SportyFeetEssential foot care advice for anyone playing sports

The Society of Chiropodists and Podiatrists www.feetforlife.org

2 • SportyFeet

Contents

Introduction ................................. 3

Foot health tips for all sportsGeneral advice .............................. 4What if I have an injury ................. 4Children playing sports .................. 5Professor Pod ................................ 5

SportsFootball ........................................ 6Cricket ......................................... 8Cycling ......................................... 10Dancing ....................................... 12Golf ............................................. 14Racquet Sports ............................. 16Rugby .......................................... 18Running ....................................... 20Skiing .......................................... 22Walking ........................................ 24

Footwear AdviceGeneral advice .............................. 26A different sport, a different shoe .... 26Socks ........................................... 26Blisters ......................................... 27

Further Information What does a podiatrist do? ............. 27How to contact a podiatrist ............. 27Useful contacts ............................. 28Contributor biographies .................. 28

SportyFeet • 3

IntroductionFeet have a rough time of it. They carry us the equivalent of five

times around the earth in an average lifetime, yet we give

them less attention then they deserve and, if we play

sports on a regular basis, that just adds to the

battering they get. Fear not though help is at

hand. This guide has been written to give

you general advice on how best to look

after your sporty feet, children’s sporty

feet, specific advice on the 10 most

popular sports, footwear advice,

how to seek specialist advice

and further information

and links. More helpful

information can also be

found on the Society’s website

at: www.feetforlife.org

4 • SportyFeet

Sport demands a lot of our feet, so weneed to take extra care of themPlaying sport regularly is a great thing: it’senjoyable, good for our health, our mind andrecommended by medical professionalseverywhere. However exercise can have adistinctly unhealthy effect on our feet. When werun, our body weight is multiplied up to threetimes, with our feet bearing the brunt of thisstress at every stride (over 1,000 strides per mile,per foot). An average-sized man will process 112tons of weight through each limb per mile.

The demands made on your feet and lower limbscan lead to a range of injuries, including blisters,sprained ankles, torn ligaments, shin splints (legpain), knee pain, lower back pain and other jointor muscle problems (see www.feetforlife.org foradvice on these problems). Added to these arecommon complaints such as corns, callus andathlete’s foot. Asking too much, too soon of yourjoints and muscles can lead to injury. Runningstyle, poor footwear and even minor limb lengthdifferences can also contribute to injuries.

So how do you look after your feet whenplaying sport?As in all aspects of foot care, prevention is thekey. You can look after your feet easily byfollowing these simple rules: • Condition yourself gradually with stretching

exercises for fifteen to twenty minutes beforestarting any activity, and remember to warmdown

• Wash your feet every day, and dry thoroughlyespecially between the toes

• Wear only good-quality, well-fitting socks

• Always use the correct shoe for each sport andsurface

• Get in shape. Being overweight or out of shapeplaces added stress on the feet

What if I have an injury?Rest is best for minor injuries. You can thengradually return to exercise when any pain ordiscomfort has gone. If there are any cuts, washthem and cover with a clean dressing. Leaveblisters unopened, if possible. I.C.E. – ice,compression and elevation – helps with mostminor sprains and strains. If the problem is moreserious, or if you are in any doubt, it is best to

seek the help of apodiatrist. Podiatrists cantreat a number of acuteinjuries, and can also helpprevent injuries developingin the first place. For furtherinformation please see“What does a podiatrist do?”on page 27, and to find apodiatrist in your areaplease see “How to contacta podiatrist” on page 27.

Foot health tipsfor all sports

SportyFeet • 5

Children and SportsAs children take up a particular sport and becomemore active at school, foot and lower limbproblems associated with unaccustomed exercisecan occur. Growth, possible weight gain andincreased exercise contrive to cause a wide rangeof painful foot and lower limb conditions. Thesecomplaints should always be taken seriously anda diagnosis made as soon as possible. Failure torecognise and treat these overuse symptons canlead to long-term problems for the child and aninability to reach their true sporting potential.Most problems can be readily managed by yourpodiatrist (see page 27 to find one in your area)utilising a variety of methods. But the treatmentmay also require periods of rest and a change toeveryday footwear and activity footwear. Often theproblem can be solved with footwear advicealone. Always remember to wear the correctfootwear for that particular sport.

Barefoot activities, ie karate, judo are goodexercise for the foot but also cause problems dueto the foot having a relatively lower heel fromwhat is it is used to.

This puts strain on the arch of the foot and theback of the lower leg. Careful training andpreparation are essential.

If a child indulges in any form of activity, injuriescan occur and there will be aches and painsfrom time to time. Children are no different toadults in this respect but they tend to repair morequickly. Also, they tend not to rest when injuredand need to be monitored carefully. Very youngchildren may regard the problem as the normand not complain. All aches and pains inchildren should be taken seriously andinvestigated professionally, particularly duringperiods of active growth.

Further Reading Looking out for Children’s Feet – Free 28-pagePDF booklet available from: www.feetforlife.org

Professor Pod and the Boots that Bite BackRead all about Professor Pod and the Boots that Bite Back on the Society of Chiropodists and Podiatrists’ website – www.feetforlife.org

You can also download Professor Pod in his football strip and colour him in with your team’s colours. The best entry will win a prize. Seewww.feetforlife.org for more information.

6 • SportyFeet

How playing football impacts on the footFootball can place a great deal of stress on thefoot and the more you play, the higher the stress.There can be a lot of friction involved,particularly when playing on surfaces such asastroturf. A player often stops suddenly andtwists and turns. Likewise, when playing on hardground the studs can result in pressure to thesole of the foot.

Football boots can also be quite stressful on thefeet, particularly as most players wear a tight fitfor better ball control. It is not uncommon for afootballer to suffer with pressure points, corns,callus or ingrowing toenails as a result of footballboots. This is particularly damaging for thosewho are still growing.

