Biomechanical assessment involves

assessing the architectural merit of the foot. The joints are examined for their potential range of movement, with one foot being compared with the other. Past injuries are important, as are current problems, but equally important are athletes without symptoms at the time. Detailed training schedules need to be taken into account so that type and length of training may be given consideration. Usual footwear and training

footwear should be available for examination. The athlete will normally be examined on both a weight and a non-weight basis in order to compare areas such as arch profile. Gait analysis may well be considered necessary, in which the athlete is asked to walk with or without footwear to monitor the angle of the femur, patella and tibia and the angle the foot takes in motion. Routine clinical treatment

from a podiatrist helps to keep discomfort under control. General clinical work in the athlete is better done from a minimal and frequent scenario, which is a different concept from a normal clinic. The athlete needs to be able to continue with their sport, and it is essential that skin and nail are not left in a pre-vulnerable state where any further trauma caused may create problems and the healing

process may take longer.

NAILS Nails naturally vary in shape and thickness, and this shape and thickness may change due to trauma either from a one-off event or from multiple minor trauma against the shoes. It is not unusual to find a corn under the nail, either at the corner or in the middle, caused by the snug fit of some sports shoes. Nails are also prone to press into the sides, causing ingrowing toenails, and may separate from the nail bed due to trauma.

Once the nail has separated from

the nail bed, it is much more vulnerable to bacterial and fungal infection such as Candida infection, which can give rise to inflammation surrounding the nail known as paronychia. (See Box 1 for an explanation of some clinical

BOX 1: CLINICAL TERMS

Corns (helomas) and calluses are both formed from frictional and direct pressure. Both are found on the dorsal (upper) and plantar (underneath) parts of the feet. A corn has a nucleus or hard centre, which is an indication of more severe pressure, whereas a callus does not.

n Blisters are caused by friction. They may occur anywhere on the foot. The depth of the blister is dependent on the severity of the friction. They may be filled with clear fluid or blood.

n Athlete’s foot is caused by a fungal infection. It may affect the skin or nails. The skin may be treated by over-the-counter preparations. If the nails are affected, prescription-only medicines are considered to be more effective. The skin may take various appearances, such as white and moist between the toes, blisters in the arch area, and flaky dryness around the heels. The nails are usually thickened, discoloured and crumbly.

n Verrucae (warts) are viral infections that are normally not harmful and will disappear with no treatment. The skin striations (lines) will not continue through a verruca. They tend to bleed easily, and sometimes dried blood within the verruca may look like a thorn. They can be painful on sideways pressure (pinching).

n Paronychia is inflammation of the skin surrounding the nail, which may look red and swollen and be painful.

terms.) The podiatrist can keep the nails cut and reduced to a reasonable thickness, which will help to prevent problems. Paronychia can often be treated with an over-the-counter (OTC) preparation such as Canesten. Bacterial infection, which is very often caused by the edge of a nail piercing the skin, is usually cleared up by removing the offending piece of nail, using saline (salt) footbaths and simple dressing. Antibiotics are required very rarely. Blisters under the nail are common.

They are usually filled with blood but can also contain pus. The crucial management of these is to release the pressure by piecing through the nail, often using a fine drill. The blood will then be released and the pain resolved almost immediately. Then all that is usually required is a saline footbath and a simple dressing of gauze.

SKIN

Skin is subject to pressure-related lesions such as hard skin and corns. The most usual place for these is underneath the hallux (big toe) and the fifth (small) toe, both on the top of and in between the toes. This can be due to snug-fitting sports shoes, the shape of the toe area in the shoe, and shoe

12 sportEX dynamics 2009;20(Apr):11-13