Active Feet

Soccer, which fills huge stadiums the world over, is among the most popular youth sports in the UK. With the increase of soccer athletes, there has been an increase in the frequency of injuries to the foot and ankle.

Soccer requires miles of running - with quick stops and starts - per game. Competition is usually on grass fields, which "give" so players may change direction quickly. It also provides a soft landing surface on which to crash.

The lower extremities - an athlete's steering, accelerator, and braking systems - are particularly susceptible. But with proper conditioning, equipment, and technique, competitors in contact sports have successful, healthy playing seasons.

Foot Health Practitioners, specialists in care of the lower extremities, not only treat injuries athletes and get them back into competition as soon as safely possible, but also help athletes get into a condition that minimises their risk of injury to the foot and ankle.

PREVENTING 'OVERUSE' INJURIES

The time a soccer player spends in an actual game represents only a tiny fraction of time spent in practice, conditioning for competition. Practice involves hours of running, repetitive drills and scrimmages every day.

While conditioning exercises in practice will strengthen and improve flexibility in the lower extremity, the repeated stress of practice may bring on chronic, or "overuse" injuries. These injuries can nag at a player and hamper, if not end, a season of competition.

Overuse injuries also come from faulty biomechanics of the feet - how the lower extremities physically adjust to the ground. If an athlete has "flat" feet, which tend to pronate (out-toe) or excessively high arches, which often supinate (in-toe), extensive running and cutting can produce chronically strained ankles.

Before taking the practice field, it's wise to be examined by a Foot Health Practitioner specialising in sports medicine, who will identify any biomechanical abnormalities that increase the chance of injury. The Specialist  may recommend specific exercises to strengthen and improve flexibility of the foot and ankle, or recommend taping or padding of the foot or ankle before practice and competition. A Specialist may also prescribe orthoses, customized shoe inserts that correct biomechanical problems by redistributing the body's weight.

Proper stretching and warm-up before and after workouts, practice and before games go far to prevent overuse injuries to the supporting structures of the lower extremity. Warm-up and cool-down exercises should take five to10 minutes and should be conducted in a stretch/hold/relax pattern, without any bouncing or pulling. When muscles are properly warmed up, the strain on muscles, tendons and joints is reduced.

MAKING CONTACT

Though technically soccer is not a contact sport, players of any age will tell you that high-speed collisions, kicks in the shin and body contact happens all the time.
The foot and ankle bear the brunt of the crashes, bumps and bruises of contacts sports. Feet get stepped on, kicked, jammed, twisted, and cut. Quick changes in direction and hard tackling can lead to sprains and fractures of the ankle.

Impact or trauma injuries are more serious than overuse injuries, and require recovery time away from the practice and game field. Immediate treatment should include the "RICE" formula: Rest, Ice, Compression and Elevation.

Trauma injuries should always be treated by a medical professional such as a Foot Health Practitioner and be fully healed before returning to the field. Players who lie about how an injury feels, or take pain-killers to play through a trauma injury, are not helping their team by doing so, but rather putting themselves in danger of aggravated or permanent injury.

FOOTWEAR

It's important for athletes of all ages to pay careful attention when selecting any type of athletic shoe including soccer cleats. If heel pain or any other type of foot pain is experienced, consulting a Foot Health Practitioner is recommended. Not only can the Practitioner help you select the proper shoes, but treat any foot problems that may occur.

For adults, cleats are generally a good footwear choice, provided they fit properly. Cleats should be light and flexible. Uppers should be supple and at least a finger's width should separate the tip of the big toe and the end of the shoe. Laces should be tight.

When shopping for cleats, wear the same style of socks you intend to wear in competition. Shop in the afternoon, when the feet are naturally slightly swollen. Investing in proper footwear for a young athlete is much less expensive than medical treatment later.

For children, the design of soccer cleats can contribute to injury in young athletes, according to a study published in the journal "The Foot," the official publication of the Journal of the American College of Foot and Ankle Orthopedics and Medicine.

Many children are playing soccer year-round, often three or more times a week. Over time, the frequency of play could put a young football player at risk for calcaneal apophysitis (Sever's Disease), the most common cause of heel pain in children between the ages of eight and 16. Sever's Disease results from stress placed on the growth plate of the heel bone. Excessive amounts of running or jumping causes inflammation to the growth plate of the heel bone, which causes pain and limits a young soccer player's ability.

The study found that a soccer shoe doesn't have the same shock absorbency quality as a running shoe. A cleated shoe places the foot in a position where the heel is lower than the toes (it's similar to walking uphill). This causes pressure to be focused on the heel, causing stress that can result in inflammation and pain.

ARTIFICIAL TURF

Football is sometimes played on artificial turf, which presents a new set of concerns for an athlete. Some surfaces simulate the texture of grass, and others are little more than carpet. All forms of artificial surface are harder than grass, and makes for a faster pace of play. Cross-training shoes or sneakers are the footwear of choice on artificial turf.

Because the surfaces do not "give" like grass, playing on them may be more hazardous to the lower extremity. Players should be well familiarised with the dynamics of running and changing direction on "turf" before competing on that surface.

Trainers and physicians frequently tape the feet and ankles of their players for added stability, especially on artificial turf. Proper taping can help prevent injuries from occurring, and keep a minor injury from becoming a major one.

INJURIES AND TREATMENTS

Keeping the lower extremity healthy is so important to an athlete that most all professional soccer teams have a team foot practitioner, who treats minor problems like corns, calluses, and blisters, to major injuries like fractures and dislocations. These are the most common injuries suffered in contact sports:

Heel pain - Calcaneal apophysitis (Sever's Disease), the most common cause of heel pain in children between the ages of eight and 16. Sever's Disease results from stress placed on the growth plate of the heel bone. Excessive amounts of running or jumping causes inflammation to the growth plate of the heel bone, which causes pain and limits a young soccer player's ability.

Subungal hematoma - Pressure in the toe box of a running shoe can result in bleeding under the toenail known as a subungal hematoma or "blackened toenail." See a Doctor to help prevent the loss of a toenail.

Turf toe - Turf toe is a painful jam or hyperextension of the big toe. The condition is more common on artificial turf, but can happen on grass as well. Immediate treatment includes the RICE regimen, and wearing a stiffer shoe prevents aggravation of the injury. Splinting the toe or special orthoses can also help.

Ankle sprains - Making contact on a firmly planted ankle can forcibly invert the joint and damage ligaments, resulting in a sprain. Immediate treatment using the RICE formula to reduce swelling is important to quick healing. See a Foot Specialist for any sprain that doesn't show improvement in three days.

Stress fractures - There are two distinct kinds of fractures that require vastly different treatment. Stress fractures are incomplete cracks in bone caused by overuse. Stress fractures heal with complete rest.

Fractures - Fractures are more serious injuries that require immediate medical attention. Casting and sometimes surgery is required to immobilise fractures and set breaks. Requiring 10 to12 weeks for rehabilitation, a fracture or a break essentially ends the soccer season.