Potential problems and when to seekthe help of a podiatristWe would advise anybody actively participating infootball who starts to feel pain in the foot, ankle orheel to seek the advice of a podiatrist soonerrather than later. People tend to persevere withpain, thinking that it will go away. There is a bigdifference between muscular aches from a hardsession and pain that reoccurs after every trainingsession or game, or even pain that is graduallygetting worse. In these situations, it is best toconsult a podiatrist with a special interest inbiomechanics and musculoskeletal problems.

Any signs of pressure such as redness, blisters,hard skin or extra bone developing (osteophyticformation) definitely needs assessing by aprofessional. Areas to check are around the back of the heel, the toes and the base of the big toe joint.

Maintaining healthy feet for footballPrevention is always better than cure. Support yourfeet whenever you can, not only when playing butas much as possible. Toenails should always bekept to a good length, cut straight across and nottoo short – you would not want to miss animportant game due to an ingrowing toenail.

Football ByLindsay A Fitzgerald

Good foot hygiene is essential to prevent anumber of foot problems such as bacterial,fungal or viral infection. These can appear minorbut can result in complications leading to painand even missed training sessions and matches.

Footballers often neglect their flexibility, which can be important in keeping a good posture,maintaining a wide range of motion at all jointsand preventing injury. This is particularlyimportant in those that are still growing. Teenagerscan suffer from excruciating heel pain becausethey have extremely tight hamstrings or calves.Once this flexibility is increased with a stretchingprogramme, their posture improves and theproblem is resolved. Sometimes prescribed insoles/orthoses are also needed to support the feet.

Having good balance and awareness is essentialfor football. This can be improved by increasingthe communication between the feet and thenervous system (brain). This is referred to as‘proprioception’ and can be improved with theuse of orthoses for those with flat feet.

Equipment requiredA good, well-fitting pair of football boots isessential. There shouldn’t be any signs of pressureon the foot after a game or training session. A pairof flip flops is recommended if using communalchanging areas and showers, as this can preventpicking up any infections that can causeunnecessary problems. It is strongly recommendedthat these are used for this purpose only.

Further information on page 26.

SportyFeet • 7

Five top tips whenplaying football1. Stretch, stretch, stretch!

2. Support your feet (good footwear).

3. Good foot hygiene.

4. Look after your nails.

5. Contact a podiatrist immediately if youhave any concern. See page 27.

8 • SportyFeet

Cricket BySimone McConnie

How playing cricket impacts on the feet As with any sport involving running, repetitiousactions can lead to stresses of all kinds. Thereare forces of high impact on the structures of thefeet – the toes, ankles, muscles, ligaments,tendons and the bones that support the feet.These forces can be two to three times our bodyweight so it is easy to appreciate the damagethat can be done. Other stresses may be a resultof ill-fitting shoes and socks.

Potential problems and when to seekthe help of a podiatristLower back pain Pain in the lower back may be an indication ofimproper gait during actions like bowling, or ofstructural limitations such as limb lengthdiscrepancies (one leg longer than the other).

Pain in the toes• Black and blue under the nail (subungal

haematoma) may be a result of an inappropriatefitting shoe; it is not uncommon to cut a hole inthe toe box area, but this is not recommendedas it changes the mechanism/function of theshoe and may result in other problems

• Yellow/green nails: may occur naturally or if anail is partially lifted during a game and, ifuntreated, can result in unwanted bacterialand fungal growth leading to a fungal nailinfection,

• Paraonychia: redness and swelling at the sideof the toe mostly seen on big toes

• Ingrowning toenails: redness and swelling atthe side of the toes sometimes accompaniedby discharges

Pain in the bottom of the foot (arch area)• Plantar fasciitis is very common. The pain can

be mild to severe and is likened to a feeling oftearing under the skin in the arch whilestanding. It is usually noticeable in themornings after rest, but sometimes it can beworse after a game or training session and mayor may not involve discomfort in the heels.

• Retro calcaneal tendonitis is pain at the backof the heel area and may radiate up the backof the leg a little, but not as far up as the calf.

SportyFeet • 9

Pain in the heelHeel pain is sometimes accompanied by archpain but can also occur in isolation. The pain isusually noted in the heel area on standing afterrest and sometimes only noticed after playing.This can be as a result of over use, poorbiomechanics or due to the equipment notfunctioning correctly or being too worn tofunction properly, such as a spike protruding inthe sole of the shoe.

Pain to the side of the foot near the outside ofthe ankleThis problem may be due to rubbing from insidethe shoe, inappropriate shoe fitting or poor landingduring the delivery of the ball while bowling.

Generalised problems Other problems affecting the foot can be relatedto hard skin on the soles of the feet calledcalluses, or corns and verrucae. These usuallypresent with soreness over bony areas under thefoot due to badly fitting footwear. It is importantto remember that when areas of hard skin areidentified, consultation with a podiatrist isessential as it can be easily misdiagnosed to theuntrained eye. If it is a verruca the treatment is

different and needs immediate attention.Verrucasare caused by a virus that gets into the skin andcauses a lesion looking like a corn. However,they are contagious and can be spread so becareful when using communal showers. Customorthotics maybe required to assist with themanagement or treatment of some of theseproblems, consult a podiatrist for advice (seepage 27 to find one in your area).

Five top tips Good foot care is essential to maintaininghealthy feet for the game:

1. Change socks in between games to avoidthe friction incurred by wet socks andbacterial accumulation.

2. Wash, dry and trim toenails regularly anduse a light moisturising cream on your feet.

3. Make sure your foot wear is not too tight,you should be able to wiggle your toes.

4. Check inner soles regularly for any excesswear that can cause damage to feet.

5. Seek professional help for pain, structuralanomalies or other symptoms sooner ratherthan later.

Cycling

10 • SportyFeet

How cycling impacts on the footCycling requires the entire lower body to functionas a harmonious unit and bring sufficient forcedown on the bicycle pedal to move forward. Thistremendous force begins in the hip joint and thighmuscles, and passes through the ball of the foot tothe pedal. As long as the bones, muscles, andjoints of the lower extremity are properly alignedwith each other, there is an efficient and pain-freeexcursion of the pedal. Deviations from thisalignment may eventually cause foot, ankle, lowerleg, knee, thigh or hip pain.

