My Blog

Posts for category: Sports Injuries

I wanted to spend some time today addressing a common athletic foot injury that I see very commonly in women. The injury that I frequently see is a metatarsal stress fracture. This short blog will give you valuable information of how to recognize and treat this common sports related injury.

Typically a metatarsal stress fracture will presents acutely with pain and swelling on top of foot just at the base of the lesser toes. The most common symptom is pain and swelling to the dorsal forefoot with or without trauma. Stress fractures often result from increasing the amount or intensity of an activity too quickly. This could be due to increasing the amount of mileage associated with walking or running while training for a road race. Other factors found more commonly in women would be poor bone density (osteoporosis), low body weight,  and menstrual disturbances.

Oftentimes I will see patient's that present with pain four weeks prior and they may have initially had a X-ray that was negative for a stress fracture. When we see a patient for the first time four weeks after the symptoms manifested we then take a repeat X-rays which shows a stress fracture. It may take 10-14 for a stress fracture to be visible on X-ray examination. Typically bone callus on both sides of the metatarsal will confirm the stress fracture is healing. If a metatarsal stress fracture is not promptly treated with immobilization with a cam walker and reduction of activity this could lead to further swelling/pain and possible delayed healing of the fracture.

Stress fractures take 6-8 weeks to heal and are treated with either a surgical shoe or cam walker boot. We do advocate low impact non-weight bearing activity to keep patient's active such as swimming or biking during the healing phase.

A protein deficiency, along with an overall calorie-deficient diet can relate to associated medical problems. One of these could include loss of regular menstrual cycles. Estrogen levels decline when menustration stops. This drop in estrogen leaves the bones in the body more prone to a stress fracture.

I usually recommend that women over 40 follow up with their family doctor for a bone density test. Certain blood work can be ordered such as determination of calcium, potassium, and magnesium levels which are vital for proper bone health.

If you have noticed increased pain and swelling on the top of your foot this could be a stress fracture. This is not normal and it is essential that this be treated to ensure the fracture heals correctly.

Dr. Brown and Dr. Saffer have all the available clincial and diagostic tools to diagnosis this condition correctly and can expedite the healing of this common sports related foot injury.

If you have suffered from chronic heel pain and your symptoms have not improved with traditional conservative treatments options then we may have a solution that will cure your heel pain for good.

We are offering a new treatment modality for chronic heel pain called (EPAT) Extracorpeal pulse activation technology. Intense pulse sound waves are introduced into the soft tissues to break up scar tissue and increased blood flow to the injured area. This procedure reduces pain and inflammation as well as stimulates your own bodies healing mechanism. 

The advantages of this procedure are:

1)Painless

2)No down time

3) No anesthesia

4) In office procedure

Typically, the procedures takes 5 minutes and is done weekly for three weeks.

After the treatment you will experience decreased pain and begin to have relief from symptoms which continues to improve over a 3-5 week period.

So, if you experience chronic heel pain make an appointment with our practice to see if you are a candidate for EPAT.

https://www.carolinafootspecialists.net/heel-pain.html

Foot blisters can be a frustrating foot condition. Foot blisters are caused by friction, usually your shoes or socks rubbing against your skin. Anything that intensifies rubbing can start a blister, including increasing your pace, poor-fitting shoes, and  improper socks.  Heat and moisture intensify friction by making your feet swell. That explains why many runners only suffer blisters during races, especially marathons.

The body responds to the friction by producing fluid, which builds up beneath the part of the skin being rubbed, causing pressure and pain. While most blisters don't pose a serious health risk, they can have a negative impact on your exerices routine.

First Aid

If you have a large blister that is painful you can drain it with a sterile needle. If you don't drain it, your blister will hurt, and it could puncture on its own or cause a potential infection. To drain a blister first wash your hands, then wipe a needle with alcohol to sterilize it. It is not recommended to heat the needle.Once you've punctured the blister, carefully drain the liquid by pushing gently with your fingers near the hole. Then cover the blister with a tight bandage to keep bacteria from getting in. You can take the bandage off periodically and soak your foot in warm water and Epsom salts to draw out the fluid. After soaking, put on a fresh bandage. If you have a small blister that is not necessarily painful leave it intact. The skin acts as a protective covering over a sterile environment. Furthermore, if the fluid amount is small and you try to pop it, you could cause additional problems by making it bleed.

Blister prevention tips:

Choose blister-free socks. Synthetic socks wick moisture away from the skin. Cotton may be lighter, but it retains fluid. It is well worth spending a little extra money on this type of sock at a local sporting goods or running store.

Run with slick skin. Coat your feet with Vaseline or another lubricant before you run. Or use Second Skin, a padded tape that stays on even when wet. Both methods form a protective shield between your skin and sock.

Wear shoes and socks that fit. Shoes that are too small will cause blisters under the toes and on the ends of the toenails. There should be a thumb's width of space between the toes and end of the toe box. Your socks should fit smoothly, with no extra fabric at the toes or heels.

