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More serious than athlete’s foot

Sportspeople with atypical feet, like a very high arch or flat feet, are at greater risk of injury if they do not take extra caution. Medical student Vanessa Mercieca highlights some common problems.

There is no doubt that the demands on athletes’ feet are high. Biomechanics, which is the study of our feet’s structure and its motions, clearly shows that sportpeople with atypical feet, for example having a very high arch or flat feet, can increase the risk of injury. Therefore it is imperative that athletes have optimum foot posture. Athletes having abnormal foot structure should practice extra caution as they are at greater risk for injury.

Jogger’s heel

A common condition which is caused by incorrect foot posture and function is plantar fasciitis which is also known as heel pain or ‘jogger’s heel’. This is a painful disorder which involves the plantar fascia. The plantar fascia is a thick band of connective tissue that extends from the heel to the middle toe bones. It supports the arch in the foot and can be likened to a shock-absorbing bowstring.

Plantar fasciitis occurs when the fascia starts to degenerate due to frequent strains and repeated stress which start to take place as time goes by. These tiny tears will cause the fibres of the fascia to break down, resulting in inflammation and pain at its attachment to the heel bone causing severe distress.

People with high arches or very flat feet tend to put their plantar fascia under stress. People having high arches lack the flexibility required to properly shock absorb so that the plantar fascia is under extra pressure. Over-pronation, which happens when the feet roll too far in while walking or running, is also a problem as its range flattens the fascia and strains it.

Prompt medical attention is crucial with any ankle sprain

Plantar fasciitis can be particularly resistant if not tackled at the earlier stages. Symptoms of foot, knee, hip and back problems may arise because the disorder will cause the person to change their gait in order to prevent further strain on the fascia.

Ignoring it may result in chronic heel pain that hinders regular activities. If the plantar fascia continues to be used in the setting of plantar fasciitis, the plantar fascia can rupture.

Ankle sprains

The ankle is a flexible joint which contains ligaments that help the bones in the joint remain together. These provide stability to the ankle joint as they limit side-to-side movement.

Ligaments are elastic structures and are used to stretch within their normal limits and then go back to their normal positions. However, when the sole of the foot turns excessively inwards, the ligaments on the outside of the ankle are forced to stretch beyond their normal range which results in an ankle sprain.

Ankle sprains are extremely common in sport, especially in those which involve lots of side-to-side movement. The risk of incurring a sprain is greatest when the athlete’s heel posture is slightly turned towards the inside, making it easier to turn on the ankle.

Prompt medical attention is crucial with any ankle sprain. This is important because ankles which have not properly healed and straightened are more likely to suffer from repeated strains, leading to chronic ankle instability. This is a condition marked by permanent discomfort and instability, a feeling that the ankle is ‘giving away’ causing chronic pain.

Athletes should always make sure that their footwear has the correct arch support and the appropriate cushioning

Possible complications also include loss of positional sense, also known as the loss of proprioception. This is the ability of the ankle to sense position, location, orientation and movement. There may be imbalance and muscle weakness which increases the likelihood of a re-injury.

It could also be the case that a more severe ankle injury may have occurred along with the sprain. This might include a serious bone fracture which if left untreated could lead to complications. Rehabilitation for ankle sprains is very important as long-term consequences include long-term joint pain and weakness.

Athletes’ feet are subjected to an inordinate amount of stress. They should always make sure that their footwear has the correct arch support and the appropriate cushioning. Their doctor can also recommend orthoses which can be custom made to correct and control any biomechanical imbalance as well as provide adequate support to muscles and ligaments. Prompt medical attention should always be given to any injury as it may have serious long-term repercussions.

Neuromas

Abnormal foot posture can also give rise to neuromas. A neuroma is a thickening of the tissue which surrounds the nerve. As a result, this thickening will compress and irritate the nerve, causing it to enlarge and bringing on a sensation of tingling and pain. This enlargement can result in permanent nerve damage.

The most common neuroma in the foot is called Morton’s neuroma and usually occurs between the third and fourth toes but it can also occur between other toes.

Female athletes are much more prone to develop Morton’s neuroma than their male counterparts, especially those who have flat feet. Females who wear high heels to go to work force their feet into shoes which cause the toes to squeeze together and unwanted pressure to the forefoot.

This is especially worrying if they have other biomechanical deformities such as bunions and hammertoes, which bring about instability around the toe joints, leading to the development of this condition. People who excessively pronate will compensate by flexing their foot in an upward direction subsequently irritating the nerve.

Morton’s neuroma can make walking difficult and uncomfortable. Athletes with this foot condition will not only be unable to practice their sport well but may also have trouble with activities that put pressure on the foot, such as pressing the gas pedal while driving. Wearing certain types of shoes, such as high heels, will also cause discomfort.

When symptoms become more intense and the damage becomes permanent, then surgery would be required to remove the inflamed and enlarged nerve.

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