AEROBICS

The benefits of aerobics include increased cardiopulmonary efficiency, strengthened heart and lungs, improved circulation, lowered cholesterol levels, and stress and anxiety reduction. But it is a strenuous form of exercise, and thorough preparation, wise choice of routines, proper equipment, and consideration of floor surfaces are essential to avoid injury.

It's a good idea to see a doctor of podiatric medicine specializing in sports medicine before beginning an aerobics regimen. The podiatrist will perform a biomechanical or gait analysis to assess your risk of injury.

IMPORTANT FACTS ABOUT YOUR FEET

Because aerobic dancing involves quick lateral movements, jumping, and leaping for extended periods of time, proper care of the foot plays a crucial part in keeping the entire body fit to endure the "pain" that precedes the "gain" of a more fit physique and efficient heart and respiratory system. If your feet suffer from excess pronation or supination (your ankles tend to turn inward or outward too much), it's especially important to see a podiatric physician, who may recommend controlling the sometimes harmful motions with an orthotic shoe insert.

Proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability. Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot. Because of the many side-to-side motions, shoes need an arch design that will compensate for these forces, and sufficiently thick upper leather or strap support to provide forefoot stability and prevent slippage of the foot and lateral shoe "breakup." Make sure shoes have a toe box that is high enough to prevent irritation of toes and nails.

Running shoes, perhaps the most popular athletic shoes, lack the necessary lateral stability and lift the heel too high to be considered proper for aerobics. They also often have an acute outside flare that may put the athlete at greater risk of injury in sports, like aerobics, that require side-by-side motion. Running shoes are not recommended by podiatric physicians for aerobics.

CAN INJURIES BE PREVENTED?

In a physically challenging sport such as aerobics, injuries are common, and often involve the foot, ankle, and lower leg. (Other susceptible parts of the body are the knee and back.)

New, properly tied, well-fitted aerobic-specific shoes will address the first problem, and common sense will help the with the others. The key to injury prevention is proper conditioning, which will provide muscles the flexibility and strength needed to avoid injury.

If you are attending an aerobics class, make sure it is led by a certified instructor. Hardwood floors, especially with padded mats, are the best surfaces possible. If you can, start with a multi-impact class, where you can start at a low-impact level and work your way up as your conditioning improves.

If your routine is at home with a video, be very careful. Read the label to determine whether the video is produced by certified aerobics instructors and whether you can handle the degree of impact. While it's safe to do low-to-moderate impact aerobics on the living room carpet, that's not a proper surface for high-impact routines. Do not bounce or use ballistic stretching, or stretches known as the Yoga plow or hurdler's stretch. Knees should always be loose during warm-up. A static stretch held for 10 seconds can help avoid overstretching injury.

WHAT ARE SOME COMMON AEROBIC INJURIES?

Plantar fasciitis (arch pain)-Arch pain is often caused by frequent stress on the plantar aspect, or bottom of the foot, in an aerobics routine. When the plantar fascia, a supportive, fibrous band of tissue running from the heel to the ball of the foot, becomes inflamed, pain on the bottom of the foot results. Forefoot and rearfoot instability, with excessive pronation, may result in plantar fasciitis. Shoes with proper support in the arch often prevent plantar fasciitis; if not, see your podiatrist for a custom orthotic device or a recommendation for another shoe.

Heel spurs-Heel spur syndrome, related to plantar fasciitis, occurs after calcium deposits build up on the underside of the heel bone. Heel spurs form gradually over many months. Both plantar fasciitis and heel spurs can be avoided by a proper warm-up that includes stretching the band of tissue on the bottom of the foot.

Sesamoiditis-Sometimes referred to as the ball bearings of the foot, the sesamoids are a set of accessory bones found beneath the large first metatarsal bone. Incredible forces are exerted on the sesamoid bones during aerobics, and inflammation and fractures can occur. Proper shoe selection and custom orthotic devices can help avoid sesamoiditis.

Shin splints-Aside from ankle sprains, shin splints are perhaps the most common injury to the lower body, as the muscles attached to the shin bone bring the foot up and down. The pain is usually an inflammation of the shin muscle and tendon due to stress factors. Treat shin pain with cold compresses immediately after the workout to reduce inflammation. Proper stretching before the workout should prevent the onset of shin splints. Strengthening of muscles also helps reduce shin splints.

Achilles Tendon and Calf Pain-The frequent rising on the toes of an aerobics routine often creates pain and tightness in the large muscles in the back of the legs, which can create pain and tightness in the calf and inflammation of the achilles tendon. Again, stretching the calf muscles gently and gradually before and after the workout will ordinarily help alleviate the pain and stiffness.

