Posts for category: Sports Injury

As the sun is shining and kids are finishing with school, children will begin their summer activities which will see kids out on the fields running and exercising. This provides great exercise and enhanced fitness, but unfortunately can lead to injury and some discomfort. One of the most common ailments is a condition known as Sever’s disease or Calcaneal Apophysitis.

Sever’s disease causes heel pain and is a common problem with children between the ages of 8 to 13 years. It is related to physical activity and affects both boys and girls. Pain is felt in the back of the heel. Some shoes may make the pain worse due to pressure on the sore heel. In some cases, there may be pain that wraps around the heel and extends into the arch of the foot. This is due to the anatomy of the area as the Achilles tendon has fibers that extend from the back of the heel to the bottom of the heel where it joins the Plantar fascia that extends along the bottom of the foot.

Sever’s disease is caused by increased shearing forces on the growth plate. This causes mild swelling in the area and pain. Unfortunately, sports activities can worsen the condition. Due to the rapid growth of kids between 8 and 13, muscle flexibility needs to be evaluated. Tight calf muscles can exacerbate symptoms, by adding to the shearing forces on the calcaneal epiphysis.

Also, children who experience this problem seem to be prone to a pronated foot. Walking on the inside of the foot can increase the shearing forces on the physeal plate, increasing pain. Due to this orthotics should be used to correct this problem. Orthotics will limit the amount of pronation and decrease the shear forces on the physeal plate. In addition, stretching exercises are necessary to increase flexibility. Ice also should be used to allay the inflammation.

The doctors at Podiatry Associates are well versed in diagnosing, evaluating, and treating this condition. This condition can be quite debilitating and limit the activity of children which can be quite disheartening especially during the summer time. In addition, physical activity is the cornerstone for good health so let’s keep our kids active and if foot pain limits them. Then I would encourage you to have it evaluated immediately as foot pain can be quite debilitating and typically kids do not grow out of this as some people may tell you. Have a great summer!

By Dr. Marc House
May 14, 2013
Category: Sports Injury

May is National Bike Month and there are many ways you can become involved.

The city of Indianapolis has just recently completed the Cultural Trail. In addition Friday May 17th is bike to work day presented by IndyCog. I personally feel the city has done a tremendous job of making itself a more biking friendly center with great accessibility through an ever expanding network of trails. May is a great month to get out and enjoy the trails, whether you are a new cyclist or experienced rider, pavement or mountain biking.

In general, I tend to recommend cycling to my patients. It is an excellent cardiovascular workout, which is fun and can be done independently or with a group. There is also reduced force across many of the joints in the lower extremity and foot. You can do it indoors or out and enjoy a variety of scenery, which is much more pleasant than wiling the time away on a treadmill or elliptical machine. 

As you start pedaling, there are a couple foot related issues to consider to improve your performance and reduce the risk of injury. Generally speaking there are two cycling specific injuries which are most common and most annoying.

Forefoot numbness and /or pain is probably the most common chronic cycling related issue we treat. The foot, obviously, is the contact point with the cycling pedal, whether you are using a cleat or a platform pedal. However, most of these problems can be easily addressed. In a 2003 study, cycling shoes with carbon fiber soles/shank were shown to induce more stress under the forefoot. The concept is to create greater transfer of energy through the foot, but this can come at a cost. There are options including nylon in lieu of the carbon fiber and a wider toebox to help alleviate some of these symptoms. Pedals with a wider platform distribute the force better than smaller pedals. Regardless of the platform width, you may still get some discomfort if you cycle greater distances. The repetitive nature of cycling with the foot typically locked into one position can exacerbate these issues. Adjusting your foot position on a platform pedal or changing your cleat position can be a simple solution. You may need to experiment with this or consult a fitting specialist for anything but a minor adjustment can affect your cadence significantly. If you have access to a trailer or roller you may find it most convenient to experiment in this more controlled environment. There are several OTC inserts which are cycling specific which may also address mechanical issues which maybe causing the numbness. If these options fail to address your symptoms, it may be time to visit your friendly neighborhood podiatrist, who also happen to be biomechanical experts!

