Foot Health Information

und of golf affords the opportunity for a close to 5 mile workout that can reduce stress and improve your cardiac health. Good foot action is the mark of an accomplished golfer and has been compared to intricate dance steps. Why is it then that a golfer’s feet get no respect? Everyone talks about golf-induced pain, but foot injuries are hardly ever discussed. Most people just try to limp around the course, ride a cart or just throw their swing off and increase their stress when their feet hurt! Over 45 million Americans participate in amateur golf. Addressing your foot biomechanics can add yards to your game and make your golf outing much more enjoyable.

During the golf swing the body acts as a whip, power production starts with the feet pushing against the ground. The foot pivots and provides intrinsic lateral movement to enable the hip to fully rotate around a fixed leg position. Each foot moves differently during a golf swing, the back foot must allow for more pronation (rolling in to collapse the arch) during the follow through of the golf swing than the front foot.

The anatomy of a biomechanically sound swing goes like this: During set-up, your weight should be evenly distributed on both feet with slightly more weight on the forefoot as you lean over, and slightly more weight on the insides of both feet. Maintenance of proper foot alignment on the back swing is critical for control of the downswing and contact position. During the back swing, weight should be shifted to the back foot; it should be evenly distributed on the back foot or maintained slightly on the inside.

As the back foot remains in a solid position on the back swing without any rolling to the outside, the front foot is in turn rolling to the inside. The front heel occasionally comes off the ground to promote a full shoulder turn. Completion of the back swing places the weight on the back foot, evenly distributed between forefoot and rear foot, with the weight left on the front foot rolling to the inside.

The downswing involves a rapid shift of weight from back to front foot; momentum brings the heel of the front foot down, and follow-though naturally causes a rolling of the back foot to the inside and the front foot to the outside. Golf should always be played from the insides of the feet.

As you can imagine, healthy feet are critical to a successful golf game. Having biomechanically sound, stable feet will attain that goal!

What kinds of injuries are seen in golf that are caused directly or indirectly by foot function?

1. Lower Back Pain: This is the most common golf injury. Pain and stiffness in the back and neck are usually caused by the twisting motion of the golf swing as the shoulders rotate around the hips. This twisting of the torso in a coil fashion can put enormous pressure on the vertebrae, muscles and ligaments of the spine especially during the recovery phase. Indeed when one addresses the ball, the bent back puts the golfer in a most vulnerable position. A very common, yet insidious cause of lower back pain is over pronation in the feet. Even a slight postural misalignment caused by over pronation can lead to back pain.

2. Knee Problems: Inflammation or pain in the knees is caused by the twisting motion of the golf swing and sometimes by walking in ill fitting shoes. Rest, is again the best medicine. However, a re-evaluation of one’s swing and foot orthotics to realign the knee can help prevent this condition from occurring.

3. Shin Splints: Pain in the muscles of the lower leg is usually caused by excessive walking after a period of inactivity. It can also be caused by over pronation in the feet, putting excessive pressure on the lower leg.

4. Heel/Arch Pain: Plantar fasciitis is very prevalent in all sports and commonly occurs due to excessive pronation in the feet. Golfers will often complain of pain when first rising in the morning and after periods of rest. Pain will be located in the center of the heel radiating along the arch.

5. Achilles Tendonitis: Inflammation of the Achilles tendon is caused by repetitive stress when pushing off or following through. Your swing can really inflame this tendon with excessive stress.

6. Hallux Limitis: Jamming and deterioration of the big toe joint cartilage is caused by overextension during the follow through. This can eventually cause the joint to swell, stiffen and limit its motion. Hallux limitis can be so painful that it affects your walking and eventually hampers your swing.

7. Metatarsalgia – This term actually refers to any pain in the forefoot region. This can be caused by excessive twisting which causes painful blisters, calluses and sore joints.

8. Morton’s Neuroma – Inflammation of the nerve in the ball of the foot in between the toes occurs from excessive twisting in your swing. This can be very painful for golfers who walk around the fairway and can often make their toes feel numb or have significant burning pain.

