Monday, September 1, 2008

Common Sports Injuries

It is estimated over 1,700 athletes suffer foot or footwear related injuries during the Beijing Olympic Games and countless on the way. To cater for these advents it is usual for an army of medical experts to accompany the athletes to Olympics and Paralympics. Most major national teams have their own medical teams as well as medical services being available in the Olympic Village. Podiatrists and pedorthists make a valuable contribution to foot care with pedortists experts in shoe and shoe modifications and podiatrists, foot physicians. Pedorthists design, make, fit and modify shoes to alleviate painful and debilitating foot and leg problems and podiatrists use foot inlays called foot orthoses to add lateral stability to the mobile foot. Shoes are frequently cited as the cause of injury in athletes but this usually relates to superficial problems only such as blisters and black nails. Rarely do serious foot injuries arise as a result of shoes alone but when athletes are constantly in training and competition then repetitive stress injuries are common. In a report conducted by American Orthopaedic Foot and Ankle Society, runners were asked to self report shoe related injuries. Sixty three (63%) of injured runners reported wearing shoes for less than six months and had ran less than 300 miles. (It is recommended runners replace their shoes every 300-400 miles). Expert opinion prefers overuse or rapid increase in mileage and training intensity as the more common causes of foot injuries with shoes a minor contributor to injury. Statistically athletes are more likely to sustain injury during training than in competition but it does happen and when this presents it becomes an Olympic moment caught on camera for million to witness. The dramatic events which surrounded Olympic 110 metres hurdles champion, Liu Xiang when he pulled his Achilles tendon is a good case in point.

Some of the more common below knee and foot injuries that occurred during the Beijing Olympics, included:

Knee Injuries
Patella femoral pain syndrome (PFPS) is a common knee affliction and arises when the patella is pulled obliquely over the articulating surface of the knee joint. The increased 'Q angle’ predisposes the joint surface to osteoarthrothosis of the inferior surface of the patella as it moves laterally over the tibia. A contributory factor is subtalar pronation during late propulsion which causes internal rotation of the lower limb altering the track of the patella. Reduction in symptoms may arise when the athlete wears wedged running shoes giving better lateral stability. When combined with physical therapy this helps reduce the ‘Q angle’ which in turn assists rehabilitation and prevents reoccurance.

Menisci Tears (torn cartilage)
The two articulating bones of the knee i.e. femur (thigh) and tibia (leg) rest on two semi-elliptical C shaped menisci. These are cartilage like material which sit on either side of each other in the joint capsule. One meniscus is on the inside (or medial aspect) of the knee and the other semi circular meniscus, rests on the outside of your knee i.e. the lateral meniscus. The menisci help dampen down shock which passes through the weightbearing knee and distribute weight to improve the stability of the joint. Tears in the menisci are due to trauma caused when the knee joint is flexed and twisted. The injury is often associated with contact sport but does arise in athletics too. It is not uncommon for the meniscus tear to occur along with injuries to the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) Damaged menisci reduce the shock absorbing capacity of the joint which increases the risk of developing damage to the articular cartilage surface of the knee joint. Loss of the meniscus increases the risk of osteoarthrosis which inevitably will end an athlete’s career.

Shin splints
Pain in the anterior or posterior compartments of the shinbone (tibia) caused by inflammation due to muscle tears, tendon damage or separation of Sharpey's fibres and periosteum of the tibia. Muscle bulk builds up in a contracting facial compartment due to combination of internal rotation of the knee and subtalar joint pronation during propulsion. Customised foot orthoses may reduce symptoms associated with late pronation but professional help is recommended because condition can worsen.

Achilles tendon
Achilles Tendonitis - Irritation causes inflammation of the tendon attaching the calf muscle to the back of the foot (calcaneum). Depending on the severity the insertion may pull away for the bone or be partially damaged. When the periosteum (bone lining) is damaged bone spurs may result. Over stretching in warm ups, or overtraining are a known cause and sometimes symptoms are relieved with heel lifts in the shoe or if the athlete wears wedged heels.