Stress fractures-Probably the most common injuries to aerobics instructors, stress fractures are caused by poor shoe selection, hard surfaces, and overuse. Women are more likely to develop stress fractures, usually in the lesser metatarsal bones, than men. When swelling and pain surface, see a podiatrist. X-ray evaluation and early treatment can prevent a disabling injury.

If you experience any of these injuries, see a physician (a podiatrist can treat most of them), who will prescribe treatments to alleviate the pain, and make recommendations to prevent recurrence of any discomfort. As foot specialists trained in all aspects of foot care, podiatrists are also qualified to perform foot surgery if the condition requires it.

BASEBALL AND YOUR FEET

For more than a century and a half, America has carried on a love affair with baseball. 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.

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.

For more than a century and a half, America has carried on a love affair with baseball. 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.

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.

WHAT ARE COMMON 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 with 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.

BASKETBALL AND YOUR FEET

Basketball's essential elements of running, jumping, cutting, stopping, and shooting on a hard floor remain the same.

TREMENDOUS PRESSURE

In basketball, tremendous pressure is exerted on the foot and ankle. Without proper equipment and preparation, podiatric physicians say, injuries will invariably occur. Two distinct types of injury to the lower extremity can occur in basketball: acute injury from a sudden and forceful blow, or chronic injury, which develops slowly and becomes aggravated over an extended period of time. Most acute foot and ankle injuries, which occur from landing improperly from a jump or twisting while falling, are accidental and difficult to prevent. The most common acute injuries include ankle sprains, torn ligaments, muscle pulls, tendon ruptures, and fractures.

Chronic, or overuse, injuries can be caused by inadequate warmup, poor conditioning, improper and ill-fitting shoes, worn out shoes, or a biomechanical deformity that causes undue stress on the foot and ankle. Common chronic injuries sustained in basketball include stress fractures, plantar fasciitis, shin splints, achilles heel, tendinitis, patellar tendinitis, sesamoiditis, and blisters.

Similar injuries, especially ankle inversions and stress fractures, are also seen in another indoor court sport, volleyball. Volleyball is more purely vertical than basketball; there is less running and cutting, but more quick-step reactions from a stationary position.

CAN INJURIES BE PREVENTED?

Some acute injuries occur following mid-air collisions, erratic lunges for a rebound, or scrambles after a loose ball, and can't be helped. But chronic injuries can be averted with proper conditioning.

Another means of preventing injuries while playing basketball is a proper shoe. Shoes should be basketball-specific, with lots of ankle support and shock absorption. Some high-topped shoes offer more ankle support than others and are preferred by many doctors of podiatric medicine. Shoes should fit well and be replaced before the soles become smooth, or before the uppers begin to tear or come apart. A typical basketball shoe should be replaced every two to three months for five days a week worth of play. Acrylic socks should be worn to avoid blistering. Volleyball-specific shoes should also be worn by devotees to that sport. They are similar to the basketball shoe, but typically are lighter, have less midsole support, and a "tighter" sole more responsive to quick starts and stops.

WHAT SHOULD BE DONE IF INJURY OCCURS?

Acute injuries require immediate medical attention. After a bad fall or painful twist, the game's over. When an injury occurs, podiatrists advise, get off the court immediately and apply first aid. The best initial treatment for acute injury is ice, rest, compression, and elevation of the injured extremity. See your podiatric or family physician as soon as possible.

When bothered by a chronic injury, reduce activity level in accordance with the severity of the pain. If nagging pain gets worse in the course of a game, get off the court and apply ice and a compression bandage, and elevate the foot. Over-the-counter anti-inflammatory medications such as aspirin or ibuprofen can be taken at proper dosage for temporary pain relief.If pain does not subside within three to five days, see a podiatrist, who will explore possible causes of the injury. Chronic pain can often be traced to a biomechanical abnormality that is placing undue stress on a particular part of the foot or ankle.

Biomechanical imbalances can be corrected by prescription orthotic devices-specially constructed shoe inserts that redistribute the body's weight evenly on the foot and ankle.

Selective stretching and strengthening programs, shoe modifications, or strapping of the foot and ankle can also correct biomechanical problems. Lower extremity structural problems that often lead to injury include high arches, flat feet, bow legs, and tight calf muscles.

When injury to the foot or ankle does occur in basketball, the injured part must be given time to get over the acute inflammatory phase of healing. Then, adequate support with shoes or splints and/or tape may be necessary. Finally, and just as important, is the need to strengthen the injured part back to its pre-injury condition. If not, it will continue to remain weak and predispose the athlete to re-injury.

RUNNING & YOUR FEET

Nowhere is the miracle of the foot more clear than watching the human body in motion. The combination of 26 bones, 33 joints, 112 ligaments, and a network of tendons, nerves, and blood vessels all work together to establish the graceful synergy involved in running. The balance, support, and propulsion of a jogger's body all depend on the foot.