Potential problems and when to seekthe help of a podiatristsEvery day, podiatrists treat cyclists who havesustained overuse injuries by pushing themselvesbeyond their limitations. Here are some of themost common cycling injuries and their causes.

As with all athletic injuries, pain that is persistentindicates a need to seek treatment from apodiatrist familiar with cycling injuries.

Achilles TendinitisIrritation and inflammation of the tendon thatattaches to the back of the heel bone can becaused by improper pedalling, seat height, lack ofa proper warm-up or over training. This conditionis usually seen in more experienced riders and canbe treated with ice, rest, aspirin or other anti-inflammatory medications. Chronic pain or anyswelling should be professionally evaluated.

Knee PainSome intrinsic knee problems like swelling,clicking or popping should be immediatelyevaluated by a sports medicine specialist.Cartilage irritation or deterioration, usually underthe kneecap, can be caused by a biomechanical

SportyFeet • 11

imbalance, improper saddle height or faulty footpositioning on the pedals.

NumbnessImpingement of small nerve branches betweenthe second and third or third and fourth toes cancause swelling that results in numbness, tingling,or burning, or sharp shooting pains into the toes.Wider shoes, or loosening toe straps or shoe lacescan alleviate the problem. If the problem persists,try a clipless shoe system. Numbness or tinglingwith leg pain may represent a serious problemknown as “acute compartment syndrome”, whichrequires immediate medical attention.

SesamoiditisSometimes known as the “ball bearings of thefoot”, the sesamoids are two small bones foundbeneath the first metatarsal bones; the sesamoidscan inflame or rupture under the stress ofcycling. Sesamoiditis can be relieved with propershoe selection and orthoses.

Shin SplintsPain to either side of the leg bone, caused bymuscle or tendon inflammation. This may berelated to a muscle imbalance between opposingmuscle groups in the leg. It is commonly relatedto excessive foot pronation (collapsing arch).Proper stretching and corrective orthoses forpronation can help prevent shin splints.

Equipment requiredBesides selecting a bicycle that meets your specificneeds, proper shoes are the most important pieceof cycling equipment. Cycling shoes must have a

stable shank to efficiently transfer power from yourfeet to the pedals. The lack of shank support insneakers allows the foot to collapse through thearch while pedalling, which may cause arch pain,tendon problems, or burning under the bottom ofthe foot. A rigid shank protects your feet from thestress of pedalling.

Select a shoe that’s right for you among modelsdesigned for racing and mountain biking. For thecasual rider without known foot problems, cross-training shoes provide the necessary supportacross the arch and instep in a shoe that can beused for other purposes. They also provide theheel lift that cycling shoes give. Combinationcycling-hiking shoes meet the needs of the casualrider well and have become popular recently.

Cycling tips1. Carefully choose the shoes you will wear

in cycling.

2. Make sure your bike fits you properly.

3. Warm up properly. Condition yourselfsafely in the off season.

4. To stop pain before it starts, podiatristsadvise stretching the major muscle groupsused in cycling - the gluteals, thequadriceps, calves and hamstrings -before and after getting on the bike. Ridersshould start slowly and work up to normalcadence (rate of pedalling).

5. Ensure the seat is at the proper heightwhen knees are slightly flexed.

Copy reproduced with permission from the American Podiatric Medical Association. www.apma.org and www.ourfootdoctor.com

12 • SportyFeet

It is important for dancers to look after themselvesin terms of their health and appearance. However,prime assets that are often overlooked are the feet.

It is vital for dancers to keep their feet inpremium condition so they can perform to thebest of their ability. Dancers’ feet experienceconsiderable wear and tear in comparison withthe average person, due to long hours spentexercising, training and performing.

The constant pounding of your feet on the hardfloor places immense stress not only on yourfeet, but also your legs and spine, as the feetabsorb the full impact of the dance move.

Common dancer foot ailments Common foot problems amongst dancersinclude: Metatarsalgia, Plantar fasciitis, Shinsplints, Achilles tendonitis, calluses and blisters.

Forefoot pain is very common and is due to theamount of moves that involve loading the forefoot

eg landing on the forefoot after a jump. This inmost cases can be alleviated or avoided withelastic metatarsal bandages or a simple orthotic(insole). This type of device will unload thepressure at the forefoot.

Friction blisters are another big problem fordancers and in severe cases (especially withyoung dancers) can stop them dancing. Theseare caused by your skin rubbing againstsomething - usually a poor fitting shoe. Mostfriction blisters are filled with clear fluid. It is bestto leave most small blisters alone.

To minimise blisters, firstly ensure that your shoesfit correctly. This does not always prevent blisters,especially after a long dance session, but ill-fittingfootwear is the most common reason for blisters. Ifthe blisters persist try wearing two pairs of socksto ease friction against foot or use an anti-blisterfoot cream before putting your socks on. This willmake the skin more supple and able to resistfriction. See page 27 for more information.

Dancing

Copy reproduced with permission from www.foothealthcare.com

SportyFeet • 13

How Irish Dancing impacts on the footIn Irish Dancing feet have a great deal of stressplaced on them, more so than in other dancesports. The majority of the body weight isplaced through the ball of the foot andthe big toe. The tendons and muscles onthe bottom of the foot which support ofthe arch also get frequently strained. Asis the nature of the dancing, thesestresses are often repetitive andtraumatising.

Potential problems andsymptoms to look out forand when best to seek thehelp of a podiatristFour main areas subject to stress are:• Soft tissue: such injuries which are

common are bruises, blisters, strains ofthe muscles (plantar fasciitis).

• Nerve: common injuries are painshooting into the middle three toes(Morton’s neuroma), damaged nervesand numbness (neuropathy).

• Bone: slight breaks of the bone are calledstress fractures.

• Nail: Bruising of the nail and ingrowning nailsare common.