Products over the counter for blister care: Moleskin, Body glide, Foot Glide, Compeed blister pads, Blister shield, gold bond powder, and aquaphor healing ointment.

If you have any upcoming races and have experienced chronic foot blisters please contact at: Carolinafootspecialists.net

 

This weekend I was able to attend my daughter Taekwondo tournament. I was able to witness and help treat a few minor foot injuries of the participants. I would like to take a moment to discuss common Martial arts foot injuries as well as review how to avoid and treat them.

Martial arts, such as karate and tae kwon do, have become very popular in recent years for both adults and children. Karate and tae kwon do have been promoted as excellent activities for maintaining good health and fitness. People frequently perform these activities after school or work.    Given that the foot and ankle account for at least 10 percent of the total injuries sustained in the martial arts — and may even be higher due to the lack of reporting of many digital injuries such as contusions, toenail trauma and uncomplicated fractures — most podiatrists are likely to encounter these athletes in their offices.    Students of the martial arts practice kicking and punching to improve their techniques and power. Students start with simpler kicks and work up to more difficult techniques. Attempting a more difficult kick without the appropriate training will often cause injury. Sparring too early without the proper training is also a common cause of injury.    The student becomes injured due to either a lack of balance, flexibility, strength or speed. For example, one can kick and punch while standing in one location or while moving. A lack of balance while performing this move will cause the support foot to be loaded without stability. This can produce sprains or strains of the foot and ankle

What Causes Common Types Of Martial Arts Injuries?

Blunt force trauma and sprains are the two basic categories of martial arts injuries that occur in the foot. Blunt force trauma injury is a direct result of the foot hitting another solid object. The object could be a sparring bag, a board, an opponent or other firm objects used in the practice of martial arts. Students frequently use heavy canvas sparring bags for kicking and punching in order to improve strength and technique. Boards varying from 1/2 inch to 1 inch in thickness are used as part of promotion tests as a student passes to the next level throughout the training experience. The boards are lined up (either singularly or in multiples) and students use their hands or feet to break them. If the student has not built up the power, speed or accuracy to strike the board with the correct technique, there can be resulting trauma to the foot or hand. Martial arts instructors assess each student to determine the level of breaking skill. Inappropriate execution on the part of the student can be very painful.    Misjudging the opponent’s intended next move can result in trauma. Normally, students step back from the kick and prepare to counter the kick with another kick. This cannot always be executed as trained due to the speed of the opponent. The consequences of missing a step or inappropriately positioning the foot while attacking or retreating from an opponent can be trauma to the ankle and foot, resulting in a sprain or fracture.

A Guide to Treating Fractures

   As a result of blunt force trauma, the martial arts student may suffer a fracture, a contusion or a laceration. Fractures require early diagnosis and immobilization to expedite healing. The most common foot fractures occur as spiral oblique injuries of either the digits or the metatarsals. They are usually the result of the torsion generated by the impact of the moving foot hitting a fixed object such as an opponent.    If one suspects a fracture, do not allow the athlete to continue the competition. Further trauma from competition can convert a simple non-displaced fracture into a displaced, comminuted fracture or even a compound fracture. If one suspects a fracture, immobilize the injured part or at least move the athlete without moving the injured area. Apply ice and elevate the limb after achieving initial immobilization. The marital artist should not go back to martial arts activity until the specific fracture is completely healed, which is usually eight weeks.

Addressing Common Contusions

   Contusions, which are usually less severe than fractures, are a common result of sparring or board breaking. This weekend I witness a severe contusion to the foot while two fifth degree black belts were sparring. One of the participants blocks a side kick but hit the top of his opponent’s foot in an awkward way. A severe contusion occurred with pain, bruising, and swelling to the top of the foot. While sparring, the student wears a chest protector, a helmet and a mouth guard as well as pads on the arm, hand, foot and lower leg. During sparring, one must perform each kick and punch in a fraction of a second to be effective. From a tactical standpoint, when students see an opening in the opponent’s defense, they will usually execute three to four moves sequentially to further reduce the opponent’s defenses. However, the opponent will also counter the attack. Both participants are vulnerable when each is trying to anticipate the other’s move.    Advancing opponents often cut short well-intentioned kicks, which land in an unintended area. A kick meant for the opponent’s torso might land on a non-padded upper thigh area, resulting in a thigh contusion. Any non-padded area such as the thigh or knees can now be a vulnerable target. Accordingly, the common areas to receive contusions are the top and sides of the feet as well as the toes. Contusion injuries may have symptoms for up to six weeks although one can usually recommend an early return to martial arts activities.