It is a good idea for a beginning jogger to visit a podiatrist before getting an exercise program started. Your podiatrist will examine your feet and identify potential problems, discuss conditioning, prescribe an orthotic device that fits into a running shoe (if needed), and recommend the best style of footwear for your feet.

Frequent joggers ought to see a podiatrist regularly, to check for any potential stress on the lower extremities. During a 10-mile run, the feet make 15,000 strikes, at a force three to four times body weight.

If you are more than 40 years old, see a family doctor before starting any exercise regimen. The doctor will perform an electrocardiogram, check for any breathing problems, high cholesterol levels, and high blood pressure before giving the go-ahead for a vigorous exercise program. Anyone, regardless of age, should check with a doctor if a cardiac condition, weight problem, or other medical complication already exists. Running asks a lot of your body, so make sure your body's ready to run.

THE IMPORTANCE OF STRETCHING

Before beginning an exercise regimen, proper stretching is essential. If muscles are properly warmed up, the strain on muscles, tendons, and joints is reduced. Many experienced runners prefer to jog easily for a half-mile or so before stopping to stretch. After a run, repeating the same stretching process allows the body to cool down and reduces muscle stiffening the next day

Warm-up and cool-down exercises should take 5-10 minutes, and ought to be conducted in a stretch/hold/relax pattern without any bouncing or pulling. It is important to stretch the propulsion muscles in the back of the leg and thigh (posterior), and not forget the anterior muscles. Some effective stretching exercises include:

The wall push-up.

Face a wall from three feet away, with feet flat on the floor, and knees locked. Lean into the wall, keeping feet on the floor and hold for 10 seconds as the calf muscle stretches, then relax. Do not bounce. Repeat five times.

The Hamstring Stretch.

Put your foot, with knee straight, locked, on a chair or table. Keep the other leg straight with knee locked. Lower your head toward the knee until the muscles are tight. Hold to a count of 10 then relax. Repeat five times, then switch to the other leg.

Lower back stretch.

In a standing position, keep both legs straight, feet spread slightly. Bend over at the waist and attempt to touch the palms of your hands to the floor. Hold the stretch for 10 seconds and repeat 10 times.

Proper Footwear.

A good pair of running shoes is the most important piece of equipment a jogger needs. Shoe choice should be determined by weight, foot structure, and running regimen. Keep in mind that all shoes have a different shape, and sizes are not uniform from shoe to shoe.

Consider whether an orthotic device will be placed in your shoe, and whether your running style is flat-footed or on the balls of the feet. Shoes should provide cushioning for shock absorption, and ought to be able to fully bend at the ball of the foot area. Visit the shoe store in the afternoon, when the feet are slightly swollen, and wear thick running socks when trying shoes on.

Shoes fit properly if the heel is snug and does not slide, and there is a thumb's width between the longest toe and the tip of the toe box. You should be able to wiggle the toes. Always try on both shoes, fully laced. Stand and walk around the store. If it doesn't feel good in the store, it won't in training, either.

When running, lean forward slightly at the waist to develop a smooth, even stride and full chest expansion. Your stride should be about equal to your height. Feet should touch the ground with the weight toward the rear, either in heel-toe motion or flat-footed.

Do not land on the toes. This works against the natural lever action of the foot and may lead to injury. Do not slap your feet on the ground. Follow through on your stride so the foot lands without jarring the body. As the foot lands, your center of gravity should be over or slightly ahead of the foot. Carry your arms at a right angle, and do not let them cross in front of your body. Relax your wrists, but carry hands straight with thumbs up. Breathe from the belly, through the mouth.

Proper foot hygiene can also prevent injuries. Keeping feet powdered and dry is important, especially to the jogger suffering from blisters. Blisters can be prevented by application of petroleum jelly or creams to the feet where they occur. If you get a blister, opening it with a sterile needle, then soaking the foot in warm water and covering it with antibiotic ointment and a bandage will help it heal quickly. Do not remove the "roof" of the blister.

ACHES AND PAINS OF RUNNING

Even with the best preparation, aches and pains are an inevitable result of a new jogging regimen. If the pain subsides with slow easy exercise, you may continue, but if it gets worse, rest. If it persists, see your podiatrist.

The most common pain associated with jogging is known as runner's knee, a catch-all for jogging-related knee pain. One of the most common causes of runner's knee is excessive pronation of the foot. (Normal pronation, involving the rolling in and down of the foot as weight is transferred from the outer heel to the ball of the foot during walking or running, is necessary for shock absorption. But a normal pronation pattern can be changed by tightness of the heel cord or running on angulated surfaces.)

Orthotics prescribed by your podiatrist are the best way to alleviate excessive pronation. Occasionally, rubber pads in the arch of the shoe will help.

