (heel bone).

Risk Factors:

Certain sports. Activities that place a lot of stress on the heel bone and attached tissue, i.e. running, dance and aerobics.
Flat-footed or high arches. People with flat feet may have reduced shock absorption, increasing strain on the plantar fascia. High arched feet have tighter plantar tissue, leading to similar effects.
Middle-aged or older. Heel pain tends to be more common with ageing as muscles supporting the arch of the foot become weaker, putting stress on the plantar fascia.
Overweight. Weight places a greater mechanical load on the plantar fascia. There is evidence that overweight and inactivity lead to chemical damage to the plantar fascia, with a worsening of pain.
Pregnancy. Weight gain, swelling and hormonal changes that accompany pregnancy may lead to mechanical overload of the plantar fascia.
Being on your feet. People with occupations that require a lot of walking or standing on hard surfaces may suffer plantar fascia pain.
Wearing shoes with poor arch support or stiff soles. Poorly designed shoes may contribute to problems.

Signs & Symptoms:

Sharp pain in the inside part of the bottom of the heel, which may feel like a knife sticking into the bottom of the foot.
Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe.
Heel pain after long periods of standing or after getting up from a seated position.
Heel pain after, but not usually during, exercise.
Mild swelling in the heel.

Treatment:

Orthotics. A sports medicine professional may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to the feet more evenly, and to stimulate the small foot muscles.
Dry Needling and/or Cold Laser Therapy is used at Oakleigh Foot Clinic to improve heealing by promoting increase in the micro-circulation at the localised area of injury.
Exercises: series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilises the ankle and heel. We also apply athletic taping to support the bottom of the foot.
Medication, injection and surgery. These measures are for the most persistent cases, and do not replace the need for the treatment methods detailed above.

Shin splints – also referred to Anterior Compartment Syndrome. Shin pain is a common injury in many running based sports, e.g. basketball, netball, football. It is characterised by pain in and around the tibia (shin bone) in the lower leg and usually occurs as a result of a sudden increase in the frequency, duration and/or intensity of activity.

Risk Factors:

Abnormal biomechanics – overpronation, tibial malalignment e.g. bowed legs.
Training methods – inappropriate increases in the intensity, duration or frequency of exercise.
Training surfaces – running on hard surfaces or uneven ground.
Footwear – wearing inappropriate footwear for the activity or worn out shoes.
Poor flexibility, muscle imbalance or inadequate strength – affecting muscles of the lower limb.

3 Types of Shin Pain

Medial Tibial Stress Syndrome

Cause: A change in the amount or type of activity may lead to the muscles of the lower leg pulling on the lining of the tibia.
Area of pain: Pain along the front and/or inside of the tibia. It may be painful to touch and vary in intensity. Pain will be present as activity begins but is likely to decrease as you warm up. Pain is generally worse in the morning and after exercise.

Stress Fracture

Cause: This fracture is an overuse injury that occurs as a result of repeated stress to the bone causing a small fracture.
Area of pain: Localised to an area along the front of the tibia, but usually near the middle. It is normally constant pain that increases with exercise. The pain develops suddenly and is sharp in nature. May be too painful to exercise.

Compartment Syndrome

Cause: In the lower leg there are a number of muscle compartments, which are muscles contained within a lining called a fascial sheath. As a result of overuse/inflammation or a direct impact injury, these muscle compartments may become swollen and painful.
Area of pain: Pain along the front and/or inside of the tibia and in the muscles at the front of the lower leg. Pain usually increases as activity begins and decreases when it stops. The muscles affected may feel weak or numb. The sensation of pins and needles may also be a feature, and this requires urgent medical attention.

Treatment:

Pain relieving techniques.
Correction of biomechanical issues.
Specific stretches for flexibility.
A specific strength and muscle conditioning program.

Archilles Tendonitis/Tendinopathy is a chronic, yet common condition in sports people and recreational athletes. This type of injury does not involve inflammation and is most likely due to a series of microtears (tendinosis) that weaken the tendon. This condition may be coupled with retro-calcaneal bursitis

Risk factors:

A sudden increase in the intensity, frequency and duration of activity.
A decrease in recovery time between activity.
Wearing inadequate or incorrect footwear.
Excessive pronation (force on achilles tendon increases).
Running on hard or uneven surfaces.
Change of surface (seasonal).
Poor muscle flexibility (e.g. tight calf muscles, weak calf muscles).
Decreased joint range of motion (e.g. stiff ankle joint).
Inadequate warm up, stretching and cool down.

