As your cold-weather footwear makes the seasonal migration from the back of your closet to replace summer’s flip flops and bare feet, don’t underestimate the benefits of padding around naked from the ankles down.
Barefoot activities can greatly improve balance and posture and prevent common injuries like shin splints, plantar fasciitis, stress fractures, bursitis, and tendonitis in the Achilles tendon, according to Patrick McKeon, a professor in Ithaca College’s School of Health Sciences and Human Performance.
The small, often overlooked muscles in the feet that play a vital but underappreciated role in movement and stability. Their role is similar to that of the core muscles in the abdomen.
“If you say ‘core stability,’ everyone sucks in their bellybutton,” he said. Part of the reason why is about appearance, but it’s also because a strong core is associated with good fitness. The comparison between feet and abs is intentional on McKeon’s part; he wants people to take the health of their “foot core” just as seriously.
The foot core feedback loop
McKeon describes a feedback cycle between the larger “extrinsic” muscles of the foot and leg, the smaller “intrinsic” muscles of the foot, and the neural connections that send information from those muscle sets to the brain.
“Those interactions become a very powerful tool for us,” he said. When that feedback loop is broken, though, it can lead to the overuse injuries that plague many an athlete and weekend warrior alike.
Shoes are the chief culprit of that breakdown, according to McKeon. “When you put a big sole underneath, you put a big dampening effect on that information. There’s a missing link that connects the body with the environment,” he said.
Muscles serve as the primary absorbers of force for the body. Without the nuanced information provided by the small muscles of the foot, the larger muscles over-compensate and over-exert past the point of exhaustion and the natural ability to repair. When the extrinsic muscles are no longer able to absorb the forces of activity, those forces are instead transferred to the bones, tendons, and ligaments, which leads to overuse injuries.
It’s not that McKeon is opposed to footwear. “Some shoes are very good, from the standpoint of providing support. But the consequence of that support, about losing information from the foot, is what we see the effects of [in overuse injuries].”
Strengthening the foot core
The simplest way to reintroduce the feedback provided by the small muscles of the foot is to shed footwear when possible. McKeon says activities like Pilates, yoga, martial arts, some types of dance, etc. are especially beneficial.
“Anything that has to deal with changing postures and using the forces that derive from the interaction with the body and the ground [is great for developing foot core strength],” he said.
McKeon also described the short-foot exercise, which targets the small muscles by squeezing the ball of the foot back toward the heel. It’s a subtle motion, and the toes shouldn’t curl when performing it. The exercise can be done anywhere while seated or standing, though he recommends first working with an athletic trainer or physical therapist to get familiar with the movement.
He notes the exercise seems to have especially positive results for patients suffering from ankle sprain, shin splints, and plantar fasciitis. It’s even been shown to improve the strain suffered by individuals with flat feet.
The payoff could be more than just physical, as there could be financial savings. With strong feet, McKeon suggests that — depending on the activity — consumers may not need to invest hundreds of dollars in slick, well-marketed athletic sneakers (though he doesn’t recommend going for the cheapest of cheap sneakers, either). People with a strong foot core can actively rely on the foot to provide proper support, rather than passively relying on the shoes alone.
“You might be able to get a $50 pair of basketball shoes that don’t have the typical support that you’d expect. Because you have strong feet, you’re just using the shoes to protect the feet and grip the ground,” he said.
The easiest way to get started on strengthening the small muscles of the foot, though, is to kick off your shoes in indoor environments.
“The more people can go barefoot, such as at home or the office, is a really good thing,” McKeon said.
Ithaca College. “Going barefoot: Strong ‘foot core’ could prevent plantar fasciitis, shin splints, and other common injuries.” ScienceDaily. ScienceDaily, 17 November 2015. <www.sciencedaily.com/releases/2015/11/151117181929
Ankle sprains are a common injury after a fall, sudden twist or blow to the ankle joint. Approximately 40 percent of those who suffer an ankle sprain will experience chronic ankle pain, even after being treated for their initial injury.
A review article published in the May 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) explains that tendon injuries to the ankle can be a possible cause for this chronic pain. In some cases, the condition is untreated or overlooked which prolongs the pain and the problem.
“When patients injure their ankles, the injury may not seem serious at first,” explains Terrence Philbin, DO, lead author of the article and Fellowship Director of the Orthopedic Foot and Ankle Center in Columbus, Ohio. “People may not seek medical attention and they can think it will just get better on its own. I think that is why this condition often goes undiagnosed.”
The authors of the article describe how in some cases chronic ankle pain may actually be the result of injuries to the peroneal tendons.
The peroneal tendons are located behind the outside portion of the anklebone (called the fibula). The tendons help to stabilize the foot and ankle.
Tendon injuries can include tendonitis or swelling around the tendons. In more severe cases, the peroneal tendons can actually tear or there can be a swelling of the tendons behind the fibula bone. This can cause the ligament that holds the tendons together to stretch out and tear, or even rupture.
Symptoms associated with peroneal tendon injuries can include:
•Ankle pain that is not responding to treatment
•Swelling and tenderness around the outside of the ankle
•Pain behind the anklebone
•Pain that transmits from the ankle down into the foot
The use of magnetic resonance imaging (MRI) or ultrasound can be helpful when identifying and diagnosing peroneal tendon injuries and disorders. “These imaging techniques offer a more complete look at the peroneal tendons,” noted Philbin. “One might consider getting an MRI or ultrasound especially if you have chronic ankle pain.”
