SPORTS MEDICINE PODIATRY ASSESSMENT

BOX 1: EXTRINSIC FACTORS

Sport Each sport comes with its own risk factors and incidence of injury. An individual is more likely to injure the lower limb when participating in sports such as football or running, whereas head and upper body injuries are seen more often in sports such as boxing.

Schedule The level of competition dictates the schedule of play and training that an athlete may undertake. The schedule of play needs to be assessed for each athlete, depending upon the level of play. Stevenson and colleagues found that the incidence of injuries to the lower extremity or back was greatest within the first four weeks of

BOX 2: INTRINSIC FACTORS

Sex and age It is well documented that the incidence of knee injuries is greater in female athletes compared with male athletes (9,10). Lindenfeld and colleagues found the overall rate of injury to be similar in both men and women, but they reported the incidence of ankle ligament injuries to be three times higher in men and the incidence of sustaining a knee ligament injury to be three times higher in women (11). A number of suggestions have been put forward to explain this difference. Murphy and colleagues have looked at three studies investigating hormonal fluctuation (12); the exact mechanisms involved remain unclear. They have identified receptors for progesterone and oestrogen on rabbit anterior cruciate ligament (ACL) and suggest amplification of other risk factors during cyclic changes in the biomechanical properties of the ACL. This could “result in compromises to proprioceptive feedback, neuromuscular control, or biomechanical loading”.

Style

Each athlete has his or her own style of play, and a preference for one limb may exist. This may also be down to the fact that certain sports require specific actions, for example kicking, pushing off, jumping or landing, for which the dominant leg will be used. Baumhauer and colleagues found that athletes who were left-leg-dominant and participating in soccer, field hockey and lacrosse incurred more ankle sprains than right- leg-dominant athletes (13). It is therefore important for the podiatrist to establish the particular style of play of the athlete in order to prevent or ascertain risk factors that may have caused injury.

Stamina and strength

It is important to find out the athlete’s fitness level in relation to the level of play. Several studies show a correlation between fitness/stamina and injury. Bell and colleagues found the slowest runners in a 1mile run had a 3.5-fold greater risk of incurring an injury than the fastest runners (14). Murphy and colleagues state that “diminished aerobic fitness may cause fatigue leading to a reduction in the protective effect of

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musculature on skeletal structures” (12). Ankle, knee and overuse leg injuries

have been reported to be associated with muscle strength (13). Fitness levels are questioned and the strength of all of the main muscle groups is tested with individual muscle strength testing when associated with a specific injury.

Stretch

Muscle tightness is assessed by the podiatrist routinely, as several studies have shown a relation between muscle tightness and injury. Krivickas and Feinberg found a correlation between tight iliopsoas and overuse knee injuries (15). Achilles tendonitis was found by Kaufman and colleagues to be associated with tight gastrocnemius muscles (16). Athletes who did not stretch during warm-up were also found to be at greater risk of injury than those who did stretch.

Stability

Stability is the ability to control one’s centre of gravity. Several studies have found an increased incidence of ankle sprains in athletes with diminished stability.

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training (2). This may be indicative of the intensity of play/training or be because a training effect scheduled in after this time reduces the number of injuries.

Skill level

Peterson and colleagues found a twofold increase in the incidence of an injury in young players with low skill levels compared with more skilled players, resulting in 79% of injuries to the lower limb (3). Chomiak and colleagues found the same incidence in athletes (4). However, Hosea and colleagues found a twofold increase in the incidence of ankle injury in basketball athletes with a higher skill level compared with those with a low skill level (5). Evidence shows that skill level alone is not precursory to injury

but in combination with the type of sport (5).

Shoes and socks

A fourfold increase in the number of ankle injuries was found among elite and recreational basketball players wearing basketball shoes with air cells in the heels compared with those wearing basketball shoes with no air cells in the heel (6). It was thought that wearing air cells in the heels caused rearfoot instability.

Surface structure A number of studies have found an increase in the number of knee and foot/ ankle injuries from playing on artificial turf compared with grass or gravel (7,8).