Biomechanical abnormalities, such as a shorter (or longer) limb, bunions, hammertoes, neuromas, etc can all contribute to the problem and can be addressed with an extra insole in the forefoot (up to 1/4 inch if you have enough volume in the shoe), adding washers/shims between the cleat and the shoe or moving the cleat back on the longer leg's shoe. One of the most common underlying problems is a condition known as: pre-dislocation syndrome, which affects the 2nd metatarsal phalangeal joint. This is the joint at the base of the 2nd toe. It is relatively common to have a longer 2nd toe or longer 2nd metatarsal bone behind the toe, which increases the pressure on this area. This can be further worsened by any mechanical instability or bunion deformity, transferring additional force and pressure across the area. The nature of cycling and the contact point of the foot on the bike pedal or cleat further stresses this area causing pain, swelling and sometimes progressive deformity of the toe. The good news is this can usually be alleviated by icing, NSAIDs, and ROM exercises. If this fails to successfully reduce the symptoms, a functional foot orthosis may be employed to redistribute the forces to a more biomechanically sound position. These can be specifically made to your cycling shoes, with minimal additional weight. Occasionally an injection or surgery may be needed for severe deformity. Specific modifications may be employed for any other structural changes in the foot and ankle and to a lesser extent the knee.  Foot orthoses with a forefoot extension can help control excessive internal leg rotation, which can cause knee pain (patello-femoral syndrome/chondromalacia). Keep in mind there are other factors which may contribute to these symptoms such as a seat positioned too low or high, and cycling with too high a gear, can also contribute to knee pain. 

Achilles tendon problems are not uncommon with cyclists, particularly those covering a lot of mileage. The covering of the Achilles, known as the paratenon, can become inflamed from the continuous friction and repetitive stresses. Physical therapy, staying in the saddle and using lower gears can help. Stretching and home exercises as well as a proper warm up period will also help reduce this chronic situation. This may unfortunately progress to tendinosis in which there is thickening and scarring of the tendon fibers, which is more likely fail conservative treatment. Sometime surgery is needed and is very helpful at this point.

Follow a couple simple steps and you can avoid most of the overuse injuries associated with cycling and enjoy a great season in the saddle. If you need our assistance with fit, shoes, or biomechanical analysis, we are just a phone call away and ready to help.

By Dr. Tracy Warner
February 11, 2013
Category: Sports Injury

By now you have committed to your New Year's Resolution Dr. House had blogged about earlier this year and if you were not exercising regularly and have started a new walking or running routine you may be finding your feet are hurting despite getting a new pair of shoes. Dr. Glynn has already blogged about how to pick those running shoes and you have followed her recommendations so the shoe is not an issue, but despite that the outside of your foot and ankle is painful. You also read Dr. Abdo's blog on high ankle sprains and you have not had any direct trauma so it is not that and you read my earlier blog about plantar fasciitis and you may or may not have associated pain on the bottom of your foot. So what is going on?

There are 3 tendons that are on the side and top of your foot and they are responsible for bringing your foot up to help clear the ground and if you have resumed an exercise program or upped your activity they may not like all the extra stress. These 3 tendons are the Peroneal tendons. So what can be done? First it is good to know for sure that that is the problem and physical exam is important. We may check x-rays to look for a fracture and ultrasound to evaluate the tendon for inflammation or tear. Sometimes MRI is also necessary.

Once it is confirmed that you have PERONEAL TENDONITIS, what can you do about it? For any acute or new pain or trauma RICE is important. R is for Rest and that may be from the activity or with immobilization with an ankle brace or boot. I is for Ice. C is for Compression and E is for Elevate. This can help you get through the short term but you need to look at the biomechanics and getting into a custom molded orthotic to give your foot the biomechanical advantage and is important for long term treatment.

Now you may have done all this and still have pain. We do due surgery to clean up the tendon if there is a split and also stimulate the tendon with either topaz, radio colblation therapy, or with PRP, platelet rick protoplasm to help the body heal itself.

You may have to go to physical therapy before or after surgery.

It is important to continue with your custom molded orthotics from Podiatry Associates of IN to help keep your feet healthy, so you may reach your fitness goals.

By Dr. Tarick Abdo
January 31, 2013
Category: Sports Injury

While lateral ankle sprains are the most common athletic injury occurring in sports, high ankle sprains have been responsible for more lost time from game play and training activities. Unfortunately, high ankle sprains are commonly mistaken for lateral ankle sprains, thus they are less commonly reported. 

Misdiagnosing a high ankle sprain can result in lingering pain and recovery as the treatment course is much longer, requiring longer periods of offloading and rehabilitation in comparison to lateral ankle sprains. 

