Foot Injuries

Q. I have a problem with bruised toes caused by sudden stops on the court. Do you have any recommendations?

A. You need to buy a shoe with a wider toe box. Perform your tennis movements in the store before you purchase the shoes to make sure that your toes have adequate room.

Q. What recommendations do you have for treating and preventing tarsal navicular stress fractures in the foot?

A. Stress fractures are related to overuse and are most commonly seen in long distance runners, soccer and track athletes. Navicular stress fractures are disabling and very difficult to treat.

Some navicular stress fractures are resistant to traditional, conservative treatment methods - which typically involve not putting any weight on the foot for 2-4 weeks, followed by a period of time of partial weight bearing when the foot is in a boot (exact durations vary from physician to physician and the amount of healing that has occurred).

Keep in mind, recovery is usually very slow (can take up to several months) and if conservative management is unsuccessful, surgical intervention may be indicated.

Stress fractures can be avoided by using proper training protocols that incorporate rest and are designed so you do not increase your workload too rapidly.

Consider the intensity and frequency of your tennis play, especially when coming back from an injury, and look to play on clay if possible which will reduce the pounding your feet and legs take.

Q. I am wondering what you recommend for the prevention and care of blisters both during and after a tournament. My 15 year old has been experiencing problems with blisters that develop during a tournament. How do you care for them to allow continued play and prevent them in the future?

A. To prevent blisters, I have several suggestions. First, don’t wear new shoes during a tournament. Break them in slowly by alternating new shoes with older ones during practices. Make sure the brand of shoe fits properly and is not too tight. Another suggestion is to try wearing 2 pairs of socks during play. Also, make sure the foot stays dry (change socks, use powder regularly) and aired out as much as possible (for example: change into sandals immediately after a workout). Finally, keep calluses shaved down as much as possible without exposing new skin by using a pumice stone or file.

Q. I am looking for some advice on the relationship between orthotics and injury. My daughter has played competitive tennis for 6 years. At age 10 she started training full time 5 days a week / three hours per day and playing approximately 12-15 Tournaments per year. When she began training full time she was starting to have some very mild plantar fasciitis symptoms and was fitted with orthotics to help distribute the impact load across the whole foot therefore allowing her play and train pain free.

She has now played for 2 years with orthotics in her shoes everyday. Recently she was fit with a new pair of orthotics but she had to remove them due to some "new" low back pain (The back pain became a complaint approximately three to four weeks after she started using the new orthotics). The pain was showing up during the uncoil, or follow through, of her two handed back hand. She has removed the orthotics and her back pain vanished within two days.

Question: Do you feel that orthotics reduce the risk of plantar fasciitis in women and also do the orthotics reduce the severity and frequency of ACL injuries?

Question: What are the professional tour players using (brand name & manufacturing materials) for orthotics?

A. Very few young people get plantar fasciitis. This is a problem seen more in older players with tight calf/leg muscles, over pronation, and weak hips, with occasionally loose joints. She may have had some foot pain, but it was probably not plantar fasciitis. Almost all of these problems at this age respond to stretching and core stabilization. Orthotics have never been shown to prevent any problem, but have often been given undue credit in the lay press. Shoes with a stiff sole distribute load better than the orthotics.

Orthotics have no effect on the presence or prevention of ACL injuries. Foot alignment is a minimal risk factor for ACL injuries. All the literature supports lack of core and hip strength as the major risk factor. As you know, ACL injuries are rare in tennis players anyway, so this should not be a factor in any decision about orthotics.

I don't know the relationship of foot orthotics to back pain, although there appears to be some type of connection in this case. However, her back pain, coming at the end of her follow through in the two-handed backhand, suggests some tightness in the hip and back and some weakness of the lumbar extensors as causative factors. She is very likely to have this combination at this age. The orthotics were probably the "final straw".

If she is this age and playing this much, she needs a good musculoskeletal exam including the High Performance Profile. I would suggest she stay out of the orthotics, get a serious stretching/strengthening program from a knowledgeable source, and see how she does.