Achilles tendinitis, sometimes caused by an excessively tight tendon and/or excessive pronation, also commonly strikes the jogger. Adequate flexing and stretching of the calf muscle will usually prevent the condition, which left untreated will cause chronic thickening and inflammation of the tendon. Shin splints, which painfully appear at the front and inside of the leg, are caused by running on hard surfaces, overstriding, muscle imbalance, or overuse. Treatment includes changing running technique or insertion of an orthotic device in the shoe.

Always Remember . . . Some discomfort is a natural part of any jogging regimen, but serious pain will not go away and should be treated professionally. When body and feet are finally "in shape," running becomes a pleasant social encounter, and can be engaged in with others. Most communities have running clubs that sponsor organized runs for the competition-oriented. No matter what path you take with running, chances are it will enhance your life, health, and happiness.

WINTER SPORTS & YOUR FEET

Winter's Own Sports

From the downhill rush of snow skiing or sledding, to rough-and-tumble ice hockey or placid casual skating, winter provides a fast track for fun and cardiovascular health. In the absence of long, sunny days, winter sports provide the exercise active Americans otherwise couldn't get without being cooped up in a gym. High speeds attained on skis and skates make for exhilarating sports, but expose the body to injuries.

Healthy feet and ankles, which act together as accelerators, steering, brakes, and shock absorbers in winter sports, are not only crucial to success in competition, but also help keep the body upright and out of the emergency room.

As you exercise, pay attention to what your body, including your feet, tell you. If you feel discomfort, you may be trying to do too much too fast. Ease up a bit or take a break and start again at another time. Drink fluids on hot days or during very strenuous activities, to avoid heat stroke and heat exhaustion.

Preventing Cold Feet

Without warm, dry clothes, any wintertime outdoor activity is a potential health risk. Proper footwear-insulated, waterproof boots or shoes-is as important as coats, hats, or gloves in the outdoors during the winter.

Socks are also important. Podiatric physicians recommend a single pair of thick socks made of acrylic fibers, or a blend including them, that "wick" away moisture caused by perspiration in the boot. Feet soaked in snow should get back indoors quickly. In sub-freezing temperatures, soaked feet are in immediate danger of frostbite, a serious, painful condition that can result in loss of toes or fingers.

Impact Trauma

In skiing, particularly at an intermediate or advanced level, high speeds and force of gravity place tremendous levels of impact trauma on the lower extremity, especially on steep and bumpy runs. Skating also puts tremendous stress on the ankle. Hockey players change direction at speeds near 30 miles per hour, and even casual figure skating requires quick turns and stops negotiated by the lower extremity.

If any preexisting foot conditions, such as corns, calluses, bunions, or hammertoes are present, see a podiatric physician, a specialist of the foot and ankle, for evaluation before buckling or lacing up. A medical examination is also important if you have any preexisting circulatory problems, such as Raynaud's Disease or diabetes

Before taking to the ice or slopes in cold weather, it's important to loosen up the muscles by stretching. Stretching helps to prevent muscle pulls and tears, and prepares the muscles for the flexing required by the constant "forward lean" stress of skiing and skating.

Ski Boots and Skates: A Perfect Fit

Podiatric physicians specializing in sports medicine say properly fitted ski boots and skates are the single most important factor in safe and successful skiing and skating. Without a snug (but not too tight) and accurate fit, the pressure exerted by the constant forward motion and lateral movement of skiing and quick turns of skating will surely result in discomfort or injury.

If boots and skates are too loose, toes quickly get irritated in the toe box. If they are too tight, pressure leads to blisters and abrasions that result in a host of painful problems and keep you indoors or, worse, compromise control and lead to an accident.

Tight footwear also may inhibit circulation of the blood vessels of the lower extremity and cause cold feet, which both compromises performance and presents danger in the cold. Ski boots are available in a forward-entry variety, a rear-entry style for easier entry and more comfort, or "hybrids" which incorporate both designs. Modern systems of cables and buckles make it possible to alter the boots to a near-perfect fit.

With ice skates, proper fit is equally important. Do not put children in hand-me-downs; skates that are too large or too small will cause blisters, inflammation of the foot, or nail irritation. The lack of proper ankle support in a too-large skate will leave the ankle susceptible to sprains, strains, or fractures. Whatever the style, skates should be laced snugly, using all the eyelets. If you are not sure your ski boots or skates fit properly, or if an apparently proper-fitting pair still hurts, take them to a podiatric physician, who can evaluate the fit and make recommendations to improve both comfort and performance on the ice or slopes.

Cross-Country Skiing and Winter Running

Cross-country skiing is quite distinct from downhill. An excellent way to maintain cardiovascular fitness in the winter, cross country involves the entire body and requires different equipment. Cross-country footwear is more like a bicycle shoe than a downhill boot. Bound to the ski only at the ball of the foot, cross-country boots should not irritate the balls of the feet.

