PODIATRY SPORTS MEDICINE

stitching in these areas. Lightweight football boots can create excessive skin in direct relation to the position of the studs. Podiatry management of these is to remove the excess skin frequently, which will reduce the pressure on the area. Skin is subject to a bacterial infection, albeit a different type of infection to that of nails. The most common type of bacterial infection is one that can mimic the fungal infection athlete’s foot between the toes. The same type of bacteria can be seen on the sole of the foot, this time appearing like white macerated pitted areas. Athlete’s foot is prevalent among

people using communal showers, showing itself as itchy red areas between the toes, blisters that itch intensely as they form in the arch area, or a dryness that is slightly inflamed on the underside of the foot. Verrucas, a viral infection, are not uncommon among athletes. Diagnosis is essential in order to ensure correct management.

OTHER CONDITIONS Other conditions seen by podiatrists involved in sport include pain and injuries in the soft tissues and bone. These vary from common toe injuries caused by trauma, which require no treatment, to metatarsalgia, heel pain, ankle sprain, shin splints and other problems associated with leg- length discrepancies. They may be unilateral (one-sided). Many require a biomechanical assessment, perhaps gait analysis, shoe advice and perhaps orthoses therapy. Metatarsalgia is a general name

given to pain over the metatarsal head area. This is more commonly found in athletes who need to jump off the ground in their activity, landing on a hard surface. Pain under the first metatarsal head (base of the big toe), where the small sesamoid bones are (sesamoiditis), is more common in cyclists and other athletes who have a high arch profile, thereby increasing the pressure on the first metatarsal head area.

Plantar fascia is the big band of

tissue that goes underneath the foot. It is quite commonly inflamed and can be extremely painful, especially in the heel area. It is particularly painful after rest, such as first thing in the morning, but it can also be painful after exercise. The

www.sportEX.net

pain is usually brought about when the band is stretched and pulls, giving little micro-tears/bleeds at the insertion in the heel. Runners and cricket players are particularly vulnerable to plantar fasciitis, which can also be referred to as enthesopathy and calcaleal spur. The area underneath and at the back of the heel is prone to bursitis formation. A bursa is a deep sac of fluid (as in tennis elbow) caused by a shearing type of force. This can cause the heel to be inflamed and painful and is usually seen in walkers. Achilles tendon problems at the

back of the heel are seen frequently and usually mean that the foot is functioning in such a way that puts stress on the tendon. It is seen in many different types of sport and usually requires orthoses therapy. Ankle sprain, shin splints and

knee pain can also be found to be biomechanically related and be aided in recovery by orthoses.

ORTHOSES

Orthoses can be a particularly useful adjunct to therapy, providing they are the correct type for the condition, made of the correct material and form part of the multidisciplinary therapy, and the athlete is involved in the decision- making process. Experience has taught me that, although these points seem obvious, this simple process does not always happen.

An orthosis is often an insole, but

it may also be a piece of material that may be functional (changes function of the foot) or may be palliative (provides comfort). Materials range from sponge- type materials, some of which are highly technical such as those that spring back to their original shape, to firmer materials available in different densities (softness) and that can be moulded.

An orthosis can be described as simple (not moulded), off-the-shelf (ready-made) or moulded. Ready-made orthoses usually have a moulded arch. Many of these can be adjusted on a grinding machine or with a heat gun, and material may be added. Moulded orthoses require a plaster of Paris cast of the foot. The foot may be cast either in an impression box or with plaster of Paris bandage. The former method is very often the choice of the podiatrist. The type of footwear is a major consideration in recommending the

VALUABLE

ASSESSMENT PRESEASON CAN BE PARTICULARLY

type of orthosis. There are also cost differences between the devices, with moulded orthoses being the most expensive at £300 and above. Simple devices can be highly effective. A piece of technical foam/sponge may be all that is required under a blistered first metatarsal head in a close-fitting sports boot or in bursitis in the heel. A lateral (outside) posting to a heel can reduce inflammation on a tendo achilles, but it is likely that sesamoiditis, plantar fasciitis and shin splints will need a moulded device.

CONCLUSION

The multidisciplinary approach to athletes is the way forward. It is one in which podiatry should play its part, either as a member of the medical team or on a consultancy basis. The holistic approach of core stability, massage, stretching, emollient therapy and management of foot problems will enable the athlete to achieve their goal.

THE AUTHOR

Alison Barlow has a fellowship in podiatric medicine and general practice and is director of prosthetics and orthotics and

podiatry at the University of Salford. She has a wealth of clinical experience, especially in dermatological areas, where she continues to act as podiatrist to a Premier League football club, attending twice a week for both clinical and orthoses sessions. She is also consultant to DEBRA (epidermolysis bullosa charity), an external advisor and examiner for other universities, and a member of the Faculty of Education at the Society of Chiropodists and Podiatrists. Previously she was programme leader for both the undergraduate and postgraduate podiatry programmes.

13