DOCTOR’S CORNER with Dr JOSEPH KABUNGO
INJURIES to the foot can turn out to be very frustrating to the soccer player and to the attending health worker, especially if the cause of such an injury is not known.
The player will in most cases find problems in running which will exclude them from taking part in any form of training and competition.
Planter fasciitis is one such condition which any soccer player will dread to have at any given time. This injury deserves special mention all the time because as it is commonly seen in many young soccer players.
Any pain affecting the foot is always a bother and worries the affected individual. Almost a year ago, I discussed pain arising from the side of the foot as another form of overuse injury.
The discussion was mainly centred on the fractured fifth metatarsal and its clinical presentation. The signs and symptoms of a fractured thmetatarsal where looked and the options of treatment that are available.
The past few months have been characterised by many incidences including the injuries suffered by national team players at the 2015 Africa Cup of Nations in Equatorial Guinea.
It is in the same line that I want to continue discussing another problem affecting the foot in sports men. I had experience with one senior player who struggled with pain is his right foot and localised to the heel, just before the Africa Cup of Nations tournament which was co-hosted by Gabon and Equatorial Guinea in 2012.
It is interesting to note, how the player was managed and finally managed to contribute to the teamâ€™s success in 2012.Just like I discussed a fractured 5th metatarsal as an overuse injury, I want to describe how plantar fasciitis present or show itself as heel pain.
Plantar fasciitis can have more than one cause, I will try to describe how the various factor contribute to this condition resulting in a painful heel. For easy discussion, I will use football players when describing the problems with the plantar fascia.
The plantar aspect of the foot is the lower part, while the upper part is known as the dorsal part. The plantar fascia is a ligament type of fibrous structure that connects the heel to the bases of the five toes.
It therefore goes without saying that plantar Fasciitis is the inflammation of this strong structure that connects the heel to the base of the toes.
The plantar Fascia is important in maintaining the normal arches of the foot and helps in shock absorption when one is walking, jumping and running. Once there is irritation leading to inflammation of this structure, it results in pain that will limit the playerâ€™s ability to run.
It is also a common thing to find that, even the gait (i.e. the way someone walks) is also affected. The player will not manage to walk properly since they want to avoid exerting pressure on the affected heel.
Plantar fasciitis is mostly localised to one foot but it is not unusual to find the two heels affected at the same time. Many football players will actually agree that they have experienced pain in the heel at one point in their career.
The common complaint in individuals suffering from plantar fasciitis will be heel pain that is worse in the morning with the first few steps. Since it is difficult for a person to completely rest the foot, this problem will worsen as time progresses.
As earlier indicated this pain will result in distortion of the way someone walks because there will be avoidance of bearing full weight on the affected foot.
Plantar fasciitis in football players or sports men generally must be seen to be an overuse injury. As was defined previously overuse injuries are as a result of repeated micro trauma to the affected part.
This happens over a prolonged period of time and ultimately results in the inflammation of the affected structure and in this respect it is the plantar fascia that is affected.
One common cause of plantar fasciitis is that one associated with tight calf muscles or tight Achilles tendon. With repeated training and sometimes, inadequate recovery time, this will result in tightness in the muscle.
It must be remembered that the calf muscle is attached via the Achilles tendon to the heel, which is also an attachment point for the plantar fascia. The plantar fascia attaches to the heel or calcaneus and goes all the way to the bases of the toes.
Once this is appreciated then it is easy to understand why, calf muscle tightness will lead to irritation and subsequent problems associated with plantar fascia.
The other cause of plantar fasciitis is related to the weak muscles of the foot. The foot has got small muscles within itself that are responsible for various actions .It is the weakness of these muscles which will result in inflammation of the plantar fascia.
The other causes of plantar fasciitis are sudden increase in activity or training and this is the reason why training has to be done in a well-structured manner in order to prevent some of these overuse injuries.
Weight has got its own problems in sport. In some instances an individual who has gained weight, will tend to suffer problems associated with the plantar fascia. The added weight of an individual will result in more weight transmitted to the foot.
It is the reason why inactive sports men have to be concerned about maintaining their weight so that they do not only become slow to run, but also avoid some of these injuries like plantar fasciitis of the foot.
The type of running or playing shoes that an individual has, also plays an important role as a cause of this condition. Playing shoes or football boots have to be comfortable to an individual so that the stress on the foot is reduced.
It is not recommended to wear a shoe or football boot meant for very wet conditions on a hard and dry pitch.
This will result in plantar fasciitis and the player or athlete will lose the much needed training as well as playing time. It is not all about the elegance or fashion related to the type of playing shoes, but a player must be very careful in the choice of the training or playing shoes.
The best way to avoid getting plantar fasciitis is by reducing some of the risks associated with this condition. Good training patterns and recovery in between training sessions is important.
Be selective on the type of footwear that you use in training or competition. Most of the playing surfaces, which we use in our country, are not very soft and the use of football boots with a hard sole is not advisable, and also avoids the six studded boots which are meant to be used in wet and soft playing surfaces.
The coaches also have to be mindful on the loading and training pattern, which they subject their players to. It is important that players who are having tight calf muscles and the Achilles tendon receive the appropriate treatment from physiotherapists. Ignoring a tight Achilles tendon tightness is not only a risk factor for a plantar fasciitis, but also can lead to ruptured or torn Achilles tendon.
The effective treatment of this condition has to be targeted at reducing the pain. There has to be restoration of flexibility to the tight structures around the ankle joint and the arch of the foot.
The muscles of the foot have to be put under a good muscle strengthening exercise programme. The return to training and actual competition must be gradual if the desired results are to be attained.
As a sports man there are certain things, which you can do, in helping sorting out this problem. As I have always emphasised, rest is an important component of the healing process. You must avoid prolonged walking, running and jumping. You must rest from all activities, which put a lot of pressure on the foot.
Remember to use ice as a form of cold therapy in reducing the inflammation and also reducing the pain. It is also important to use anti-inflammatory drugs, which are readily available in our health facilities.
In some cases you might benefit from the use of orthotics or shoe inserts to reduce the pain and discomfort associated with this condition.
These Orthotics or shoe inserts decrease the pressure transmitted to the injury site (the heel). There are heel pads or heel cups that can be prescribed as measures of alleviating the symptoms.
The message that I want to put across is that, it is important to know your body very well and if there is pain in the heel associated with exercise, it must be reported to the team medical staff. Any pain arising from the heel must be investigated and treated because this can be a Plantar Fasciitis.
As the Zambian soccer season slowly gains momentum, let us all remember the problem of planter fasciitis!!! Ignoring pain in the foot is delaying treatment which in due course results in loss of valuable game time by the affected player.
Avoid taking medicines which are not prescribed by a qualified medical doctor in order to have the best outcome from such an injury….
For Questions and Comments Write To Dr Kabungo Joseph
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DOCTOR’S CORNER with Dr JOSEPH KABUNGO