Maintaining healthy feet for Irish Dancing• Use of emollient (foot) cream enables the skin

to retain moisture.• Stretching of the foot and ankle can help

keep the foot flexible. One such stretch isdone using a tennis ball and rolling itbackwards and forwards under thearch. Calf stretches are also very useful.• Cut nails short so they don’t impact

on the front of the dancing shoe,causing damage.

Equipment required• Strapping tape can help supportthe foot if injured.

• Nail cutters are useful if the nail isdamaged

• Ice on standby for swelling.

Focus on Irish DancingBy Robert James Hill

Five top tips whenIrish Dancing

1. Massaging arches in between sets.2. Stretching in between sets as mentioned

above.3. Joint mobilisation, grasping hold of

joints and rotating them (ankle and bigtoe).

4. Shoe padding, protection and orthoticcorrection to aid the support of the foot.

5. Correctly fitting shoes.

How playing golf impacts on the footAny golf professional will tell you that problemswith the feet, even a painful corn or callus, canimpede timing and balance to the point where itaffects the scorecard at the end of the day.

The torque of a golf swing can strain muscles inthe legs, abdomen and back. The fact that thegame is usually played on hilly terrain increasesthese forces, and can lead to injury.

However, a full round of golf adds up to a four orfive-mile workout that can reduce stress andimprove cardiovascular health.

Potential problems and when to seekthe help of a podiatrist If a round of golf is painful on the feet, firstassess the quality of your shoes. Any time pain isnot adequately resolved with good, stable golfshoes and is present for more than two or threeconsecutive rounds, it’s time to visit a podiatrist.They can diagnose and treat any problems andhelp make your feet an asset, not a liability, toyour golf game.

If biomechanical imbalances arepresent, these existing stresses willoverload certain structures, andpredispose the golfer to overuse ofmuscles and strain on ligaments andtendons. Orthoses will equalise the weight loadon the lower extremity and in essence rest theoverused muscle.

Other problems, such as tendinitis, capsulitis,and ligament sprains and pulls can also keep agolf enthusiast in the clubhouse. Improper shoescan bring on blisters, neuromas (inflamed nerveendings) and other pains in the feet. Podiatristssee these problems daily and can treat themconservatively to allow for a quick return to thesport.

When injured, participation is no substitute forrehabilitation. Injured body parts must bethoroughly treated and rehabilitated to meet thefull demands of golf or any other sport. If you areinjured, your return should be gradual. As muchas you may want to get back to your game, takeit slowly.

Orthoses: preventing pain, improving game For the foot that is not able to function normallydue to biomechanical conditions such asexcessive pronation (rolling in) or supination(rolling out), a state of optimal biomechanics canbe achieved through the use of orthoses, customshoe inserts that can be prescribed by apodiatrist. Orthoses not only allow the feet tofunction as they ought to but can alleviate thepredisposition to injury brought on bybiomechanical imbalances.

14 • SportyFeet

Golf

If biomechanicalproblems are present

in your swing, they willinvariably cause symptoms when walking thecourse as well. Addressing biomechanicalproblems in walking may therefore result in thesecondary benefit of an improved swing throughproper foot function.

Equipment requiredOnce driven by fashion, golf shoes were wing-tipoxfords with spikes. Today, shoes are constructedusing basic principles of athletic footwear. Someeven incorporate advanced technologicalinnovations such as graphite shank reinforcements,which keep them light and add strength.

Don’t wear anything on your feet that wouldn’tbe comfortable if you were taking a good longwalk. Make sure shoes fit well in the store beforepurchasing them. It’s best to shop for them inthe afternoon when the feet are slightly swollen.Try on shoes with the same socks you’ll wear onthe course. Tie both left and right shoes tightlyand walk around your store or pro shop for a fewminutes before deciding on a make and model.

Maintaining healthy feet for golfProper warm-up and stretching exercises specificto golf can help in injury prevention. A sportspodiatrist can recommend a suitable warm-upregime.

SportyFeet • 15

Five top tips whenplaying golf1. Start easy and build up your playing

time carefully.2. Don’t forget to stretch regularly,

especially before taking to the first tee.3. Fit your shoes with the socks that you

plan to wear.4. Stretch to alleviate stiffness after a day

of golf.5. Lift with your legs. This applies to

lifting golf bags in particular - bendingat the waist to pick up your bag willstrain your back.

Copy reproduced with permission from the American Podiatric Medical Association. www.apma.org

16 • SportyFeet

How playing racquet sports impacts onthe footRacquet sports players burn a lot of calories onthe court. Their feet get quite a workout too. Thegame requires constant movement: forward andbackward, side-to-side, running, jumping,lunging and sometimes stumbling!With all this pounding that the feet, ankles andthe Achilles and other tendons around the ankleendure, racquet sports can cause a number offoot-related problems for players.

Potential problems and when to seekthe help of a podiatristOne of the most frequently encountered courtinjuries is the common ankle sprain, due to thelateral aspect of these sports. Other court injuriesare more shock-related, such as stress fracturesin the foot or tibia. Stress fractures can be hardto detect and often people will continue to playand delay the correct diagnosis.

If the stress fracture is in the metatarsal bone -the most frequent site - there can be swelling inthe forefoot. But stress fractures can occur in anyof the 26 bones of the foot without manysymptoms. Some are more common than others,but all of them can happen in court sports. Inthe stronger, more dense area of the mid-foot,they can take a long time to diagnose, and if notproperly diagnosed, can lead to devastatingconsequences. Whether competing in courtsports on an organised level or as an amatuer,the foot should not hurt. If pain persists, consulta podiatrist.

Another common injury site is the heel. Heelpain can indicate a plantar fascia injury or bonespur. The plantar fascia is a thin, very strongtissue band that supports the arch of the foot,stretching from the heel to the ball of the foot. Asthe arch falls, the band of tissue is underincreasing tension and the weakest link is wherethe tissue attaches to the bottom of the heel.Over time and with repeated shocks, micro-events can occur and cause the fascia to tearfrom the heel, resulting in bone spurs.