As with running in winter, proper stretching is vital before cross-country skiing. In cross country, the heel goes up and down constantly. Without proper loosening up first, the motion can result in painful Achilles tendinitis and plantar fasciitis, among other problems. A podiatric physician can recommend proper stretching exercises.

Dedicated runners hate to give up their passion during the winter months. Remember, however, that muscles take longer to warm up in the cold, and the body is much more susceptible to muscle pulls and tear injuries. Again, proper stretching is essential.

Whether consciously or unconsciously, runners may change their foot-strike pattern to protect themselves, which can lead to muscle strain or other overuse injuries. To increase traction, runners may land on slippery surfaces with the whole foot instead of the natural rolling action of the heel-to-toe strike. Lateral slippage could result in a painful groin pull.

It's best to avoid running on icy areas, but if that's impossible, podiatric physicians give a qualified endorsement to use of spikes slipped over running shoes. Spikes, however, have their own problems, so don't use them in winter if you're not familiar with their use on a running track

Even though your feet are in motion while running, they're still susceptible to frostbite in thin nylon running shoes. Feet will sweat while running, and cold will permeate the thin material, inviting the condition. If shoes are too tight, there is an even greater chance of frostbite.

BIOMECHANICS OF WINTER SPORTS

Keeping the ankle perpendicular to the ground and straight up and down while skiing brings out the best performance. Users of custom orthoses (shoe inserts) should transfer them to skis and skates to help maintain the best possible position.

Skiers with minor biomechanical imbalances may encounter a frustrating phenomenon known as "edging," in which the ski rolls to the inside or outside edge, inhibiting control going down the slopes. Ski boots and skates can be "canted" internally to adjust the relationship between the boot and leg. For cases of rolling-in of the foot, or pronation, or rolling-out (supination), caused by flat feet or high arches, cants may be applied directly to the skis or within the boot. This improves edging and enhances performance and control, making the sport safer and more enjoyable

Ski shop technicians can work in conjunction with podiatric physicians on specific biomechanical adjustments to improve performance and safety. Ice skates do not come in as many shapes and sizes as ski boots. Common side-to-side wobbling in the heel area can be remedied with "shims," or pads, in the heel. Shims can also be added to the counter area, or middle of the skate, for a more snug fit.

PROBLEMS TO WATCH FOR

Frostbite.

It's impossible to overstate the importance of understanding symptoms of frostbite. Skin-color changes, from blue to whitish, can't be seen under a boot, but if toes are extremely cold for a prolonged period, feel burning or numb, there is a danger of frostbite. People with a history of frostbite often get it again in the same place. New battery-powered heated ski boots are effective in preventing its occurrence. New exothermic packs are also effective in keeping the extremities warm and preventing frostbite

Sprains and Strains

The stress of skiing and skating can result in sprains and strains of the foot and ankle. They can be treated with rest, ice, compression, and elevation (RICE). If pain persists, seek medical attention.

Subungal Hematoma.

Pressure in the toe box of a ski or skate can cause bleeding under the toenail known as a subungal hematoma. Such a condition should be treated by a podiatric physician to prevent the loss of a toenail.

Bone Problems.

Bunions and tailor's bunions, bony prominences at the joints on the inside or outside of the foot, often become irritated in ski boots or skates. Pain at these joints may indicate a need for a wider or better-fitting boot. Other preexisting conditions, such as hammertoes, and Haglund's Deformity (a bump on the back of the heel) can be irritated by an active winter sports regimen. If pain persists, consult a podiatric physician. Fractures caused by trauma require immediate medical attention. Copyright American Academy of Podiatric Sports Medicine

CHILDREN AND SPORTS

All parents know that children take to sports like ducks to water. Almost as soon as they start to walk, they're chasing balls, swinging sticks, and running races against nobody in particular.

Children's sports used to mean baseball, basketball, or football. That's changed. Soccer has leapt onto the youth sports scene, as have wrestling, tennis, and lacrosse with older children. The starting age for training in individual sports such as swimming, skating, track, and gymnastics grows younger every year.

Parents should encourage their children to participate in sports, but never forget that competition should be fun. Too much emphasis on winning can alienate a child from athletic competition.

Children active in sports programs will improve their cardiovascular and musculoskeletal systems, coordination, and state of mind. Participation in sports develops a sense of self discipline, teamwork, and recognition of the importance of a healthy body-good habits that last a lifetime.

TRAINING EMPHASIS

Every child physically matures at his or her own rate, and has a different degree of athletic ability. No amount of training can improve a child's natural athletic ability, but training helps improve coordination, and therefore performance.

Early training should emphasize proper technique and basic movement skills in all sports, especially in children younger than 10. Podiatric physicians, specialists in treating the lower extremities, say children who concentrate on a single sport at too young an age are more likely to develop injuries of the foot and ankle. Save specialization in sports for the late teens, they advise.