Signs & Symptoms:

Mild to severe pain and tenderness in the Achilles tendon area (tenderness may be more noticeable in the morning).
Swelling.
Stiffness that may diminish as the tendon warms up with use.
Decreased strength and movement
Achilles Tendinopathy is graded from 1–4 according to severity.

Treatment:

Treatment includes rest, pain relief, stretching exercises, and changes in sports techniques and footwear to reduce stress on the tendon. Orthoses may alos be prescribed

Ankle sprains – Sprains to the ankle are one of the most common sporting injuries. A sprain is defined as a tearing of the ligaments that connect bone to bone and help stabilise the joint.

Sports requiring jumping, turning and twisting movements such as basketball, volleyball, netball and football; and explosive changes of direction such as soccer, tennis and hockey are particularly vulnerable to ankle sprains.

Risk Factors:

Previous or existing ankle injury especially if poorly rehabilitated (biggest risk factor).
Lack of strength and stability related to the ankle.
Lack of, or extreme flexibility, in the ankle joint.
Poor balance.
Sudden change in direction (acceleration or deceleration).
Increasing age of player.
Poor condition of the playing surface.
Inappropriate, inadequate, or no warm-up.
Wearing inappropriate footwear for the activity.
Lack of external ankle support (taping, bracing) for previously injured ankles.

Morton’s Neuroma Morton’s neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Morton’s neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock.

Morton’s neuroma involves a thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb.
The podiatrist may elicit a ‘clicking sound’ on examination
High-heeled shoes have been linked to the development of Morton’s neuroma. Many people experience relief by switching to lower heeled shoes with wider toe boxes.
Radiological scans will often be recommended for a positive diagnosis

Treatments:

address poor biomechanics with strapping, padding and orthoses
guided cortico-steroid injections, radiofrequency ablative therapy, alcohol sclerosing injection

Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.

Freibergs Disease

Freiberg disease, also known as a Freiberg infraction, is a form of avascular necrosis in the metatarsal bone of the foot. It generally develops in the second metatarsal, but can occur in any metatarsal. Physical stress causes multiple tiny fractures where the middle of the metatarsal meets the growth plate.

Freiberg disease is thought to occur more frequently among pubertal females and among people who have a short 1st metatarsal bone or long 2nd metatarsal bone, which increases stress on the 2nd metatarsal head and joint. The metatarsal joint tends to collapse, and activities that repetitively stress this joint, such as dancing, jogging, or running, may accelerate this process.

Treatment includes:

Immobilization and weight unloading if acute, then modification of footwear
Corticosteroid injections and immobilization may help alleviate acutely painful flare-ups. Long-term management of Freiberg disease may require orthoses with metatarsal bars and low-heeled footwear, possibly with rocker sole modifications, to help reduce stress on the 2nd metatarsal head and joint. Rarely, surgical excision of the metatarsal head may be necessary to relieve recalcitrant pain.

Cuboid Syndrome

Cuboid syndrome is the result of partial dislocation of the bones in the middle of the foot. It is considered an overuse injury most common in runners and dancers.

The following are common symptoms of cuboid syndrome:

pain on the lateral of foot, which is the side of the little toe
pain gets worse with weight-bearing
pain can be dull and aching, or sharp and acute
difficulty walking
hopping is very difficult
possible swelling
pain can be worse when lifting the heel and pushing off the toe

Causes:

Pronated feet

Cuboid syndrome might also be more common in people with pronated feet, which means that their feet turn inward as they walk. When a person’s calf muscles (peroneus longus) are particularly tight, they can tug the cuboid bone out of place when the foot is pronated.

Overuse

The most frequent causes of cuboid syndrome are overuse or injury. This explains why cuboid syndrome occurs most often in athletes and dancers. Overuse injuries tend to develop after frequent extended periods of intense activity, such as running.

Sprained ankle

The injury most likely to lead to cuboid syndrome is an inversion sprain of the ankle. This happens when the ankle suddenly twists inward, although outward twists have also been known to cause the condition.

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