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Stay on your feet

Tuesday, September 11, 2018

Sportspersons often bear the brunt of repetitive pounding and succumb to foot and ankle injuries, but adequate warm-up and care can help, says Dr Pradeep Moonot

Health is one of the major concerns for sportspersons who are most of the times prone to some or the other kind of injuries. And due to the repetitive pounding of the game, players have to endure its brunt.

The most common injuries are related to the foot and ankle, and the condition may take a while to recover.

Heel pain

One reason for this could be if players undergo training without proper warm-up. This is the most common and the severest form of pain any sportsperson may face:

Plantar Fasciitis This is acute pain in the thick tissue (Plantar fascia) at the bottom of the foot that connects the heel bone and toes, which occurs when this tissue becomes swollen or inflamed. Ignoring this pain may result in chronic heel pain and can also change the way of walking. Also, people with very flat feet or very high arches are more prone to plantar fasciitis.  If a person has a flat foot or weak and misaligned first toe, the pain is almost sure to occur. Weak foot muscles with high arch can contribute to this, which also leads to tight and shortened calf muscles.

Achilles Tendonitis Achilles is the large tendon connecting the two calf muscles with the back of the heel bone. Heavy pain is felt in the heel when this tendon is ruptured and it can lead to ankle pain as well. This may be caused due to overuse, excessive running without warm-up.

Shin pain

This happens in the front and inner aspect of the shin due to imbalance between the calf muscles and the muscles in the front leg, which causes calf pain. This happens as a reason of inadequate stretches and over-pronation (inclination of the foot towards the ground).

Stress fracture

It is a tiny incomplete crack in the surface of bone found usually in the lower leg of the foot. It is caused when there is a sudden increase in the volume of training. Stress fractures can be present in any of the bones comprising the foot, but fractures occur most typically in the metatarsals.  

What should be done to relieve pain?

Pain in the knee and heel should never be ignored. Consult a knee, foot and ankle surgeon immediately if any of the above symptoms persist after one or two weeks of rest along with basic ice treatment. 

As the doctor will examine and confirm the required treatment.

You may require further investigations like blood tests and x-rays. Blood tests may show low haemoglobin, iron levels or vitamin D3 levels. X-rays may show stress fractures of the metatarsals or the leg bone (tibia). Heel pain may be because of a stress fracture of the calcaneum.

If the x-rays are normal and pain persists, an MRI may be required to assess the extent of the damage. This will also help in the assessment of the knee pain.

Medications If your condition has developed recently, anti-inflammatory/ analgesic medication (in tablet form), coupled with heel pads may be all that is necessary to relieve pain and reduce inflammation. Stress fractures will require rest, analgesics and supportive treatment like a plaster or a walker boot for four to six weeks.

Non-surgical treatment Along with rest, ice and compression, medical treatment is required to correct and abnormal blood levels like low haemoglobin and vitamin D levels.

Exercise and stretching In case of heel pain, stretching is the best treatment as it helps to try to keep weight off your foot until the initial inflammation goes away. You can also apply ice to the sore area for 20-30 minutes several times a day to relieve your symptoms. Home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treatment and reduce the chance of recurrence.

In case of the knee pain, hamstring stretches and stretching of other tight muscles is an important part of the treatment. A supportive knee cap which reduces pressure on the knee cap may help.

Surgical treatment

Sometimes if the pain is not relieved by non-surgical methods or in athletes, surgery may be required for fixation of the stress fracture or knee keyhole surgery (arthroscopy) for knee pain or the release of the IT band.

Dr Pradeep Moonot is a specialist in knee, foot and ankle and Sports Medicine, Breach Candy Hospital

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