Doing too much of a good thing can cause foot and ankle injuries.
by The Iowa Clinic on Thursday, June 25, 2015
Your Local Health | Written by BJ Towe
There's little more invigorating than being active outdoors, especially when ideal weekend temperatures beckon you to do something you don't do most other days, which might include going for a long walk, running, or playing a rigorous game of soccer, softball, or baseball. But beware: Because your foot bears tremendous forces — sometimes more than 20 times your body weight — doing too much too soon can lead to overuse injuries and sideline you for months.
“We see an uptick in foot and ankle injuries when the weather warms,” says Eric Barp, D.P.M., a Foot and Ankle Surgeon with The Iowa Clinic. “On the weekends, people who want to get out and enjoy the weather do things they aren't used to doing; they go from zero to 100 all at once. They haven't prepared themselves for the sudden change in physical demands, and that can lead to injury.”
Overuse injuries usually start small: Minor aches and pains result from rapid increases in exercise intensity, duration, or frequency. Without rest and proper treatment, those tiny aches and pains can evolve into much more severe injuries.
The No. 1 Foot Problem for Kids
Among pre-pubescent youth, Dr. Barp sees Sever's disease more than any other foot- or ankle-related problem. It stems from repetitive stress to the heel that leads to swelling of the growth plate (which helps bones grow). Although painful, this condition exists only while a child is still growing and does not have long-term effects.
“Sever's disease doesn't go away on its own and can affect the youth's ability to play sports to his or her full potential,” Barp says. Treatment usually involves taking Tylenol® and wearing heel cups, which can be purchased over-the-counter.
Barp adds that too many kids are involved in multiple sports all at once: “To help prevent injuries, kids really need to get adequate rest in between sports activities.”
In fact, the American Academy of Pediatrics Council and Sports Medicine and Fitness recommends that children play only one sporting activity per season to a maximum of five days a week, with at least one day off per week. Further, the Council recommends children play a mix of sports through the year to reduce injuries, extend the length of play, and improve performance.
Adults & Weekend Warrior Syndrome
Adults who have “Weekend Warrior Syndrome,” or WWS, are enthusiastic about participating in a sport or activity but don't have enough time to adequately train for it. When given the chance to participate, they do so at full throttle.
This can lead to injuries such as tendonitis and stress fractures.
“Whether it's running, biking, or working out in a fitness center, you can't expect to do it for an hour without having worked up to it,” Barp says.
He advises adults to rest from any given rigorous activity for a full 48 hours between workouts. “It's also wise to cross train and do strength training. Many runners feel they need to run to have a good workout; that's just not the case,” he says.
Many of the patients seen in The Iowa Clinic's Foot & Ankle Surgery/Podiatry department have tried to run or exercise through the pain. “This can cause further injury,” Barp says. “Tendonitis can lead to a tendon rupture; a stress fracture can become a full bone fracture that requires surgery.”
At the first sign of foot or ankle pain, back off what you're doing, give it a day using the RICE self-care method (see chart below), and if symptoms persist, seek medical care.
“The foot bone's connected to the ankle bone…”
If you have foot pain, it may be related to the back, the hip, the knee, and other parts of the musculoskeletal system “Even evaluating the arm swing could show weakness in the abdominal muscles which could ultimately affect a runner's foot mechanics,” says Tara Reinders, a Physical Therapist with The Iowa Clinic who regularly helps identify factors that contribute to foot and ankle injuries.
“In physical therapy we do a thorough musculoskeletal evaluation of our patient's whole body to identify specific impairments related to muscle length, strength, and mobility because frequently an individual will have more than one joint that is involved,” she says.
“It's hard to convince long distance runners that they need to rest between long and or intense runs for at least 24 hours. During that time they would benefit from some type of strength training twice a week focusing on the abdominal, hip, and thigh muscles,” Reinders adds.
What about those minimalist shoes?