Warming up before participating in sports is more important for adults than children, but it helps loosen the muscles and prevent injuries in athletes of all ages. Light jogging and smooth stretching exercises (be sure not to bounce when stretching) are all that's necessary for young athletes. Learning to stretch at an early age will set a good pattern for sports activities as the body develops.

FOOTWEAR

Whether parents like it or not, part of a child's image revolves around footwear. Expensive sneakers have become fashion statements as much as athletic equipment. But for good foot health, the condition of the shoe is more important than the price tag or brand name.

Podiatric physicians agree it's often better to buy a child two $50 pairs of shoes than a single $100 pair, so the shoes can be rotated, to avoid rapid wear deterioration. Excessive wearing of the outsole, loss of shoe counter support, or wearing out in the midsole indicate it's time to replace the shoes.

Because a child's feet are constantly growing, it is important to allow at least one finger's width from the end of the longest toe when buying shoes. Remember, proper fit is very important. You can have the best shoe in the world, but if it doesn't fit right, it doesn't do its job.

In the shoe store, children should put on both shoes, with their athletic socks and the laces tied tight, for several minutes to properly check the shoes' fit. Shop for shoes in the afternoon, when the feet are naturally slightly swollen.

In young children, an "all purpose" sports shoe works well for most sports. A running-specific shoe is not suitable as an all purpose shoe; moving laterally in a running shoe is more difficult and presents greater risk of injury for children. After the age of 10, sport-specific shoes can help improve performance and protect the feet. With the exception of the running shoe, a degree of crossover between sporting shoes is usually not harmful to the feet of a child athlete.

Rubber cleats are not usually necessary for children under 10, though they pose little potential harm for them. They are most useful on a soft-field sport such as soccer. Podiatric physicians recommend molded shoe rubber cleats rather than the screw-on variety. Metal baseball spikes can be dangerous and should not be used until the teenage years.

GROWING BONES AND LIGAMENTS

The immature bones of children are different from those of adults. The "growth plates" in children's bones do not finish closing until age 15-17 in boys and 13-15 in girls. When stressed, these plates are more susceptible to injury than the tendons and ligaments that support the joints. Ligaments tend to "give" before bones in adults.

Podiatric physicians warn repetitive overuse can cause inflammation of the growth plates. They advise parents to promote diverse physical activities for their children rather than one sport. This is especially important with individual sports such as running, gymnastics, and tennis, which require long hours of practice.

Statistics show children who concentrate on just one sport for long hours at a time are setting themselves up for injuries. Because of the susceptibility of bones with open growth centers to overuse injuries, sponsors of the Boston Marathon recently increased the minimum age to participate from 16 to 18.

A sports medicine podiatrist can offer a thorough examination of the entire lower extremity, and identify a leg length imbalance, weakness, or biomechanical imbalances that may need to be addressed to prevent injuries on the athletic field.

INJURIES AND TREATMENTS

Many children suffer from mild "torsional" imbalances, commonly known as in-toeing and out-toeing. Most children outgrow these imbalances without medical treatment. However, if a child has obvious torsional imbalances, he or she may be more susceptible to injury. If that is the case, keep a close eye out for foot and ankle injuries associated with sports activity. Foot injuries commonly seen in very active children include:

Ankle Sprains. In older children, stretched or torn ligaments in the ankle, known as sprains, are more common than fractures. A sprain may cause extensive swelling around the ankle just like a fracture. Immediate treatment is crucial to quick healing. A podiatric physician can provide treatment as well as recommend balancing and strengthening exercises to restore coordination quickly.

Fractures. Fractures from overuse in child-athletes are commonly seen in podiatric medical offices. Growth plates are particularly susceptible to injuries, but mid-shaft fractures of the bone also occur. If a fracture is not severe, rest and immobilization may be the best treatment. More complicated injuries may require casting or surgical correction. If swelling and pain persist, see a podiatric physician.

Sever's Disease. An inflammation of a growth plate, Sever's Disease is often felt as pain behind the heel caused by inflammation of the apophysis, a growth center where a tendon is attached to the bone. Rest, ice, and heel lifts are usually prescribed.

Shin splints and stress fractures. Shin splints are microtears or inflammation of the anterior leg muscles, as are Achilles tendon pulls in the posterior region of the leg. Again, rest is most important in healing these injuries. If pain is persistent, see a podiatrist, who can recommend strengthening exercises, certain shoes, or, if indicated, prescribe custom-made shoe inserts known as orthoses.

A WORD TO PARENTS

All parents want to see their children do well in sports. But putting too much pressure on a child to become a star athlete may result in both physical and emotional injury to the child. A child should enjoy playing a sport, but if forced, could be turned away from all sports for a lifetime.

