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Published in NorthEast Tennis Magazine Summer 2006

 

NorthEast Tennis Magazine
Summer 2006

By Lonnie Resnick, DPM

Foot Injuries

Does foot pain prevent you from playing at the top of your game?

orthoticsWhen exercising or conditioning your body, do you ever include your feet? Agility, quickness and balance in tennis are all dependent on healthy and proper functioning feet. As strange as it may sound, a basic knowledge of foot injuries and how to care for them can provide many more hours of enjoyable, pain-free tennis.

Heel and Arch injuries

The most common injury near the heel is called "plantar fasciitis". The plantar fascia attaches from the heel bone to just behind the toes. It's a cord-like structure that stretches as the arch collapses. In cases where it's repeatedly stretched, injury may occur to these
fibers. You'll feel the pain at its attachment to the heel or in the arch area. Often, the pain is worse after sitting and then standing up - this can be a very debilitating injury.

Prevention involves stopping the motion of hyper-pronation (excessive flattening of the arches). This is best done by replacing tennis shoes before excessive wear occurs. When purchasing tennis shoes, look for a model with a significant built-in arch. Some people may need to add an over-the-counter arch support or a custom-made orthotic to control their hyper-pronation. Stretching your calf muscles and/or using night splints can also lower your chances of developing plantar fasciitis.

If symptoms occur, treatment may include a combination of anti-inflammatory remedies and reducing hyperpronation. Icing, non-steroidal anti-inflammatory medicines, physical therapy and massage are examples of ways to reduce the inflammation. New shoes, tapings, over-the-counter arch supports or custom-made orthotics are ways to reduce hyperpronation. A decrease of activity also helps allow for healing.

Mid-foot Pain

foot1Tennis players are prone to pain under the balls of their feet due to the amount of "bouncing" and pounding in that area. There are five metatarsal bones which bear almost all the weight when standing in a ready position alone. A high-arched foot type is more prone to injury in this area. The soft tissues (ball of the foot) below the metatarsal bones are prone to inflammation from the repeated trauma. This will make weight bearing painful.

X-rays may be necessary to rule out a stress fracture -x-rays can also tell the length and position of each bone, which can explain why one bone becomes stressed from excessive pressure. In most cases of stress fractures, a removable walking boot and rest is all that is needed to heal. If the injury is isolated to the soft tissue at the ball of the foot, the approach is a combination of therapies to reduce the inflammation as discussed above and an effort to disperse the pressure. The latter is done by increasing the arch support so that the arch will bear more weight. A "metatarsal" pad placed under the shoe insole just behind the ball of the foot may also disperse the weight.  Prevention tips? The best approach is to take action at the first signs of pain. Replace worn down sneakers ASAP. Begin icing the area about 15 minutes after playing, and again in the evening. Consider adding a metatarsal pad. Finally, see a local podiatrist if pain persists.

Pain along the tops of the feet

Pain across the top of the feet is very common - due to the many positions the foot goes through while playing. Tendons may work overtime to continually reposition the foot. This excess strain on the fibers of the tendons can lead to tendonitis - a condition more common in players with "fallen" arches. The pain is usually felt while active, and not while resting. Since this injury is most common in people whose feet flatten out excessively, arch supports, along with sneakers designed to control hyper-pronation (the flattening motion) are effective in prevention. Rest, ice, elevation, compression, physical
therapy and anti-inflammatory medicines are a few of the treatments.  Another area on the top of the foot that often becomes painful is the  big toe joint known as the "first metarsal-phalangeal joint". During tennis, the big toe can become hyperextended, causing a jamming of the joint and injury to the surrounding soft tissue, causing pain just behind the big toe. This, again, can be treated with rest and the anti-inflammatory remedies.

Blisters

Blisters come from a rubbing force combined with moisture. Tennis players, naturally, are prone to both of these conditions. Obvious prevention: try to limit both friction and moisture! Friction can be limited by wearing proper-fitting shoes and athletic socks. Socks should fit the foot snugly, but not too tightly. Be careful to avoid socks that bunch or have prominent seams. Moisture can be controlled by applying a thin coat of powder, or even an anti-perspirant spray. Painful blisters are treated by draining with a sterile needle; antibiotic ointment is then applied and the area is covered with a sterile bandage. Once treated, the player must correct the source of the friction. Do not "de-roof" the blister - you'll only increase the odds of infection. If a blister is not painful, simply cover with a band-aid or gauze to alleviate the friction.

Toenail injuries

The consistent stop-and-go motions of tennis lead to a repeated trauma of the toenails.  Many tennis players experience discolored, painful toe nails. Pressure on the nails can result in a jamming effect at the back of the toenail or a loosening of the nail with a resulting bleeding under the nail (subungual hematoma). This injury needs to be drained to alleviate the pressure and pain - sterilizing a needle with heat and slowly creating a hole in the nail to allow drainage of the blood is the best way. If toenails become loose or partially torn, it's best to use a bandage to hold the nail in place until the nail can be
properly reduced or avulsed. Throbbing along the side of a toenail associated with redness and swelling often is an ingrown toenail. In this condition. the nail may actually push into the skin. Ingrown toenails can be a result of the nail growing improperly, or from the flesh along the nail border being pushed into the nail from ill-fitting footwear.  Players are prone to this condition due to the "stop and go" and "side to side" motions of tennis resulting in shoe pressure on the toes.

Prevention consists of properly-fitting shoes and maintaining the toenails at an appropriate length. The nail should not protrude beyond the flesh at the end of the toe. It's also advisable to cut the nails straight across. However, if a portion of the nail is growing into the skin, that corner of nail will have to continuously be cut back.

Treatment of ingrown toenails requires avulsion of the offending portion of the nail.  Sometimes it becomes necessary for the podiatrist to apply acid to destroy the nail root or remove the entire border of nail utilizing local anesthesia. That border of the nail will never grow again. The absence of the nail border has no affect on the function of the toe.

Preventing foot injuries

The following list should be helpful in preventing foot injuries: Always wear properly-fitting tennis shoes.  It is helpful to buy your sneakers from an athletic shoe store where the employees are trained to fit you with the correct- fitting shoe, as well as the brand and model to fit your level of play.  Look for areas of redness, swelling, blisters or irritation on your feet. Check between the toes as well. Use a mirror for the bottom of the feet if you're not flexible enough to view it.  Keep toenails relatively short and cut them straight across. Observe the toenails for any changes in color or shape. Dry your feet thoroughly after they get wet for any reason.  Seek over-the-counter arch supports or custom-made orthotics if foot pain comes on without a history of injury. Visit a podiatrist for a foot exam. Be sure to let him or her know you are a tennis player. A podiatrist often can see signs of problems before symptoms begin. It is much easier to treat conditions early on.

Remember:  prevention is always the best treatment!

Dr Resnick maintains a podiatry practice in Norwalk, Connecticut.