Custom Foot Orthotics and Golfing Injuries

Orthotics allow a golfer’s body to establish a better point of contact with the ground when executing a golf swing. They will also stabilize your feet, evenly redistribute weight and correct your entire body posture during the golf swing. In recent research, it has been shown that the use of orthotics while playing golf improved balance in 71% of participants. An impressive 50% felt that they were hitting the ball harder and 38% of participants reported a lower golf score while using orthotics. This research suggests that orthotics can help golfers improve balance, hit the ball harder and obtain a lower golf score. Why is everyone not taking this easy advantage to improve their swing?

Anyone who has a foot that is not able to function normally due to biomechanical conditions such as excessive pronation or supination can achieve a state of optimal biomechanics with custom foot orthotics from your podiatrist. Orthotics not only allow your feet to function better, but they also can prevent and treat a variety of painful injuries that can affect your concentration and ultimately your golfing handicap. Bringing painful knees, legs, feet or an aching lower back to the fairway can prevent you from playing to the best of your golfing potential.

And don’t forget the shoes! Remember to make sure your golf shoes fit well before you leave the store. Shop in the afternoon when your feet are slightly swollen so the fit will be accurate. Wear the socks you play in to try on the new shoes. This also helps you get the right fit. Don’t buy anything you wouldn’t wear on a long walk, remember the close to 5 miles you will be walking on the course!

Bottom line: If you want to improve your swing, lower your handicap and decrease your stress level while playing golf; address your feet – your foundation! Do not ignore foot pain; it affects your entire game!

urress was searching for an answer to his chronic foot and ankle pain. He makes his living running routes and catching balls for the Super Bowl champions New York Giants with a nagging ankle injury, flat feet and a new pair of orthotics. Burress is breaking in his orthotics at practice and expects to be ready for the season opener this week.

In May, Burress was advised to use orthotics to help improve the function of his feet. He said it took time to get fitted, and he did not start using them until recently. He admits that he is sore after running but is getting much better. Functional orthotics are improving his gait so he will not be as prone to injury as he has been in the past.

55 million Americans experience one or more foot problems every year! Failure to seek medical advice early can cause many to develop more complicated foot conditions that can be severe and difficult to treat.

One of the most common foot problems is heel pain. It is estimated that 15% of the adult population complains of heel pain, which includes one million runners who experience heel pain (plantar fasciitis) every year. The American College of Foot and Ankle Surgeons has stated that heel pain has reached epidemic proportions in weekend athletes. This common condition is typically ignored, especially by athletes. People tend to seek treatment only after the problem becomes severe and disabling or when they just can’t run. When foot health concerns are ignored, simple conditions can develop into more serious problems affecting the ankles, knees, hips or the back. A simple functional orthotic is the answer for many people experiencing this kind of foot pain.

Orthotics are devices which fit into the shoe to aid the foot and allow it to function more optimally. Relatively rigid in shoe braces that are designed to control motion and correct the function of the foot are “Functional orthotics”. Individuals with flatfeet, tendonitis, plantar fasciitis, knee, hip and back problems and certain foot deformities, may benefit from functional orthotics.

Will orthotics help my foot problems? The goal of the functional orthotic is to control the abnormal motion in the foot, improve foot function, decrease the pain in the foot, ankle, knee, hip or back and to add support. The orthotic should make standing, walking, or running more comfortable. The orthotic must be rigid to help control the motion in the foot and add support. If the orthotic is soft, the weight of the body would collapse the device and it would no longer function.

Functional orthotics are a successful treatment for many problems affecting the lower extremity. In a recent article in the Journal of the American Podiatric Medical Association, 75% of patients surveyed had good to excellent results from functional orthotics. This includes 17% who felt the orthotics “cured” their pain. Less than 10% had no relief. A painful heel was the most commonly treated condition in the study. Over 20% of patients surveyed were treated for a painful heel and 20% were treated for a painful arch. Fourteen percent of the individuals were using orthotics for flatfeet. Other conditions treated with orthotics were knee, hip and back pain, foot arthritis, bunions and high arches. Tendonitis was not specifically evaluated.