A high ankle sprain refers to injury of the ligaments that join the lower leg bones, tibia and fibula. High ankle sprain injuries commonly occur in collision sports, such as football, hockey, and court sports  such as basketball. The most common mechanism of injury is when the foot is anchored to the ground while being struck to the outside aspect of the lower leg. This forceful twisting injury may be accompanied by an audible pop and the patient’s inability to bear weight after the injury.  

On examination, patients often present with swelling and bruising above the ankle. The most commonly utilized test is the fibular squeeze test which can produce pain at the lower ankle by squeezing the outside and inside aspect of the leg at the middle of the leg.  In addition, your doctor can move the lower leg inward and this can elicit severe pain. At this stage, your doctor will order an x-ray the classic finding is widening of the tibia and fibula at the level of the ankle.  If the x-ray is inconclusive then a MRI scan provides the best confirmation of widening of the lower leg and identify specific syndesmotic ligaments that are disrupted. Treatment is then determined based on the degree of separation and the ligaments that are involved.

In some case where the degree of separation is severe usually greater than 4mm than surgical intervention is necessary to achieve anatomic reduction and can improve functional outcomes and facilitate a quicker return to activity. Without this intervention, patients can have long term pain and instability and develop post traumatic arthritis. Patients with less than 4mm of separation can be managed conservatively with immobilization for 1 week then placement in a double upright hinged ankle brace, known as a Velocity Brace this begins the next phase of rehabilitation. Then range of motion exercises are implemented with low intensity resistance and high repetition.  Gait training and light balance exercises may begin at the patient’s tolerance. The last phase of rehabilitation begins once a patient is able to hop on the injured foot without any pain. Patients then begin more active range of motion and change of direction exercises and can shortly return to full sports activity. 

The key to quick recovery from high ankle sprains is quick diagnosis by an experienced clinician. Then appropriate treatment based on the degree of instability. Most patients make a full recovery and have  no limitations once they return to activity. Hopefully this gives you some insight into this injury.    

By Dr. Tarick Abdo
July 18, 2012
Category: Sports Injury

As school slowly approaches, fall sports have started their early season practices. Specifically, cross country, tennis, and football season will be upon us shortly. Unfortunately one of the most common ailments of the lower part of the leg is shin splints medically known as Medial Tibial Stress Syndome (MTSS). The symptoms of MTSS include shin pain over the inside lower half of the leg. Pain at the start of exercise which often eases as the session continues, but can return the next morning. Mild swelling of the inner aspect of the shin bone, tibia.

The most common cause of shin pain is inflammation of the sheath surrounding the tibia bone known as the periosteum. This results from traction forces on the periosteum from the muscles of the lower leg cause shin pain and inflammation. Shin splints is a form of compartment syndrome where the muscles in either the medial, posterior, or anterior muscle groups in the lower leg swell due to increased activity. As may be seen in cross country, tennis, and football, athletes have not maintained fitness during the offseason and start engaging in high intensity activity. Thus these individuals may need to gradually increase activity and use rest, ice, compression, and elevation to reduce their symptoms.

More typically in my practice, biomechanical factors such as excessive pronation which strains the soleus muscle. This muscle has attachments along the inside of the shin bone. When an athlete excessively or rapidly pronates this places increased stretch on the soleus muscle resulting in pain and even microfractures of the shin bone. Other muscles implicated include the Posterior tibial muscle and the Anterior Tibial muscle. An experience podiatrist can aid in the proper muscle assessment.

In this case treatment is geared toward controlling the abnormal biomechanics, this is done with a custom foot orthosis. A custom foot orthosis requires a gait evaluation to gauge the degree of pronation and any compensation by the leg. In addition, a biomechanic evaluation is done with a custom mold or scan of the foot. Finally, a weightbearing foot x-ray which evaluates the position of the bones of the foot during the stance phase of gait. Furthermore, stretching to increase flexibility of the Achilles tendon helps alleviate symptoms.

Shin splints is a debilitating condition and can become chronic if not managed aggressively and diagnosed early. Thus athletes especially early in the season need to gradually increase their activity, where the proper shoes, and warm-up efficiently to prevent the onset of shin splints. If you unfortunately develop any of the aforementioned symptoms it is imperative that one rest and ice the area; however if symptoms persist, it is imperative that you consult a trained professional. Here at the Foot & Ankle Institute we can help get you back to activity quickly we are trained to evaluate this condition and manufacture a custom foot orthosis quickly so you can return to competition.

Good Luck this season to all the cross country runners, tennis players, and football teams in the Indianapolis Metropolitan area hopefully it will be a successful, injury-free season.

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