Other problems occurring in any sport that maystress the foot and lower legs are high arches,flat feet, hammer toes, differences in leg lengthand muscle tightness. Wearing the correctequipment can reduce lower leg and foot stress.

Racquet Sports

SportyFeet • 17

Equipment requiredAthletic shoes protect the feet from the stresses ofthe sport for which they are designed. So whenplaying racquet sports, wear shoes made for racquetsports. These shoes will provide stability for side-to-side movement. They are heavier and stiffer thanrunning shoes and the toes are supported for stop-and-go action. Select tennis shoes based oncomfort. Price, brand name and special featuresmean nothing if the shoes do not fit comfortably.

Select sport socks that are designed for racquetsports. They provide additional padding where it isneeded and wick away perspiration. When buyingnew tennis shoes, be sure to try on the socks withthe shoes. The sock’s extra padding can make adifference in how the shoes fit by half a size.Replacement insoles for shoes can also make adifference.

Special shoe orthotics (inserts) may correct abnormalfoot motion and alignment. They can make footmotion more efficient and correct structuralimbalances. Orthotics can also relieve pain andreduce the risk of foot injury. Always talk to apodiatrist first for professional advice to ensure you getthe correct orthotic for your feet. Remember, the rightshoes, socks and foot care will keep your feet healthyand less prone to injury.

ports

Five top tips1. Always warm up: a gentle stretching of

the lower extremities and the Achillestendon will help prevent injuries. Leanagainst a table or wall, placing one footbehind the other. Always roll the weightto the outside border of the foot anddon’t stretch to the point of producingpain.

2. Buy new, high-quality athletic shoesand replace them frequently.

3. Have the proper footgear for the sport;running shoes are not suitable forsports such as tennis due to their lackof lateral support.

4. Seek appropriate support for arches;flat and high arches call for custom-made arch orthotics (inserts) in shoes.

5. For children, be aware of the potentialfor injuries of the growth plate in theheel. Persistent heel pain is more thansimple overuse; kids should stopparticipation immediately and adiagnosis should be sought.

Copy reproduced from www.feetfixer.com

18 • SportyFeet

How playing rugby impacts on the footRugby is a multidirectional, multi-speed impactsport played on various types and quality ofsurfaces, and in every kind of weather. Researchhas demonstrated that the lower limb is the mostfrequently injured part of the body, with excessiveloads being focused specifically about the jointsof the ankle and foot, either through poortechnique (using the “wrong foot” position totackle a player) or more commonly, throughunexpected contact with the ground or anotherplayer (being tackled or going into a ruck ormaul). As a result, rugby injuries are moretraumatic when compared with other sports andspecifically relate to the player’s position.

Front row players in particular are subject togreater absorption and transmission of forces

through the foot in scrummaging and experiencea high degree of knee and cartilage injury, calfmuscle and Achilles tendon problems, lateralankle ligament damage, inflammation or ruptureof the tissue in the arch of the foot (plantarfascia) and stress fractures of sesamoids (smallbones under the big toe joint) and themetatarsals. The incidence of injury in centresand back row players is greatly increased bytackling and usually occurs as a result of directforce. Interestingly, during training sessions,running is the predominant cause of injury forboth forwards and backs.

Potential problems and when best toseek the help of a podiatrist• Injuries incurred during training or playing can

be attributed to two main factors: singletraumatic events resulting in direct injury ormultiple, repetitive, traumatic events thatimpact on joints and soft tissues and ultimatelylead to chronic injury and disability.

• Common injury as a result of direct traumaincludes damage to the nails, ligamentousdamage in particular of the big toe joint(known as “Turf Toe”) and skin lesions such asblisters or haemorrhage. Repetitive injury maylead to heel and arch pain, shin splints ormedial tibial stress syndrome and kneeproblems such as swelling/ locking of the joint.Due to biomechanical mechanisms involved,such types of injury may be more difficult tomanage and rarely respond to standardmethods of sports medicine such as rest, coldand heat treatments, physiotherapy,strengthening, proprioception retraining and

RugbyByKerry Clarke

SportyFeet • 19

rehabilitation. Where these methods areeffective, the results may be short-lived unlessthe underlying faulty mechanics are alsoaddressed.

• The key role of the podiatrist is to identify anyunderlying biomechanical issues and addressthem by means of insole or orthotic therapywhilst incorporating methods of rehabilitativemanagement, such as improving lower legmuscle function as part of the treatmentregime. Such therapy may also benefit theshort-term management of the player withdirect contact injury.

Equipment requiredProtective equipment available includes gumshields, padded headgear and clothing, fingerlessgloves, strapping, grease, support sleeves, shinguards and ankle braces. However, with theexception of mouth protection, there is no solidscientific evidence in support of or against theuse of any protective equipment. Despite the lackof research into protective clothing, suchequipment is generally advocated as apreventative measure against injury and appliesto male and female players alike.

Five top tips whenplaying rugby 1. Wear the correct rugby boot. Get them fitted

properly for your foot type.

2. Use the correct length studs for the playingsurface to minimise falls, joint sprains andstrains.

3. If using insoles ensure they are used correctly– seek the advice of a podiatrist if unsure.

4. Socks and ankle protection - socks shouldalso be well fitted and not too large or smallto increase shock absorption and support. The use of ankle protectors is an importantmeasure in avoidance of stud injuries.

5. Practice good foot hygiene. In rugby, thedemands on the foot are high, so make sureyou maintain them properly.

20 • SportyFeet

How running impacts on the footWhether you are running for fun, fitness orrunning a marathon, you put yourself and yourfeet under great stress. On average, you put sixtimes your body weight through each foot whenrunning, which can emphasise any minor ormajor potential problems significantly!

Potential problems and when to seekthe help of a podiatristPain is the body’s way of letting you knowsomething is wrong. Listen to your body and act on it!