Individuals with plantar fasciitis (heel and arch pain) who also have flatfeet usually respond best to orthotics. People with high arches may require orthotics as well, but they do not respond as well. Orthotics can help slow the progression of bunions and hammertoes, but they will not prevent this process. Orthotics may help with some pain at a bunion, but they will not “cure” the bunion. When the motion in the foot is contributing to the problem, orthotics are generally recommended.

Podiatrists are the most common prescribers of orthotics, but pedorthotists, orthotists, physical therapists and sometimes chiropractors will also provide orthotics. Remember that the device is only as good as the doctor taking the mold and writing the prescription. Make sure that your practitioner is trained in foot biomechanics and experienced in orthotic therapy.

Orthotics are indicated in the treatment of the majority of foot pain. When utilized for the correct indications, orthotics are highly successful in controlling foot pain and can add pep to your step! Orthotics have helped Plaxico Burress conquer his chronic injuries and they may help you!

Knee pain is slowing my run to a crawl! Why is this happening? What is Patellofemoral syndrome?

Patellofemoral pain a.k.a. chondramalacia patella is the most common running-related knee problem. If you have this condition, you feel pain under and around your kneecap and often swelling of the area under the knee cap may occur. The pain can get worse when you are running or when you sit for a long time. Pain can also be associated with a “crunching” sensation when the knee is put through range of motion. You can have pain in only one knee, or you can have pain in both knees. It usually starts as a minor knee pain after running that progresses to pain when you get up in the morning, pain during or after exercise then pain all the time. Prompt intervention can decrease the period of disability form this injury.

The exact cause of patellofemoral pain is hard to define. It has been described as having something to do with the way your kneecap (called the “patella”) moves on the groove of your thigh bone (called the “femur”). Contributing factors include overuse and overload of the knee joint (too much, too soon, too fast syndrome), biomechanical problems and muscular imbalance or weakness. Often it is associated with an extremely flexible foot type and over-pronation (rolling in of your foot). It is more common in women than men and this is due to the “Q angle” of woman’s hips putting more stress on the knee. Weakness of the vastus medialis or the inner thigh muscle has also been touted as a cause.

What can I do to help my knee mend and relieve the pain ?

Take a break from running and any other activities that can cause a lot of pounding on your legs. Practice relative rest activities like swimming, biking, or the elliptical trainer which supports your body weight and puts less stress on your knees. As your knees feel better, you can slowly go back to running. It is important to do this slowly, and increase the amount of time you run by only about 10-20% a week.

The mainstay of treatment is physical therapy. It is imperative to work on the muscle imbalances that led to injury as well as stretching your hamstrings and strengthening your quadriceps. Strengthening is very important because your quad muscles control the movement of your kneecap and this is the most recognized cause of this syndrome.

Talk to your podiatrist about your running shoes and orthotics; it would help to bring your shoes in for the doctor to see, proper running shoes can really help knee pain. Orthotics are often needed to decrease and stabilize excessive foot motion that causes abnormal stress on the knee. Even just a simple arch support insert from the local drug store can be helpful. Although custom orthotics are considerably more expensive than off-the-shelf devices, they last much longer and provide more support or correction. For hard core runners, the durability is important. Many people wear out a store purchased device in just a few months when a custom device can last for 2 to 3 years. In some cases, however, an over-the-counter device can be just as effective, particularly when combined with a stretching and exercise program.

Ice your knees for 10 to 20 minutes after activities, this can ease the pain and speed up healing. To keep your hands free, use an elastic wrap to hold the ice pack in place. An anti-inflammatory medicine like ibuprofen may also help, however this should not be used to “get through” your workouts.

Will I ever be able to run again?

Be patient! Keep exercising to get better. Patellofemoral pain can be hard to treat, and your knees won’t get better overnight, some people are lucky and get better quickly but it might take six weeks or even longer for your knee to get better. Very few people need surgery to relieve their knee caps instability.