A. The actual cause of plantar fasciitis is unclear. The condition has been found to be associated with a variety of conditions including flat feet, hyper-pronation, a tight Achilles tendon and others. Orthotics are generally designed to make a biomechanical adjustment to the foot in order to treat plantar fasciitis and other conditions such as stress fractures, tendinitis, shin splints, etc.

Orthotics are not routinely recommended for players with normal biomechanics who are not having problems, solely as a preventive measure. Finally, the importance of choosing a shoe which is well made and is appropriate for the type of foot the player has, cannot be overemphasized in prevention of foot related problems.

I am not aware of any studies confirming a reduction in frequency or severity of ACL injuries when using orthotics. However, neuromuscular training programs in females have been shown to be effective in reducing the frequency of ACL injuries. Fortunately, ACL injuries in tennis are not common.

On the men's tour, the players’ orthotics are fit and fabricated by many different private orthotists using a variety of brands and materials. Many of the players on the WTA Tour are fit by the WTA Primary Health Care Practitioners.

Q. I have developed a pain in the arch area of one of my feet. I have been told it is plantar fasciitis, and different people have recommended different things. I cut back on my tennis, put gel inserts into my shoes, and have tried to stretch - and it is much better - but it still flares up every other week or so. Are there some exercises that could help prevent this? Is total rest for an extended time the only real cure?

A. Plantar fasciitis is an overuse injury to the broad ligament (plantar fascia) on the bottom of the foot at its attachment to the heel bone. Although the actual cause of this painful condition is not known, it has been associated with many different factors like overtraining, a flat arch, a high arch, over pronation, being overweight and/or improper shoe wear. Rest from aggravating activities is an important component of treatment. Biking and swimming can be substituted for tennis to maintain fitness during this "rest" period.

Stretching exercises for the plantar fascia, the calf muscles and Achilles tendon are recommended. Other helpful measures include frequent icing, use of a night splint, arch taping, heel inserts, orthotic innersoles and proper shoes. Your doctor may recommend anti-inflammatory medications or a cortisone injection. Although recovery may take six months or longer, symptoms will resolve in over 80% of cases. Shock wave therapy and surgery are considerations for those who continue to have significant pain.

Q. What are the best exercises for plantar fasciitis? I have a heel spur that always hurts after I play and the sole of my foot hurts whenever I get up from a sitting position.

Q. I'm 50 years old - been playing tennis a long time - spend many hours on the court both playing and teaching. What can I do to overcome plantar fasciitis and get back to playing the kind of tennis I am used to? This condition puts serious limitations on my ability to move.

A. Colleen and Ken, many athletes suffer from plantar fasciitis (pronounced fa-she-eye-tis) and there are a couple of things you can do to help it get better and prevent it from coming back again.

The plantar fascia is a thick band of connective tissue that runs from the toes to the heel and helps support the arch of the foot. With activities that involve a lot of running it is possible for this fascia to become tight and inflamed.

When it does it can cause pain in the bottom of your foot, particularly where it attaches to the heel bone. The pain is usually worst first thing in the morning or after sitting for a while. Here is what you can do.

First, cut back on any activity that involves running to give the injury some time to recover. The provide ice and massage regularly throughout the day. Ice and massage are good for helping to treat plantar fasciitis. One way to do this is to use a frozen water bottle. Roll the frozen water bottle under the sole of your foot, massaging the fascia. Do this for 15-20 minutes several times per day.

Also, stretch the plantar fascia by pulling your toes towards your shin. You should also stretch both muscles in your calf; perform a calf stretch first with the knee straight and then with the knee bent slightly. Hold each stretch or 20-30 seconds and again, perform each several times per day.

Finally, check your shoes. Worn out shoes, or shoes that provide poor arch support can contribute to the occurrence of plantar fasciitis. As the pain subsides, gradually increase the intensity and volume of your tennis and/or running. If this does not work, check with your doctor as more aggressive treatment may be necessary.

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