With your eye on the tennis ball, you run across the court and plant your feet in preparation to attack the ball. It all sounds so simple, but there are so many factors to consider during this routine reaction to attacking the tennis ball. With each reaction and step, your feet play a vital role in whether an injury occurs.
Examining the athlete’s feet is a vital component of the evaluation process. Unfortunately, most athletes seek the attention of a doctor after the injury occurs. For many of these injured athletes, preexisting or congenital issues are present in the feet. Most of these signs are obvious to the trained practitioner. If these conditions are identified and addressed before the injury, many lower-extremity and spinal sports injuries can be prevented or minimized.
Assessing the Risk of Injury
Reducing the risk of injury should be one of the primary objectives of the practitioner as it relates to managing the active patient. Preventing sports injuries requires a detailed look at the athlete’s foundation. The feet support the musculoskeletal system from the ground up. A gait analysis or laser scan of the feet should be incorporated in all patients’ exams. These exams identify technical issues with the feet, such as excessive pronation, a condition causing abnormal lower-extremity biomechanics that can lead to excessive stress and strain on the lower extremity and transfer impact up the kinetic chain causing increased compression in the back.
Lower-extremity injuries are the most common high school athletic injuries in noncontact, contact, and collision sports1. Knowing what the most common injuries are and understanding the physiology behind the cause of the injury can help the athlete spend less time on the sidelines and more time on the court, track, or field.
Faulty Foot Biomechanics and Injury
The top two musculoskeletal sports injuries, at any level, involve the ankle and the knee. Addressing technical issues within the feet with custom orthotics, increasing strength, and improving reaction time are the keys to injury prevention and recovery. Seventy percent of ACL injuries are noncontact in nature2. These injuries can result from faulty foot foundation, as well as lack of intrinsic strength, coordination, balance, and reaction time. During the gait cycle, the foot strikes the ground and a cascade of events happens throughout the kinetic chain. The result is proper support or failure at the ankle, knee, and/or hip, depending on how the foot responds at impact. To reduce the risk of lower-extremity and back sports injuries, the practitioner must gain an understanding of simple lower-extremity anatomy and biomechanics and then consider custom orthotics as a primary treatment option.
Helping Prevent Injuries through Foot Stabilization
A detailed evaluation of both feet is the first step to preventing lower extremity injuries. The foot is the keystone of the body’s foundation. During the weight-bearing part of the evaluation, begin by evaluating the feet to determine the foot type. Pronation in varying degrees is a common finding among athletes. With pronation, the tibia rotates and the knee collapses medially, causing a genu valgum deformity. Laser 3D-scanning technology provides a state-of-the-art piece of equipment to evaluate the feet. This advanced technology offers a simple but detailed visual, allowing the athlete to see and understand the vital link between the foot and its impact on the kinetic chain. A custom-made foot orthotic supporting all three arches of the foot can be a game-changer when it comes to supporting the natural architecture of the foot, which in turn can prevent many lower extremity and spine issues. By definition, fitness is a balance between strength, conditioning, and flexibility. Addressing these issues in the athlete is vitally important for injury prevention and maximizing athletic performance. In addition to addressing the components of fitness, it is critical to have sound foundational biomechanics.
Risk Factors that Start with the Feet
During the gait cycle, the foot initiates a cascade of events that occur up the kinetic chain. The foot has three natural arches—the transverse or metatarsal arch, medial longitudinal arch, and lateral longitudinal arch. Collectively, these arches make up the foot’s plantar vault. This vault is a dynamic structure, elevated to allow the foot to absorb and disperse energy at impact, thus allowing the foot to transition smoothly from the heel strike, midstance, and toe-off phase of the gait cycle. Many technical issues with the foot, such as supination, overpronation, pes planus, flexible pes planus, and forefoot valgus, cause a myriad of biomechanical distortions, which negatively impact the normal gait cycle and lower-extremity alignment.
During the initial phase of the gait cycles, the heel strikes the ground and what happens next determines whether the impact is absorbed at the foot or transferred to the structures up the kinetic chain. Adequate architectural support throughout the plantar vault and proper biomechanics allow for maximum gait-cycle efficiency, resulting in less stress and strain on the intrinsic structures of the lower extremity. For those who have technical issues with the feet, custom-made orthotics that support all three arches of the foot will provide the needed architectural support, which in turn will allow the feet to do what they are designed to do—provide support, maintain alignment, and reduce impact.
Other factors implicated as contributors to lower extremity sports injuries are anatomic alignment, poor training, technical errors, unfamiliar techniques, and environmental factors, including athletic surfaces. These factors start in the feet. Therefore, to prevent injury, an examination of the feet should be paramount. Flattened feet, foot flare, genu valgum, uneven shoe wear, and bowing of the Achilles tendons are five signs that should be looked for when evaluating the athlete. Custom orthotics can address all of these issues by providing the necessary support to the foundation, which will help with lower-extremity alignment and reduce impact transferred up the kinetic chain significantly. With a supported foundation, many sports injuries can be prevented, and athletes can more confidently do what they love to do—play the sport they love!
Dr. Kurt Juergens has been in private practice since 1989 and has had extensive post-graduate training in Sports Medicine. Dr. Juergens owns and operates Juergens Chiropractic & Sports Rehab Center in Houston, Texas. He graduated in Summa Cum Laude from Texas Chiropractic College. In 1992, Dr. Juergens was selected to be a member of the U.S. Olympic Track and Field Trials Sports Medicine team. He has also served on the sports medicine teams for the NCAA Track & Field Championships, ATP's Tennis Masters Cup, and U.S. Clay Court Championships. Dr. Juergens continues to treat high school, college, and professional athletes in all fields from all over the world. Dr. Juergens lectures regularly for his profession on topics related to sports rehabilitation.
References
1. University of Pittsburgh Medical Center, Sports Medicine
2. Landis, S., Baker, R., Seegmiller, J (2018). International Journal of Sports Physical Therapy.
3. Percent of ACL injuries
4. https://www.ncbi.nlni.nih.gov/...