If the condition is caught early, non-operative treatment options can include:
•Rest, ice and elevation
•Immobilization in a cast or brace
More serious injuries of the peroneal tendons, including tears or ruptures, will very likely require surgery.
Peroneal tendon injuries can happen suddenly or can develop over time. The injury is most common among athletes involved in sports that require repetitive ankle motion and in individuals who have high arches of the foot.
A proper diagnosis is essential in order to treat peroneal tendon injuries correctly and to help alleviate chronic pain. Philbin reminds patients, “If you have ankle pain and it is not getting better, do not ignore it. Get it evaluated by a physician who has experience treating foot and ankle injuries.”
Terrence Philbin, DO, and the co-authors of this article received no compensation for this review article.
American Academy of Orthopaedic Surgeons. “Chronic Ankle Pain May Be More Than Just A Sprain.” ScienceDaily. ScienceDaily, 11 May 2009. <www.sciencedaily.com/releases/2009/05/090501090931.htm>.
Common Soccer Injuries
As a dynamic, high speed game where physical contact occurs both incidentally and deliberately, soccer creates many circumstances where injury may result. Most soccer injuries are relatively minor in terms of the degree of disability created; more serious injuries often result through the execution of a hard sliding tackle or other sudden physical collisions between players. Data from researchers regarding soccer injuries indicates that there are over 150,000 soccer injuries reported annually in the United States, among a playing population of over three million athletes; approximately 45% of these injuries occur in players under the age of 15 years.
As would be expected in a sport that centers on kicking a ball, injuries to the lower legs are the most common injuries in soccer. Ankle sprains are another common occurrence, often created by either an awkward plant of one of the feet while running or changing direction, or by stepping on another player’s foot, causing the ankle to twist forcefully. Most soccer players wear a cleat that is low cut to permit greater maneuverability, and this footwear is not naturally supportive of the ankle.
The Achilles tendon is vulnerable to two kinds of injury. Given the explosive movement required of a soccer player, the Achilles must instantly respond to the impulses of musculoskeletal movement. If the Achilles tendon is imbalanced in terms
Injuries to the lower legs, ankles, and feet are the most common injuries in soccer.
of either its strength relative to the connected muscles of the calf, or if the tendon is not sufficiently flexible, the fibers of the tendon can become overstretched or subjected to micro tears. The second type of injury to the Achilles results from the tendon being kicked from behind by an opposing player. The resulting trauma can significantly damage the tendon fibers.
Soccer players are subjected to numerous varieties of accidental kicks from an opponent in the course of play. Most of these kicks result only in contusions, as the players wear relatively durable shin guards. More serious injuries to the lower leg may occur as a result of a defender’s sliding tackle, where the defender slides forcefully along the turf to strip the ball from an opponent. If the tackle is not executed cleanly, the offensive player’s leg may be caught and twisted, the mechanics necessary for either a significant ankle sprain or a fracture of the tibia/fibula bones in the lower shin.
The knee can also be injured by a sliding tackle, if the offensive player’s leg is planted on impact and the knee joint is forced laterally (sideways); this type of collision prevents any of the force of impact being directed and absorbed anywhere but the knee joint. In such circumstances, the anterior cruciate ligament (ACL), a large connective tissue between the femur and the tibia in the knee joint, is at the greatest risk of injury. Other knee injuries occur in the same fashion as ankle injuries, where the leg is planted forcefully on an uneven surface, and the ultimate stress radiates directly into the knee.
Thigh injuries in soccer are typically one of two types. The first are contusions, as the thigh is exposed to all manner of physical contact in the course of a game. The second type of injuries are those common to all other running sports, muscle strains and pulls caused by repetitive and often explosive acceleration. Soccer players who have an imbalance in the function of the hamstring, which provides flexion to the knee, and that of the quadriceps, which gives the knee its ability to extend, will often experience injuries to these muscle and tendon groups.
Groin injuries are often the bane of the high-level soccer player. The structure of muscles, tendons, and ligaments in the upper thighs and the lower abdomen is complex; these tissues are also vulnerable to injury in soccer due to the almost constant lateral and stop and start movements that place stress on them. The abdominal injury that has attracted attention throughout the sports world that is popularly called a sports hernia is, in fact, a tear of the groin inguinal hernia, first identified among English professional soccer players in 1980. Such injuries require surgical repair.
Other than contusions, injuries to the upper body in soccer are less common. The collisions in the sport will occasionally cause a shoulder separation, which is damage to the acrimoclavical (AC) joint, the connection between the shoulder blade and the collarbone. Soccer goalies are more exposed to shoulder injury as a result of diving across the crease to make saves and striking the goal post.
Head injuries may occasionally arise due to collisions with opponents—concussion and damage to the player’s teeth are the greatest risk. Many players wear mouth guards to protect their teeth, which has the additional benefit of reducing the effect of concussions by keeping the tempomandibular joint (TMJ) from being driven upward into the skull. Since the mid-1990s, there has been controversy in the international sports science community as to whether the repeated heading of a soccer ball will cause damage to the brain or to the muscles and structure of the neck. Various studies initiated by soccer nations have not yet resolved this question.