Training can cause normal aches and pains.Something called Delayed Onset MuscleSoreness (DOMS) is a normal response frommuscles repairing themselves after training. Thistypically occurs one to two days after a trainingsession, and only lasts a couple of days. Aninjury is typically something that does not goaway and causes you to stop or reduce yourtraining. The most common injuries for runnersare listed below:

Pain at the front of the knee Referrered to as Patellofemoral pain syndromethis is pain in and/or around the front of the kneeor knee cap. This typically is worse with repeatedbending of the knee (ie running) and going up ordown stairs. The pain is typically non-specificwith little or no swelling.

Pain typically on the outside of the kneeReferred to as Iliotibial band friction syndrome(ITBFS), this is typically an overuse injury with atightening of the band of tissue which runs downthe outside of the thigh and inserts into theoutside of the knee. Pain typically occurs as thefoot hits the ground when running, due to theincreased angle of the leg.

Achilles Tendon painAchilles Tendinopathy is another overuse injury,involving the tendon at the back of the leg andfoot. This can either have a gradual onset orbecome painful after a particularly gruellingsession. Early treatment is ideal with IceCompression and Elevation (ICE), addressing anymechanical abnormalities that are present,leading on to a strengthening programme.

Running ByTom Austen

SportyFeet • 21

Shin splintsKnown as Tibial stress syndrome, this a pain thatoccurs either in the front or inside of the shinwhich typically improves once you have warmedup and then is painful the following morningafter exercise. A mechanical cause in relation tolower leg alignment can be a big influence inshin pain, and this should be addressed.

Heel painOtherwise known as Plantar fasciitis, this usuallyhappens on standing up first thing in themorning or after a period of rest. This improvesas you warm up but then gets worse the moreactivity you do. Podiatrists are in an idealposition to treat this, as orthoses can reduce thestress on the band of tissue under the foot.

All of the above injuries need treatmentIf you think you have one of the above problemsyou should consult a podiatrist. The podiatristcan also assess your ‘mechanics’ - the way yourun or walk and offer advice, stretches orexercises to aid performance and prevent injuryin the future. They will also assess the need fororthoses, which are special inserts that go insideyour shoe to address abnormalities in the wayyour foot works. See page 27 to find a podiatristin your area.

Maintaining healthy feet for running!Keep your feet clean and dry to prevent blisters.Ensure you shower and dry your feet thoroughlyafter you have been for a run, to prevent athlete’sfoot. Change your trainers every 500 miles, toprevent general pain from lack of cushioning orreduction of support. Trainers do not last forever!

Equipment required!It is essential to get the correct footwear, as thisis vital to keeping you injury free and at peakperformance.

TrainersThere are a number of companies that make‘functional footwear’ for running rather thanfashion-based footwear. There is also a multitudeof trainers with differing amounts of support tosuit different foot types. Find a specialist retailerwho can assess your foot properly and fit thecorrect type of trainer for your foot type. See page26 for further advice.

Socks Specialist retailers should be able to advise youon specialist socks that have improved fit, wicksweat away from the foot, prevent blisters andsome even have silver threads to reduce smelland prevent athlete’s foot infections.

Five top tips whenrunning1. Wear the correct footwear. Get these fitted

properly to suit your foot type. Too small andthey can cause black toe nails and blisters.

2. Wear the correct socks to reduce the risks offungal infection and blisters.

3. Warm up before you run.

4. Stretch and warm down.

5. Get fresh and out of those socks! Take atowel and spare socks to change in to afteryour run.

22 • SportyFeet

How skiing impacts on the footIn the cold, muscles take longer to warm up andso you may be more prone to injury whenpractising winter sports such as skiing andsnowboarding. Your feet and ankles areparticularly important in skiing, as they act asshock absorbers and brakes, as well as helpingyou to steer and accelerate when whizzing downthe slopes, and so must be as protected aspossible. Any pre-existing conditions or injuriescan not only compromise your performance, butalso leave you open to further damage to thearea. However, these risks can be minimisedwith the right equipment and training.

Potential problems and when to seekthe help of a podiatristBlistering and bruisingThese are the most common problems faced byskiers, and can be mainly avoided with qualityequipment and good fitting, but cannot beavoided altogether. Not everyone’s feet are thesame and knobbly protuberances in the foot andankle will be prone to bruising and friction,which lead to blisters. The ankle bone, toes, topof the foot and front of the shin are easily rubbedby even the best-fitting ski boot, and anymoisture held against the foot will cause frictionand quickly lead to blisters.

While these sound like very minor problems,bumps and blisters can keep you off the slopeswhile they heal and eat into your preciousholiday time. Do not pop a small blister, but if itbreaks on its own, apply an antiseptic and coverwith a sterile bandage. If you know you are

prone to blistering in a particular area, someskiers advise applying a dab of Vaseline to thearea in question before starting to ski as apreventative measure. Invest in some goodplasters and blister cream before you go.

Foot conditionsSki boots and the physical exertion of wintersports can exacerbate any pre-existing footproblems, such as bunions, and bonyprominences on the inside or outside of the footare prone to rubbing and blistering if your boot isnot well-fitted.

Other conditions, such as diabetes or RaynaudsSyndrome, which both affect circulation and aremade worse by cold and tight-fitting footwear,have to be carefully monitored when skiing. Thebest advice is to consult your podiatrist beforeyou hit the slopes. Chilblains are itchy blistersthat can pop up in cold conditions, usually onthe toes but also on fingers and even on theface. Again, keeping the areas warm and dry isthe best way to prevent them.

Skiing ByRose Brandle

SportyFeet • 23

Equipment required Ski boots are the most important piece ofequipment for skiing, and ill-fitting boots canlead to a host of problems. Ski boots should be asnug fit - if they are too loose, the foot and anklecan slide around inside the boot and thepressure exerted by the constant forward motionand lateral movement of skiing could lead tosprains, strains and fractures. Too tight, and theboot will rub and blister the foot.

The boots must be rigid enough to keep your feetand ankles firmly in place, especially the heel,but should allow your ankle to flex. The toe boxshould be snug but not too tight. You can test thefit by leaning back: your toes should just skimthe front of the boot. To check the general fit,

kick your heel and then your toe against theground while wearing your boot. If your footslides backwards and forwards, the boot isprobably too loose.