Remember, you’ll be less likely to get this pain again if you continue to strengthen and avoid “too much, too soon, too fast syndrome!”. Even though the cause of patellofemoral pain syndrome remain uncertain, the good news is that most patients recover with conservative treatment, particularly if they maintain a disciplined approach.

thing with running, unlike many other sports, is that it’s very simple to objectively measure progress. How are you progressing? Or have you got yourself into a rut? We may not all be destined to become elite runners, but most of us feel pretty psyched when we see even small improvements. The older I get the more I look to small improvements for my motivation.

The following check list may help you pinpoint areas of nutrition, training, motivation, injury prevention, or equipment to address that will help boost you to the next level.

1.Fuel right before runs – have a low fat meal or snack containing low glycemic index carbohydrates 1-3 hours before your run. I personally like oatmeal mixed with Cheerios before my morning run.

2.Core strengthening – Pilates, yoga or simply core strengthening weight workouts. Personalized programs help to strengthen core and major muscle groups important to running, as well as lengthen out tight areas. A more fluid moving, stronger, less injury prone body is the result.

3.Cross-train – even the worlds’ fastest female marathoner-Paula Radcliffe-does some of her sessions on a Nordic track (a machine which mimics cross-country skiing). Aqua running, eliptical and cycling are also useful to maintain cardiovascular fitness without the constant impact and injury risk. I finally bought a bike a month ago and I love it!

4.Refine your running technique – Your podiatrist or physical therapist can help you with gait analysis. Improving technique can not only make you a better runner, but you may feel less soreness and reduced injuries.

5.Aim to be a healthy weight – a BMI (body mass index) of 20-25 gives us a rough indicator. Running becomes more difficult when we gain weight, conversely, becoming underweight may negatively affect performance and health. I can admit that I actually have gained weight and became faster!

6.Increase your stress gradually – the general rule of thumb is to increase your mileage no more than 10% weekly. This decreases the injury risk, and gives the body time to adapt to increased stress and improve.

7.Wear appropriate shoes – that are comfortable and functional for your foot type; and above all learn to recognize when they are past their expiration date to help avoid injury. Five hundred miles or 6 months are the expiration dates on running shoes!

8. Start runs hydrated – and carry sports drink or gels on runs that are longer than 60-90 mins. Losing even 2% of our body weight through sweat can affect performance. Providing carbohydrate and electrolytes during longer races, will also be a huge benefit to your final time. Weigh yourself before and after a run. Make sure you replace your fluids!

9. Run with a group – if you find it difficult to stay motivated, running with a group, or a running peep can give you a time and place to be consistent with your running.

10. Get in the zone – Load your mp3 with music that uplifts you. Buy run gear you feel great and comfortable in, or map out new run routes to stay inspired. Mix it up!

11. Find a great massage therapist – regular massage improves mobility and flexibility of the muscles, increases blood flow, and relaxes the muscle. All this means recovery from a hard session or race (normally 48-72 hrs) can be reduced by up to 50%! A good massage therapist can also pinpoint problem areas when they are tight and before they become injuries. I love mine although I scream when she hits my sore spots!

12. Learn to run faster – do 1-2 runs every week that challenge your pace. This may be an anaerobic threshold run where you hold a faster pace for eg 20mins during your normal run. Other options are hill fartlek sessions-where you run an undulating loop, pushing hard on the uphills-or interval sessions – where a shorter distance is run hard, with a few minutes of jogging between eg 5-6 x 1 mile or 6-8 x 800m.

13. Find a mentor or supporter – this may be someone you admire as a runner, or who makes you feel enthusiastic about your running goals. It may be your coach, partner, or another runner who you catch up with regularly to talk running and how it effects your life.

14. Set goals with training and racing and follow a program. Like anything in life, we are more likely to be successful with a clear vision and tactics.

