Baseball And Your Feet
Based on a document produced in cooperation with the: American Podiatric Medical Association.
For more than a century and a half, America has carried on a love affair with baseball. Kids slam fists in their first gloves, and dream of one day playing in the big leagues. For a few, the dream comes true. The rest of us keep the fantasy alive through youth leagues, on adult softball teams, or pickup games with friends. We pledge allegiance to our favorite major league team, sharing the triumph or agony of every win and loss.
More than following big league baseball, we all want to play the game ourselves--to hear the crack of a base hit, execute an around-the-horn double play, or shag a screaming liner. But like all vigorous exercise, baseball and softball should be played sensibly and safely. Improper preparation and technique can lead to injury, especially to the lower extremities, which take us around the bases and under fly balls.
Before the First Pitch
Most American kids begin playing organized baseball at age 6 or 7. If a child is in generally good health and has no preexisting physically compromising conditions, baseball is relatively safe with proper instruction in the game's fundamentals.
Weekend warriors who pick up the sport again in adulthood are less apt to be in optimum condition than younger athletes, and should take it slow before jumping right into a game. Anyone who is more than 40 years old, diabetic, a smoker, or has any physical disability should see a family physician before taking the field. People with existing foot problems should see a podiatric physician specializing in sports medicine, who can perform a gait analysis and assess any risk inherent in a sports regimen.
Because baseball and softball involve quick starts and stops, it's important to loosen up before the game. Even the youngest children should make sure to do some simple stretching, running and playing catch before the game to avoid muscle pulls or other problems.
Before playing pickup games, make sure the field is free of hazards like holes on the base path, which could cause a foot or ankle injury. Sticks, rocks, and other debris on the field cause players to trip, risking injuries, and should be removed.
Shoeing Up for Baseball
Young players will do well to wear molded cleats rather then steel spikes. They should be gradually introduced before being worn in a game. A young player needs to get a feel for cleats, which should not be worn off the field.
While the improved traction of cleats may enhance play, it also leaves the ankle more susceptible to twists and turns. Any child with preexisting foot conditions should see a podiatric physician before putting on cleats. Never put a child in hand-me-downs; ill-fitting cleats increase the danger of ankle injuries. When sizing cleats, make sure the feet are measured by a footwear technician, and always wear a game-size sock when trying them on.
In some competitive baseball leagues, the use of metal spikes is permitted for players more than 13 years old. Spikes must be understood as dangerous weapons on the base paths; they require a certain level of maturity to be worn safely. They are not necessary for casual play, and should not be worn unless in league competition.
Spikes, which technology has made lighter and more flexible these days, perform the same function as cleats, but engage the ground differently. They too should be worn on a limited basis until the feel of how they engage the turf is understood. Unfamiliarity with spikes can lead to ankle twists and turns in a competitive situation.
When wearing cleats or spikes for the first time, watch for irritation, blisters, or redness, which could indicate a biomechanical problem in the legs or feet. Pain is a clear indicator of a problem. If cleats cause pain, discontinue wear for two to three days; if it returns, see a podiatric physician specializing in sports medicine for evaluation.
Preventing Baseball Injuries
One of baseball's most exciting moments comes when a batter stretches a single into a double by beating the tag in a dust-kicking slide. Sliding is a fun part of the game at all levels, but proper technique is crucial to avoiding foot and ankle injuries, especially when bases are firmly secured to the infield. Coaches at all levels should make sure their players are well schooled in proper sliding. Careless slides can result in sprains and even fractures of the lower leg and feet.
Pitchers also need to be coached on the proper way to come off an elevated mound with their back foot and land on an incline with the front foot. The repetitive motion of pitching can lead to overuse injuries to the feet and ankles. Pitchers experiencing pain in their windup should take a few days off before returning to the mound.
Catchers too are susceptible to overuse injuries by squatting behind home plate for every pitch. Again, coaches should teach their catchers how to alter their stance to vary weight displacement.
Today's trend of trying to achieve perfection by year round sport participation may result in an overall increase in injury. This is not just a lower extremity phenomena but is often seen in young pitchers having both elbow and rotator cuff injuries serious enough to lead to surgery while still in high school.
Lower Extremity Injuries and Treatment
Contusions. A baseball will inevitably make contact with a player's foot and ankle, whether it's a pitched ball, foul tip, or line drive, and sliding base runners often run headlong into a infielder's legs. Usually this contact results in contusions, which are not often serious injuries. Ice packs and a few days' rest will usually help the contusions, or bruises, feel better.