Remember that you will be wearing your boots foraround seven hours a day while skiing, so theymust be comfortable. Choose boots carefully,trying on a number of models and wearing themaround the shop before you make your choice.

SocksSocks are part of your insulation from the coldand are crucial in winter sports such as skiing.Good socks will not only help keep your feet dryby ‘wicking’ away moisture from the feet but willalso keep them warm and comfortable withinyour boots. It is essential to take your socksalong when having your boots fitted: thin socksare recommended by podiatrists and skispecialists alike.

Five top tips when skiing1. Choose the right boots - this is essential,

so don’t rush it!2. Wear one pair of thin socks designed for

skiing - don’t layer, and don’t wear cottonsocks.

3. Take a first aid kit with you that containsplenty of plaster and blister cream.

4. Don’t tuck your trousers into your boot.5. Look for ski clothes made of materials that

transport perspiration away from the skin,and waterproof outers to keep you dry.

How walking impacts on the footIn an average lifetime, we walk about 100,000miles, which is tough on our feet. Yet our bodieswere designed for moving not standing still, sowalking is good exercise. Walking helps themuscles and ligaments in our feet to work moreefficiently, and helps keep them supple and flexible.So even if you have to sit around a lot in your jobor at home, try to get up and walk briskly for atleast 30 minutes every day. Feet are adaptable andcan withstand a lot of pressure before they rebel. Ifyou walk a lot, it’s important to wear the rightfootwear which won’t damage your feet.

Potential problems and when to seekthe help of a podiatristWalking at a brisk pace for regular exercise helpscondition the body and improve overallcardiovascular health in the same way runningand jogging do. But compared with running,walking carries a significantly lower risk of injury.Consult your podiatrist if you start to developpain when walking, or consider a visit beforeembarking on your new walking programme.

Walkingand hiking

24 • SportyFeet

SportyFeet • 25

Equipment requiredThe key to keeping your feet healthy andcomfortable, regardless of the type of walking youdo, is wearing properly fitting shoes. When buyingwalking shoes, try on several different brands,styles and most importantly sizes. Your feet canexpand as much as half a size during the day, soshop for shoes in the afternoon or early eveningwhen your feet are at their largest. That will helpprotect them as they expand during your longerwalks. Also, wearing the same type of sockswhen fitting shoes that you wear when you walkwill help you select the right shoe.

To get the best out of your walking shoes, youneed to look after them properly. Polish themregularly and, if they get wet, put newspaperinside them and let them dry out completelybefore putting them on again. It’s a good idea toinvest in a couple of pairs so you always haveone in reserve.

Maintaining healthy feet for walkingIf you are going on a long walk, prepare wellahead. Take your shoes for a ‘trial walk’ and buildup the distance gradually; don’t try to complete theLondon Marathon on your first trip! It’s also a goodidea to pay a visit to your local HPC - registeredpodiatrist who will be able to give advice, and treatany corns or callus you may have. Take some firstaid supplies, like plasters or antiseptic cream, onyour walking trip in case of accidents. It’s also agood idea to put some vaseline between your toesto prevent chafing.

Begin your walk at a slower pace and graduallyincrease the speed of your walk. This will give themuscles, bones, tendons and ligaments thatmake up your feet the chance to get used to theactivity. If you experience any discomfort or footpain, then it may be an indication that somethingmore serious is wrong. We all know that “anounce of prevention is better than a pound ofcure”. In many cases, early diagnosis can preventa small injury from becoming a larger one.

Five top tips1. When buying shoes, wear the same

socks to the store that you will wearwhile walking.

2. Try on at least four or five pairs of shoes.Put on and lace both shoes of each pairand walk around for a minute or two.

3. Good foot care is essential in keepingyour feet comfortable and fatigue andinjury free. See page 4.

4. If you experience any sort of foot pain,consult a podiatrist (see page 27).

5. Before you walk, go through a warm-upand stretching routine.

Copy reproduced from www.walkingconnection.com

26 • SportyFeet

Footwear should be given the same considerationas any other piece of sporting equipment. Sportsshoes should protect as much as possible, bedurable, and should be right for the sport andsurface. If running, the shoe should haveadequate cushioning in the midsole and a flaredheel for stability.

Registered podiatrists will be able to give adviceon suitable footwear. They will be able to suggestsuitable warm up exercises to ease you gentlyinto your chosen sport, and help prevent injury.

Shoes for sporting activities Getting the right shoe really cuts down on thelikelihood of suffering a sports-related injury.Make sure that you buy a shoe that is designedfor the activity you are doing:

Running shoes Running shoes are designed for just that –running! They are very flexible, which enablesthe foot to bend and flex through each step. Donot use for sports such as tennis, basketball oraerobics, which involve sideways stepping.

Cross trainers These are much stiffer and provide greatersupport for the foot when side-to-sidemovements are made, allowing them to be usedacross a range of activities.

Sports shoes Designed for tennis, basketball etc and give acombination of flexibility and sideways support.

Fitness shoesDesigned for aerobics etc, they combine flexibilitywith support and incorporate cushioning tolessen the effect of shock generated during highimpact work.

Quick tips to remember when shoeshopping1. Make sure you can wiggle your toes a little.2. Try on both shoes and walk a few steps to see

if they pinch or rub.3. Leave 1cm of room from the top of your

longest toe to end of the shoe. 4. Feet are usually biggest in the late

afternoon/evening.

SocksGood socks will not only help keep your feetcomfortable within your shoes but will also keepthem dry by drawing moisture away from thefeet. Whatever you do, don’t wear 100% cottonsocks - they hold the moisture against the skin,causing painful blistering. Wool and silk are oftenfound blended with the latest generation ofsynthetic materials. If you find wool too warm orirritating, you could try an acrylic blended sock.

Footwear General Advice

SportyFeet • 27

Socks made with new materials such asCoolMax or DriMax are designed to wick sweataway from the skin, keeping it nice and dry

BlistersBlisters are painful, fluid-filled lesions producedby friction and pressure. They can be causedby the following:• Ill-fitting shoes.• Stiff shoes.• Wrinkled socks against the skin.• Excessive moisture.• Foot deformities.