Especially with individual sports such as swimming, figure skating, and gymnastics that require long hours of practice every day, be certain the child's heart is in the endeavor, not just yours. When it comes to sports, overzealous parents can potentially do their children more harm than good.

Based on a document produced in cooperation with the: American Podiatric Medical Association.

Copyright American Academy of Podiatric Sports Medicine

WHAT ARE "SHIN-SPLINTS" AND WHAT IS THE BEST INITIAL TREATMENT FOR THIS CONDITION?

Q: As a high school cross country and track coach I see many young individuals with "shin-splints". I'd like to know the best way to treat this problem.

A: A shin-splint is the most common cause of exercise-induced leg pain encountered by athletes of all levels. It is commonly used as a "garbage can" term to include a variety of exercise-induced leg pathologies but actually represents a very specific problem. It is essentially an inflammatory reaction involving the connective tissue of the leg (called the deep or crural fascia) at its insertion into the inside (medial) or front (anterior) aspect of the leg bone (tibia). Thus "tibial stress syndrome" is the common medical term used to refer to this condition though I prefer the term "tibial fasciitis" because it specifically implicates the deep fascia as the etiologic anatomic structure involved. This condition needs to be differentiated from other common and uncommon causes of leg pain as the correct diagnosis will dictate treatment. Treatment for shin-splints can vary depending on the location (medial vs anterior), duration and severity of the problem. Listed below is a comprehensive four stage initial (vs resistant or recalcitrant) treatment program that has met with excellent success at our sports medicine center. It is important to complete all four stages of the program to obtain a more predictable result. If the response to this program is not favorable then re-evaluation of the patient is indicated. If the diagnosis remains firmly established, additional (more aggressive) treatment measures may need to be considered, i.e., steroid injections, surgery, etcetera.

TIBIAL FASCIITIS INITIAL TREATMENT PROGRAM

PHASE 1- Acute Phase:

• decrease acute pain and inflammation:
• absolute rest- NWB with crutches
• relative rest- WB boot or walker
• "ICE" (ice; compression; elevation)
• NSAIDS

Note: depending on the severity of the problem the acute phase can be bypassed but should always be considered especially if clinical symptoms are significant. When palpation of the involved shin area exhibits minimal to no discomfort the rehabilition phase can be initiated.

PHASE 2- Rehabilitation Phase:

• Further decrease pain and inflammation:
• ultrasound
• phonophoresis
• neuroprobe
• contrast baths
• decrease scar formation:
• transverse friction/deep tissue massage
• augmented soft tissue mobilization (ASTM)
• Maintain/increase flexibility of injured (and surrounding) tissue:
• active > passive joint range of motion
• stretching exercises
• Strengthen fascial/bone interface:
• relative rest- WB boot or walker
• open to closed chain therapeutic exercise (isometric > isotonic >

Note: when patient can complete these exercises without symptoms then the functional phase can begin. The techniques used to decrease scar formation can initially exacerbate the condition especially when using ASTM.

PHASE 3- Functional Phase:

• Functionally strengthen fascial/bone interface (and surrounding tissue):
• continue open to closed chain therapeutic exercise
• plyometric training (trampoline > jumping rope > "vertical jumps")
• Protect injured area during functional activity:
  • shin taping
  • neoprene shin sleeve
  • consider leg brace (Air Cast)
  • orthoses PRN
  • appropriate athletic foot gear

Note: this is probably the most important phase because it prepares the patient for their return to activity. Care needs to be taken at this stage not to allow the patient to overdo these exercises and stay within their limits as re-injury can easily occur.

PHASE 4- Return To Activity

• Return to desired sport activity:
• gradual, systematic, "to tolerance"
• Initiate preventive strategies:
• orthoses PRN
• appropriate athletic shoewear
• functional exercises (i.e., pilates, plyometrics)
• revise training program

"The information provided herein by The American Academy of Podiatric Sports Medicine is strictly for educational purposes and is not a substitute for an evaluation or treatment recommendations by a podiatric physician."

EXERCISE WALKING & YOUR FEET

Everybody's Doing It

Walking. Everybody's doing it. In fact, about 67 million Americans of all ages walk for exercise on a regular basis. Walking can be enjoyed anywhere, and it's an excellent way to bring the family together and enjoy the great outdoors, or to collect one's thoughts away from the hustle and bustle of everyday life.

Walking at a brisk pace for regular exercise helps condition the body and improve overall cardiovascular health the same way running and jogging does. But compared with running, exercise walking carries a significantly lower risk of injury. Even people with arthritis, or those recovering from heart attacks can exercise walk with the approval of a doctor.

On Your Feet

The ideal walking shoe should be stable from side to side, and well-cushioned, and it should enable you to walk smoothly. Many running shoes fit all of these criteria well, and for most people are acceptable for a walking program. Most important, whether you are wearing a walking or running shoe, is that it must feel stable to you. Either type of shoe is acceptable if it works well with your foot mechanics, providing cushioning and stability.

