An Article Written by Yen-Chii Wong
Podiatrist – New Step Podiatry
COMMON INJURIES IN WINTER SPORTS
Let’s do a brief overview of common injuries we see in winter sports, the top reasons they occur, and what a podiatrist can do to help.
Ankle Sprains
Ask anyone who has played netball (or any field sports for that matter) if they have rolled or sprained their ankle, and chances are they will say yes. In fact, ankle sprains account for around:
– 40% of all netball injuries (1)
– 7.2 missed games per club per season in AFL recorded in 2015 (2)
– 80% of soccer injuries (3)
Ankle sprains [link to ankle sprain article] can occur on the outside of the ankle (lateral), inside of the ankle (medial), or higher up in the ankle (syndesmosis). The most common type of ankle sprains we see are lateral ankle sprains, which occur when your foot suddenly rolls outwards. This typically happens when landing from a jump, rapid leg rotation (to pass a ball) while the foot is planted, or player contact. A more serious lateral ankle sprain could result in bony damage to the fibula if the ligament has pulled at its attachment site too hard.
If the solution to an ankle sprain to simply walk it off, rest, then return to playing with no rehabilitation, the risk of developing chronic ankle instability and another ankle sprain occurring increases.
Podiatrists can help in all stages of ankle sprain rehab by diagnosing the type and grade of ankle sprain you have. We can help to reduce pain, help with a quicker return to sport, and reduce the risk of recurrence by addressing:
– Stability in the acute stages (with taping or bracing)
– Strength of the ligaments and surrounding muscles (with progressive loading exercises)
– Mobility of the ankle joint (through exercises and hands-on treatment)
– Balance
– Sport-specific movements (including reaction time, and landing mechanics and strategies)
– Footwear changes
Blisters
Blisters are ‘a fluid-filled tear under the skin surface caused by the skin and bone moving out of sync’ (4). They are a result of excessive shear force between the skin, bone, and soft tissue and can often be exacerbated by other factors like:
– Shoes that are too tight, have an irritating join, or are made from a thin or hard material
– Not lacing shoes up properly
– Thin socks or socks with irritating seams
– Sweating
– Playing on a wet field
– Bony protrusions you may already have on your feet
Podiatrists can help you safely manage an existing blister – we can lance, clean, and dress the area with sterile equipment OR give you advice on what to do if you just want to let it heal on its own. We can also help with strategies on how to prevent blisters from occurring in the future.
Heel Pain
Heel pain is multi-factorial and can be due to muscle or tendon strain, nerve entrapment, or bruising to the heel bone or heel fat pad. The most common types of heel pain we see affect the plantar fascia (under the heel) and the Achilles tendon (behind the heel). Both are often a result of a sudden increase in load that the structures are not used to.
In children aged 9-12 years, a common source of heel pain is calcaneal apophysitis (commonly known as Sever disease – despite what the name says, it’s NOT a disease!). It occurs when there is excessive and repetitive traction from the Achilles on the soft growth plate of the heel bone (calcaneus). We often see this in children who are very active and are going through a growth spurt. The calf muscle/Achilles tendon unit has to work hard to stretch and keep up with how quickly the bones are growing. Calcaneal apophysitis often resolves as on its own as the growth plate fuses onto the heel bone, but podiatrists can help to reduce pain and strain on the area with: in-shoe padding, stretching and strengthening exercises, footwear advice.
Ingrown Toenails
Ingrown nails are the painful result of your nail digging into the surrounding skin. We see ingrown nails mostly in the big toe (as it’s most often the longest toe and takes the brunt of your weight) but they can occur in any toes. The most common cause of ingrown nails in sports are from excessive sweating, and start/stop movements in poorly fitting shoes that put too much pressure on the nail.
Other causes of ingrown nails can be due to:
– Having naturally very curly nails are very curved
– Having a wide nail that doesn’t fit in the nail bed space
– Cutting your nails incorrectly
In many cases, there can be multiple causes for an ingrown nail. Your podiatrist can safely remove the ingrown toenail and discuss ingrown toenail management options to prevent an ingrown from happening again. These options range from education on correct nail cutting and changes in footwear, to nail bracing and minor nail surgery.