Achilles tendon rupture
A ruptured (or torn) tendon may occur when the tendon has been structurally weakened by tendonitis, or when a completely healthy tendon is subjected to a sudden, unexpected force causing a tear. Tendon ruptures are common in running, jumping, throwing and racket sports. When a tendon tears, people often report hearing a pop at the back of the ankle. Since the calf muscle is no longer attached to the calcaneum making walking and running impossible. Left untreated, the tendon often fails to heal, thereby resulting in a permanent disability. Scar tissue forms which is likely to lead to inflammation of the tendon (achilles tendonitis). In severe tears the athletes will be aware of a sudden pain in the tendon; often with minor ruptures the person is not aware of the damage in the heat of sport, but will become aware of it later when the tendon has cooled down. Athletes returning to exercise after a short period of rest may experience be a sharp pain which disappears when warmed up only to return when stopped. First thing in the morning the Achilles tendon is stiff with local swelling. Sprinter, Mark Lewis-Francis (UK) suffered a torn Achilles injury and missed the Beijing Games.

Ankle Injuries
Ankle sprains are common in runners and jumpers and caused by turning or running on a downward incline and landing badly from a jump. The majority are inversion sprains where the foot turns inwards. Ankle strains can be acute (one off) or chronic (recalcitrant). Occasionally the ankle may fracture. Unless trauma to the ankle is common in the sport ankle protection is not required from the shoe. Good traction and comfortable fit will optimize foot and leg function. Occasionally loose fitting footwear or over zealous cleats may contribute.

Feet Injuries
Bunion
A fluid filled sac caused by irritation to the bursa (adventitious) which protects the inside aspect of the big toe joint. Caused by sheering stress usually against the inner of the shoe when worn tight on the foot or due to rough seems. Not to be confused with hallux abducto-valgus this describes subluxation (partial dislocation) of the first metatarsal phalangeal joint. Always check shoes for unseen seems and wherever possible wear shoes, which does not constrain joint movement.

Hallux Abducto-Valgus
Partial dislocation of the great toe with marked rotation and lateral deviation of the digit. A firm, often painful bump forms on the outer edge of the foot, at the base of the big toe. Due to patho-mechanics principally caused by rotation of the forefoot against the rearfoot caused by a lax foot during propulsion. The medial eminence may develop a bunion if aggravated by narrow shoes. Always check shoes for unseen seems and wherever possible wear shoes, which do not constrain joint movement.

Heel spurs
Bony outgrowths from the calcaneum (usually) caused by damage to the periosteum. Area may calcify to form a spur, which is easily visible by medical imaging but maybe asymptomatic. Often found in conjunction with plantar fasciitis, an inflammation of the fibrous connective tissue (fascia), which joins the rear foot and forefoot. May also relate to inflammation of the bone cells i.e. enthosopaphy. Common in athletes who run a lot or jump and land and damage is related to micro facial tears or stretches. Good fitting shoes with torsional midfoot support may reduce ligamentous strain. When symptoms persist recommend professional help.

Ingrown toenails
The corner of the toenail penetrates the skin surface. Due to poor hygiene the condition may become complicated by bacterial infection. Usually caused by improper nail trimming, tight shoe pressure, traumatic injury, and hyperidrosis (excess perspiration) may also contribute. Good fitting shoes with plenty room at the toe box will accommodate painful nails, vented footwear, which reduces perspiration on the skin surface, will also help. Prevention includes trimming nails straight across.

Neuroma
Benign thickening of nerve tissue, frequently between the third and fourth toes, causing pain, numbness or burning sensation. The nerve is intermittently compressed and stretched during late pronation in propulsion. Early diagnosis can keep condition from worsening. Shoe inserts, toe orthoses and shoes, which cater for Windlass management of the foot, may help but prolonged symptoms need professional attention.

Sesamoiditis
The sesamoids bones are two small bones on the under-side of the first metatarso-phalangeal joint. These may become damaged with persistent use and can become inflamed during exercise. Good fitting footwear suitable to the activity is important. Shoe inserts can be useful but if symptoms persist consult a physician

Stress fractures
Small, incomplete cracks in the metatarsal bones arise due to overuse, or loss of bone strength. When these arise in the middle three metatarsals these are referred to as 'March Fracture'. Fractures of the base of the fifth metatarsal, or Jones Fracture is sometimes related to severe inversion sprain caused by a misplaced cleat. Extra padding and shoes with stiff soles may ease discomfort but rest is recommended. Left untreated the stress lines may become complete fractures and require a walking cast. Symptoms persist consult a physician. Great Britain's Rhys Williams pulled out of the Beijing Olympics after the 400 metres hurdler suffered a stress fracture to his right foot.

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