Sprains and fractures. Stretched or torn ligaments, known as sprains, can occur from running the bases, or pivoting to make a play. Sprains may cause extensive swelling around the ankle just like a fracture. Immediate treatment from a podiatric physician is crucial to quick healing. Fractures, where the bone has cracked or broken, often require casting. After a sprain or fracture, a podiatric physician can prescribe a rehabilitation regimen to restore strength to the injured area before returning to the sport.
Plantar fasciitis. Catchers are particularly susceptible to arch pain, commonly traced to an inflammation called plantar fasciitis, on the bottom of the foot. A podiatric physician can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.
Heel Spur Syndrome. A related condition, to which catchers are also susceptible, is heel spur syndrome. Often related to plantar fasciitis, heel spur syndrome occurs when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. Many times the ligament pulling on the heel creates the symptoms, and not the spur itself, especially after getting up from resting. With proper warm-up and the use of supportive shoes, strain to the ligament can be reduced.
Achilles tendinitis. The stop-and-start of baseball often creates pain and tightness in the calf, and aggravation of the Achilles tendon. Again, regular stretching of the calf muscles gently and gradually before and after the game will help minimize the pain and stiffness.
Shin splints. Shin splints usually stem from an inflammation of the muscle and tendon attached to the shin, caused by stress factors. Treat shin pain with cold compresses immediately after a game to reduce inflammation. Proper stretching and strengthening exercises should prevent the onset of shin splints.
If you are a runner/or walker and experiencing continued pain on the top of your foot you may be suffering from a stress fracture. Women seem to be more susceptible to stress fractures of the feet. Factors that predispose women more than men include a history of amenorrhea (lack of menustral cycles), osteopenia of bone, too small of body mass in the legs, and diet that may be too low in calcium.
The most common site of stress fractures that we see in our practice is the metatarsal bones in the foot. Additional factors that can contribute to stress fractures are worn out shoes, speed training, changes in running surfaces, and overtraining. Just this week I was able to diagnose two patients with stress fractures. These two patients actually were not runners but recently went to Disney world and did a tremendous amount of walking in flip flops. The combination of the long distance walking and the wrong shoes caused a hairline fracture in the metatarsal bones of the foot.
Clinically patient that I see will have pain and swelling on the top of the foot for more than two weeks. Initial x-rays may not show a stress reaction of the bone. It can take 10-14 days for a stress fracture to show up on a X-ray. In about three to four weeks bone callus (thickening of the bone) will indicate a healing stress fracture. It takes 6-8 weeks for a stress fracture to heal. We will place patients in a cam walker boot or surgical shoe in order for the bone to properly heal.
To decrease your risk for developing stress fractures replace your shoes every 300-400 miles, try to run on softer surfaces, and increase your calcium intake. You can do low impact exercises such as swimming and biking during the healing phase. It is very important to not run through the pain which can delay the healing time of the fracture.
In conclusion if you are experiencing pain and swelling on the top of the foot and it is not improving in two weeks with rest, ice, and NSAIDS, have it evaluated as soon as possible in order to correctly diagnose your foot condition. This will enable you to return to your chosen athletic activity sooner and not suffer through a chronic injury.
PRP (Platelet Rich Plasma)
Do you suffer from Chronic Heel Pain?
If so Carolina Foot Specialists will begin to offer a minimally invasive option for chronic stubborn plantar fasciitis.
A new state of the art treatment for chronic heel pain that our practice will offer is PRP (Platelet Rich Plasma) injections. The procedure is in the office setting under local anesthesia and involves taking a small amount of blood from the patient, similar to giving blood for a routine test. The vial of blood is subjected to very high speeds in a machine called a centrifuge. A yellow material is obtained containing cells called platelets, that are very abundant with factors that aid in healing. These growth factors are believed to decrease the inflammation causing plantar fasciitis. The platelets from the patient's own blood is injected into the area of pain in the heel. Patients are then fitted for a removable walking boot with light weight bearing to prevent putting excess weight on the heel for one week or less. After that, they advance to sneakers, and although the range of time for pain relief is variable, it can be appreciated as early as 10-14 days.
For more information please contact our office at carolinafootspecialists.net
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Also take a look at our CFS video on Bunion evaluation and treatment.
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Danny Dreyer has developed this running technique and if you have time purchase his book callled:
" ChiRunning: A Revolutionary Approach to Effortless, Injury-Free Running.
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