Shoes should always feel comfortable and fit well in the store. Don't cut corners on your shoe budget; buying shoes is the only real expenditure necessary for the sport, so treat your feet well. Visit the shoe store late in the afternoon, when your feet are slightly swollen (this is when you'll likely be walking, anyway).

Wear the same socks to the store that you will wear while walking. Try on at least four or five pairs of shoes. Put on and lace both shoes of each pair and walk around for a minute or two. Remember that every shoe manufacturer uses a different basic shoe shape, or "last." Some lasts are shorter or longer than others of the same size; some fit a wide foot perfectly, while others are cut for a slimmer foot.

Before buying, check the shoe's quality with the vertical heel test. Place the shoe on the store's counter and make sure the heel is straight up when looking at it from the back. Is the midsole well-connected to the upper? Is the stitching complete? Check inside the shoe for any irregular bumps.

When the shoes are on your feet, the heel should be snug. If it slides in the store, it will slide while you are walking. You should be able to wiggle your toes in the shoe, and there should be one half to a full thumb's width between the end of the longest toe on your longer foot and the end of the shoe's toe box. Make sure your ankles don't roll in the shoes.

If you have bunions or other special considerations, consult your podiatrist about the best shoe for you. If you have prescription inserts, substitute your insert for the existing one (most shoes have a removable insole) to make sure it will fit properly, if possible.

FOOT CARE FOR WALKING

Good general foot care must be maintained if you plan to subject your feet to a walking regimen. Wear thick, absorbent socks (acrylic is preferable to cotton); dry feet well after bathing, paying special attention to the toes, and use powder before putting on shoes. Nails should be cut regularly, straight across the toe.

Podiatrists warn that self-treatment of corns and calluses with over-the-counter remedies before starting to walk can do more harm than good. Serious maladies like bunions and hammertoes absolutely should be evaluated by a foot care specialist before you begin to walk for aerobic exercise. If blisters develop, self-treatment by opening the blister with a sterilized needle and draining the fluid is acceptable. Do not remove the "roof" of the blister. Cover the treated blister with antibiotic ointment to guard against infection.

Fractures. Fractures from overuse in child-athletes are commonly seen in podiatric medical offices. Growth plates are particularly susceptible to injuries, but mid-shaft fractures of the bone also occur. If a fracture is not severe, rest and immobilization may be the best treatment. More complicated injuries may require casting or surgical correction. If swelling and pain persist, see a podiatric physician.

Hitting the Road

Before you get going, a series of loosening-up exercises will help alleviate any muscle stiffness or pulled muscles that may be ahead of you. Consult your podiatrist for some specific ways to loosen up the heel cords (Achilles and calf) and thigh muscles (quadriceps in front and hamstrings in back). Take five deep breaths for each slow stretch, and hold the stretched muscle firm without bouncing. After every walk, stretch again to improve circulation and decrease buildup of lactic acid, the chemical byproduct that causes muscles to ache.

Race Walking

The sport of race walking has been an Olympic event at distances of 12.5 and 31 miles since 1908. Race walking is little more than moving as fast as possible while keeping one foot on the ground at all times.

For the walker with the competitive spirit, this is an enjoyable and relatively injury-safe sport. For fitness, the increased pace improves the aerobic benefits of walking, since it increases the heart rate. Race walkers should be aware that more aches and pains are likely to crop up with the faster pace during training. The hips are used to increase stride length, causing the characteristic wiggle of the race-walking form, and occasionally fatigue or bursitis can set in. Race walkers try to keep hip sway to a minimum to avoid these problems.

While race walkers face few of the knee problems runners do, sometimes excessive straightening of the knees strains the muscles and tendons behind the knee. If knees hurt after race-walk training, they are probably too forcefully extended or your strides are too long.

Shin splints, caused by inflammation of the shin muscles, are a common side effect of race walking. For immediate relief, use cold compresses after walking. Reducing stride length, stretching the muscles, and continuing to train should increase muscle strength enough to alleviate the pain. It is helpful to reduce your normal time by 50 percent until the pain subsides.

Because race walkers use the Achilles tendons and calf muscles to push forward with each step, pain in these areas is common. Increased stretching will help work the stiffness out, but also check your shoes, and make sure the sole is flexible enough to bend at the ball of the foot. A shoe with a half-inch heel will help with chronic Achilles and calf muscle pain. Switching from a walking shoe to a running shoe with a higher heel can be helpful in this case. An over-the-counter heel lift can also help. If you experience pain in the arch, make sure your foot is not rolling in at its heel. Check to make sure the heel cup of your shoe is holding it steady. If pain persists, an orthotic device prescribed by your podiatrist will hold the heel in a more efficient position.