How to prevent blisters• Keep your feet dry.• Always wear socks as a cushion between

your feet and shoes.• Wear properly fitting shoes.

If a blister does occur, do not pop it.Cut a hole in a 1.5”piece of foam or felt,forming a ‘doughnut’ over the blister; tape the foam or felt in place or cover with a softgel-type dressing. Treat an open blister withmild soap and water; cover it with an antisepticointment and protective soft gel dressing toprevent infection and speed up the healingprocess.

Further readingChoosing a sports shoewww.feetforlife.org/cgi-bin/item.cgi?id=477

Keeping feet healthy for sportspeoplewww.feetforlife.org/cgi-bin/iadmin.cgi?page=16

Podiatry What does a podiatrist do?The role of the podiatrist (also know as a chiropodist)is to prevent or correct deformity and maintainnormal mobility and function. Podiatrists provide thebasis for the ideal walking style and posture andidentify any medical or surgical condition that mayrequire further referral and management. They alsorelieve pain, treat infections and skin, nail, soft tissueand connective tissue problems. This is done inconjunction with other members of the health careteam. Podiatrists can also give expert advice onfootwear, so it is a good idea to take a pair of shoeswith you when you next see your podiatrist.

How to contact a podiatristTo find a local podiatrist, you can either approachyour GP practice for information on an NHS referralor if you decide to see a private podiatrist you coulduse the following link on the Society’s web page:www.feetforlife.org/cgi-site/chiropodist.cgi

Become a podiatristWorking as a podiatrist can be exciting andrewarding. It involves working in a variety ofenvironments with a number of other health careprofessionals and many different groups of patientswho have a wide range of podiatric problems. Thescope of practice of a podiatrist is often muchwider than many people realise. The work falls into four key categories: • General Clinics• Biomechanics• High Risk Patient Management• Surgery

Please visit www.feetforlife.org and click on thecareers topic for full details of this fulfilling career.

28 • SportyFeet

Feet and Podiatrywww.feetforlife.orgwww.diabetes.org.ukwww.podiatrypages.co.ukwww.epodiatry.comwww.apma.org (US site)www.patient.co.uk/showdoc/306www.myfeet.comwww.csp.org www.sportex-medicine.com

Sportswww.thefa.com www.badmintonengland.co.ukwww.britishcycling.org.ukwww.disabilitysport.org.ukwww.lta.org.uk www.netfit.co.ukwww.ramblers.org.ukwww.runnersworld.co.ukwww.rfu.comwww.trymysport.co.ukwww.ukathletics.org

Please visit www.feetforlife.orgfor may more sports and podiatrylinks.

Contributor Biographies and Contact DetailsFootballLindsay A Fitzgerald has a Masters Degree (MSc) in Sports Injury andTherapy, is currently studying at doctorate level at The University ofSalford. In October 2005 she took on an extended scope role asmusculoskeletal podiatrist for Knowsley PCT.Her particular area of interestis in the treatment and prevention of sports injuries. She works for theFootball Association , biomechanically screening the women’s footballsquad and prescribing orthoses for those players that require them andworked as the senior team's podiatrist throughout the Europeanchampionships (2005).

Contact details: Lindsay Fitzgerald BSc (Hons) MSc MChs, AXIS Podiatry,PO Box 98, Manchester, M30 0XW, tel: 07768 176669. www.axis-podiatry.co.uk

Running Tom Austen has provided Podiatry & Chiropody services at four LondonMarathons; was in the athletes village at the Commonwealth Games 2002;has worked with Gillingham FC and also works with Kent County Cricketers.

Contact details: Thomas Austen BSc (Hons) Podiatry MChS, Podplus Trackside Shop & Clinic, The Julie Rose Stadium, WillesboroughRoad, Kennington, Ashford, Kent, TN24 9QX, Tel: 01233 66085, E-mail: tom.a@podplus.co.uk Web: www.podplus.co.uk

RugbyKerry Clarke is Lecturer in Podiatry at the University of Ulster and is anAssociate Member of the Sports Institute Northern Ireland, running regularpodiatry clinics for elite athletes across a number of disciplines includingrugby, athletics, hockey, and gaelic football. Kerry has previous experienceas specialist advisor in sports medicine to Northampton Rugby FootballClub and the All England Netball Team and for the last five years has beenSports Injury Specialist to the Irish Rugby Football Union, Ulster Branch.

Contact details: University 0f Ulster Clinic (UU Clinic),kj.clarke@ulster.ac.uk, tel: 028 9036 8098

SkiingRose Brandle is a freelance journalist and editor who is currentlyseconded as the Editor or the Society’s Journals. She specialises ingeneral, business and health journalism and can be contacted at:rosybrandle@yahoo.co.uk

Cricket Simone Lorde is a UK trained Podiatrist who has been practicing inBarbados for the last 12 years. She has a keen interest in SportsMedicine, is a recent past treasurer of the Barbados Sports MedicineAssociation, and member of the American Association of Podiatric SportsMedicine. She has played an active role in assisting in the Podiatrymanagement of members of the Barbados and West Indies Cricket teamsworking closely with the other members of the team especially thephysical therapist.

Contact details: Simone Lorde BSc Pod Med, Comfeet Clinic, Suite 1B, Pine Medical Center, Belleville, St. Michael, Barbados, BB11114. Tel: 246 436 6030 Email: comfeet@caribsurf.com

Irish DancingRobert James Hill DpodM.,DCh,SRCh., BSc(Hons). Droitwich SpaHospital, Worcestershire. 01905 794793

Useful contacts

The Society of Chiropodists and Podiatrists, 1 Fellmongers Path, Tower Bridge Road, London, SE1 3LY, Tel: 0845 450 3720 • Fax: 0845 450 3721Email: enq@scpod.org • www.feetforlife.orgCopyright © 2006 The Society of Chiropodists and Podiatrists

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