15. Eat right after runs – consume a meal or snack containing 1-2g carbohydrate/kg of body weight and some protein immediately after runs longer than an hour. I personally drink an Ensure or protein shake as soon as I stop sweating! Glycogen (the muscles main energy source for running) is replaced much faster in this period immediately post training.

16. Utilize and learn to love ice-baths – or cool water soaks, especially after long or hard runs. The effect on recovery is amazing.

17. Race – there’s nothing like a race situation to push you to the next level, while also giving you a sense of accomplishment. It’s amazing how the legs find another gear to train at as well!

18. Learn to train easy – we are not invincible, and do not become great by running hard every day. In fact injury and chronic fatigue is the more likely outcome! Recovery runs or easy days are crucial to gain the benefits from our harder runs. Do a daily check…are you fatigued when you wake up? That’s a day to pull out your bike or run easier.

19. Enlist specialists – get professional advice when needed from qualified and respected Sports Podiatrists, Nutritionists, Physical Therapists, Sports Physicians, Chiropractors, Exercise Physiologists, Coaches, and even Sports Psychologists!

We are unique individuals, and one formula will not be right for everyone. It takes time to figure out what works best for us, but the important thing is that you learn from experience, and enjoy the process of becoming a better, stronger runner.

The San Diego Chargers star running back, LaDainian Tomlinson, has been hampered all season by an early turf toe injury. This injury can be devastating and has ended many NFL careers. What is turf toe really? How can we avoid this pain in the toe?

What is turf toe?

Turf toe is a condition of pain in the base of the big toe. This usually caused from either traumatically jamming the toe, or pushing off repeatedly when running or jumping. The most common complaints are pain, stiffness and swelling. The pain can be so severe that pushing off in football is virtually impossible.

This injury is especially common among athletes who play on artificial turf, hence the name. The hard surface combined with running, jumping and cutting in football and soccer, make turf toe a frequent injury. Some also blame the choice of athletic footwear. The more flexible shoes, especially used in competition, provide less support to the forefoot joints, possibly contributing to the incidence of turf toe.

How does turf toe occur?

When a player sustains this kind of toe injury they are actually tearing the capsule that surrounds the joint at the base of the big toe. Tearing this joint capsule can be extremely painful. Furthermore, tear of the joint capsule can lead to significant instability and even dislocation of the joint at the base of the toe. This may lead to accelerated cartilage wear and arthritis of the big toe known as Hallux limitis or rigidus. This wear-and-tear arthritis can end a promising career prematurely.

How is turf toe diagnosed?

Diagnosis is based primarily on the physical examination of the patient. X-rays may be taken to ensure there is no fracture or evidence of arthritis. Occasionally an MRI is needed to evaluate the surrounding tendons or to rule out an occult stress fracture.

What is the treatment of turf toe?

Treatment of toe injuries usually consist of trying to control the inflammation of the joint capsule.

Treatment protocol can include:

1. Rest

2. Ice

3. Elevation

4. Taping or padding to off-weight the toe joint

5. Anti-inflammatories

6. And in chronic cases steroid injections to the joint may be helpful

7. Long term use of a functional foot orthotics to balance the forefoot in the cleats is quite helpful.

Athletes diagnosed with turf toe should avoid stress to the joint for three to four weeks to allow the joint capsule to heal. Once returning to activities, functional orthotics can be used to limit the motion of the big toe and prevent further damage to the joint capsule.

Will turf toe return?

Unfortunately, turf toe can return, often more severe than the initial injury, and rehabilitation may be very slow. LaDainian Tomlinson has been slowed by his injury all season and most likely will not be 100% until he can rest at the end of the season. Most athletes have trouble when they try to come back to sports too soon after sustaining a turf toe injury. Surgery is rarely needed for treatment of turf toe unless this has been a chronic injury and spurs are present in the joint limiting motion. If a bone spur has formed, and severely limits the motion of the toe joint, surgery to remove the spur may be helpful.

Prevention and early treatment is really the key! If you are experiencing pain in the joint after running in practice, your shoes should be evaluated for a functional orthotic to balance your biomechanics and hopefully avoid significant turf toe.