Turf Toe
I know, … this one sounds a little silly. Turf toe is another name for an injury that results from hyperextension or jamming of the big toe joint. Its name comes from how frequently this injury occurs on harder, artificial turf so it commonly affects those who play sports on this surface, like soccer, rugby, and AFL. Other contributing factors include wearing very flexible shoes and biomechanical factors.
The big toe joint (or 1st metatarsophalangeal joint) is crucial in the propulsive phase of running, where most of your body weight pushes through the joint as it bends. A combination of sudden force and over extension of the joint can result in damage to the joint capsule or surrounding ligaments and tendons.
Your podiatrist can advise on the severity of injury and send for diagnostic imaging if needed. Treatment options include: temporary off-loading with either a moonboot, strapping, or brace, gradual mobilisation to restore function of the joint, and custom foot orthoses which address biomechanical factors and lower the risk of hyperextension re-occurring.
Calf Strains
Calf strains are particularly prevalent in those who play soccer, AFL, and rugby. There are two main calf muscles: the gastrocnemius and soleus muscles. The gastrocnemius muscle starts behind and above the knee, the soleus muscle starts behind and below the knee, and both insert into the Achilles tendon which attaches to the back of the heel bone.
Calf strains occur as a result of accelerating from a stationary position, lunging forward, or sudden upwards movement of the ankle. Injuries to the gastrocnemius muscle generally occur with high- speed running or acceleration, and injuries to the soleus muscle in steady state running. Soleus injuries are more prevalent in elite AFL. The biggest risk factor of calf strains is a history of a previous strain and an older age.
Your podiatrist can help to determine and manage the affected muscle and any biomechanical or load related factors.
Black Toenails
Black toenails are simply bruised toenails and can be caused by stubbing your toes or microtrauma from wearing poorly fitting shoes. Black toenails are particularly prevalent when participating in activities that involve starting and stopping suddenly which push the toes into the front of the shoe. Most of the time, a black toenail will either grow out or fall off and give way to healthy nail growth. We recommend seeing a podiatrist for your black toenails if they are recurrent, painful, or do not resolve after a few weeks.
References
(1) Fong, D. H. (2007). A Systematic Review on Ankle Injury and Ankle Sprain in Sports. Sports Medicine, 73-94. doi:https://doi.org/10.2165/00007256-200737010-00006
(2) Saw, R. F. (2018). Injuries in Australian Rules Football: An Overview of Injury Rates, Patterns, and Mechanisms Across All Levels of Play. Sports Health, 208–216. doi:https://doi.org/10.1177/1941738117726070
(3) Kolokotsios, S. D. (2021). Ankle Injuries in Soccer Players: A Narrative Review. Cureus, 8. doi:https://doi.org/10.7759/cureus.17228
(4) Rushton, R. (2020, December 28). What Causes Blisters On Feet: A New Blister Paradigm. Retrieved from Blister Prevention: https://www.blister-prevention.com/what-causes-blisters-on-feet/
Dustin R. Grooms, T. P. (2013). Soccer-Specific Warm-Up and Lower Extremity Injury Rates in Collegiate Male Soccer Players. Journal of Athletic Training, 782-789. doi:https://doi.org/10.4085/1062-6050-48.4.08
Green B, P. T. (2017). Calf muscle strain injuries in sport: a systematic review of risk factors for injury. British Journal of Sports Medicine, 1189-1194. doi:10.1136/bjsports-2017-098149
Najefi, A. A. (2018). Turf toe: A clinical update. EFORT open reviews, 501-506. doi:https://doi.org/10.1302/2058-5241.3.180012
Smith JM, V. M. (2021). Sever Disease. StatPearls.
Book an Appointment at Our Canberra Clinic for a biomechanical assessment to help you in your winter sports injuries
Our podiatrists are here to ensure those in Canberra have access to quality services that can help individuals get the treatment they deserve. Easily book an appointment at our clinic online or give us a call on 02 6198 4818.