Key Pearls on Treating Sprains

   Ankle sprains occur most often in the martial arts during sparring when the student is changing positions rapidly. The most common type is the lateral ankle sprain. Sudden changes in direction during sparring can result in the student being caught off balance. A slow progression of training is essential to promote increased balance, flexibility and strength while reducing the risks of foot and ankle sprains. Pay careful attention to the sprain in order to rule out a fracture. It is essential that all ankle injuries be totally healed before permitting the martial arts athlete to return to rigorous activities such as performing difficult maneuvers or competitive sparring. A common sprain to the foot is a hyperextension injury to the first MPJ (Big toe joint). This sprain is usually the result of sparring and changing directions rapidly. The Great toe becomes forcibly moved up while the athlete lunges forward to attack an opponent, resulting in a sprain of the first MPJ.    While most of these injuries are mild, be aware there are severe cases in which the sesamoids may be partially or completely torn from their bed. A forced movement up of the great toe against the first metatarsal head may also result in a fleck of cartilage being shorn from the metatarsal head. A hyperextended first MPJ (Great toe joint) sprain can last up to four months or longer. During this time, one should follow initial immobilization (Walking boot) with physical therapy as this is essential for maximum recovery.

 

Choosing the right custom foot orthotic for overpronation

Are you a runner and have not had success with custom orthotics in the past because they were uncomfortable and too rigid?  If so please read on and learn about the best material that Sports Podiatrists can use so that your orthotic is comfortable as well as provides the correct amount of support.

Q: What materials are available for orthotics and which are the best?

A: : In order to understand why certain orthotic materials are typically recommended by podiatric physicians, it is important to understand the fundamental goals in orthotic therapy. The purpose of the functional orthotic is to accurately and precisely position the foot throughout the gait cycle so as to promote proper function. Its function is not merely to support the arch, as is often the case with commercial appliances or arch supports purchased in retail stores. The functional orthotic is prescription fitted and is very effective in alleviating symptoms and establishing proper alignment. In order to achieve the desired and expected results from the use of functional orthotics, several steps must occur. First, a detailed range of motion and muscle testing examination is performed by your podiatrist. The purpose of this is to measure and quantify the motion of all lower extremity joints, identify abnormalities such as excessive laxity or limitation of motion, and determine the weightbearing and non-weightbearing functional positions of these joints. The muscle testing portion of the examination is performed in order to determine muscle groups which may be excessively weak or tight and to determine their part in the overall cause of injury, symptoms or biomechanic problem.

Following the examination, a non-weightbearing neutral position cast or three dimenstional image of the foot is taken. The specific method of casting or imaging is critical and must be done accurately in order to achieve an accurate impression of the foot in its neutral position. The negative casts or three dimensional image (email) are then sent to an orthotic laboratory accompanied by a prescription written by your podiatrist indicating not only the specification of the foot pathology that needs to be addressed, but also the materials to be used and the dimensions and accessories to be used in the manufacture of your functional foot orthotics. The manufacture of functional foot orthotics is thus a multi-step process involving detailed and intricate cast correction, orthotic fabrication and application of additional items prescribed by your podiatrist for the treatment of your specific condition.

In order to achieve the desired results, the functional foot orthotics must be made from materials which have the ability to resist the pathologic symptom-producing forces which have ultimately produced the injury. Typically, plastics or graphite are used, both offering a range of flexibilities, designed to appropriately resist abnormal injury-producing forces while allowing comfort and compliance so as to be compatible with the sport. The plastics that are used are generally made of a family of materials called polyolefins, the most common being polypropylene. The thickness of these materials ranges from 1/8" to 1/4". These materials range from quite flexible and compliant to relatively rigid. Graphite also ranges from quite flexible to quite rigid and is generally one-half as thick and one-half as heavy as orthotics made from polyolefin materials. The flexibility, or compliance, of an orthotic is a subjective choice determined by the requirements of your sport and the degree of rigidity required to resist the abnormal forces resulting in injury. Highly flexible devices are used when the forces imposed are relatively minor or the requirement of the sport mandates a compliant device. However, these materials possess shorter life spans due to the cyclic fatigue inherent in an orthotic device that has a high degree of flexibility. More rigid orthotic devices are used when more significant forces are present or the sport of choice is compatible with the more rigid device. More rigid devices have the advantage of being quite durable and can often last for many years without modification or adjustment. Typically, stop-start complex motion and/or cutting sports (ie. soccer, basketball, aerobics, tennis) require more compliance in an orthotic device, while repetitive-motion sports such as walking or running are quite compatible with more rigid devices.

Soft materials such as Neoprene, various open- and closed-cell foams or similar cushioning materials may be used in conjunction with functional foot orthoses to provide both support and comfort. A patient should always discuss these options with their podiatrist and even entertain the possibility of having more than one pair of orthotics using materials of different flexibility and/or covers as determined by the requirements of their sport, the constraints of their shoe gear, and their overall comfort.

Successful orthotic treatment should always include an orthotic device that is effective in reducing eliminating symptoms and is comfortable to wear. By selecting the appropriate flexibility material and cover material, both of these goals can generally be achieved.

Our foot specialists at Carolina Foot Specialists are active athletes that have experienced a majority of the foot ailments that patient's present with in the office. When custom foot orthotics are dispensed a detailed plan includes the proper break in period  as well as a plan to get patient's back to their chosen sporting activity. We have a policy where orthotics can be refurbished or remade within a six month period of time if required to insure that our patient's are please with the custom orthotics  that they have received.

For more information of a variety of foot conditions please refer to our website at www.carolinafootspecialists.net