Spawned by Christopher McDougall's bestselling book, “Born to Run”, the theory behind the minimalist running shoe craze is that runners perform better running barefoot or with shoes that are barely there. Barp disagrees: “We've worn shoes since we first started to walk; our feet are not accustomed to running without support. Experience shows us that minimalist shoes actually create more injuries.”
It's not only important to wear shoes, but it's also important to wear shoes that have been fit to your foot's characteristics. Retailers specializing in athletic shoes know which shoes are best for flat feet, high arches, and specific sports. They also allow customers to try the shoes out before buying.
Reinders recommends getting new shoes every 300 to 500 miles.
“If you're a runner, have two pairs and let your shoes rest for one day,” she says, adding that it takes about 24 hours for the core in the back of the shoe to recover.
Bursitis — inflammation of the small fluid-filled pads (bursae) that act as cushions among bones and tendons near joints
Achilles tendinitis or tendinosis — involves the soft tissues in and around the Achilles tendon, which connects the calf muscles to the heel bone
Sever's disease, also known as calcaneal apophysitis — in youth, inflammation of the growth plate in the lower back of the heel
Stress fracture — a tiny, hairline crack in the bone
Plantar fasciitis —inflammation of the broad, flat ligament that runs across the bottom of the foot and connects the heel bone to the toes
Metatarsalgia — inflammation in the ball (front) of the foot
- Achy or stiff heel or ankle joint; pain when moving, pressing on the bursa, wearing shoes, and/or during activity
- Mild ache in the back of the leg or above the heel after running or other sports activity
- Heel pain, mild swelling, and difficulty walking
- Begins as minor pain in a localized location and worsens with time; possibly swelling around the painful area.
- Stabbing pain that usually occurs with first steps in the morning.
- Pain and inflammation in the ball (front) of the foot.
- Usually caused by repetitive motions
- Repetitive or intense strain on the Achilles tendon; common in athletes who suddenly increase the intensity or duration of their activity
- Stress and pressure on the heel
- Repetitive striking of force, such as jumping up and down
- Common in runners, people who are overweight, and those who wear shoes with inadequate support
- Activities involving running and jumping, or wearing shoes that don't fit well
In their early stages, most overuse injuries respond well to the “RICE” approach, which involves four elements of care:
- Rest – Don't put weight on the foot until the pain is gone or nearly gone.
- Ice – Apply ice (wrapped in a towel) to the injured area for 15 minute intervals.
- Compression – Wrap the injured area in an ACE bandage (not too tight).
- Elevation – Raise and keep the foot above the level of the heart.
More severe injuries may require pain relievers; heel cups, splints, or crutches; physical therapy; steroid injections; and occasionally surgery.
Physical Therapy Restores Foot Health
For the past 15 years, Linda Ordway, 73, and her friends have walked three miles a day, six days a week. Like many devoted athletes, Ordway tends to exercise through pain. So last October after stepping in a hole and severely injuring her foot, she kept on walking — although not quite as far.
“That was silly,” says Ordway, whose injuries didn't heal on their own. By March, Ordway realized she needed medical care and saw Linda Bratkiewicz, D.P.M, at The Iowa Clinic. “That was the best thing; 'Dr. B' is an absolutely wonderful physician.”
After evaluating Ordway's injuries, which included three broken toes, Dr. Bratkiewicz referred Ordway to a series of six appointments with Tara Reinders of the Physical Therapy Department.
Improvement came quickly. By May, the therapy and prescribed exercises had significantly reduced Ordway's swelling and pain, and she was back walking three full miles every day of the week, except Sunday.
Reinders explains that physical therapy varies by patient and can include joint mobilization, soft tissue mobilization (ASTYM, myofascial release, foam rollers), strengthening, stretching, and neuromuscular re-education specific to the patients musculoskeletal impairments.
“Physical therapy made my recovery much faster,” Ordway says. “I don't think I'll quit doing my exercises. I'm walking better and feeling more confident.”