The achilles tendon is often injured during sports resulting in an inflammatory condition called tendonitis which is characterized by swelling and pain. The tendon ruptures because of weakened tendons due to advanced age or from sudden bursts of activity during sports. The classic symptom of an Achilles Tendon rupture is the inability to rise up on your toes.
Our foot and ankle complex needs to be both dynamic and stable to allow for us to walk without stressing other areas in the body. The ankle may seem like a simple joint, but there are actually four bones that combine to provide the stability and motion necessary – tibia, fibular, talus, and calcaneus. The rest of the foot consists of multiple smaller bones that each must be able to withstand the movement and stress placed on it by the weight of our body. Your ankle is also an integral part of your daily function, as it is responsible for your ability to drive a car, climb stairs, and squat. If you suffer an injury to your foot/ankle it will likely become increasingly difficult to perform your normal activities without pain. The more knowledge we have regarding prevention and common causes of injuries, the better our chances are to avoid future injury.
Unfortunately, with the complexity of the foot/ankle joints it is often difficult to isolate a singular cause of injury. As with other body parts, increasing age leads to increased risk of injury from general wear and tear. After the ankle is injured there is a high likelihood that you can suffer another injury due to remaining deficits and/or poor healing.
- Overuse (Chronic) Injuries – With age and use cartilage can wear down and the ligaments, muscles, and tendons can become damaged.
- Sudden (Acute) Injuries – During a fall or other injury, the bones of the foot/ankle can be fractured. You can also have ligament tears and ruptures of the tendons.
Foot/ankle pain can be caused by any one of these common conditions:
- Adult Acquired Flat Feet (Fallen Arches) – Fallen arch, or flatfoot, is known medically as pes planus. This is characterized as a loss in arch height in the foot. There are many causes of this disorder, but among the most common is decreased muscular strength. The muscles in the foot and ankle are required to help support the arch and if the weaken the arch can collapse
- Bone Fracture – There are multiple bones in the foot/ankle that can break and each needs to be managed differently. Most will require a period of not putting weight through the foot to allow for healing.
- Metatarsalgia – Athletes who run and jump a lot may be susceptible to metatarsalgia, a type of foot injury that results in pain and inflammation in the ball of the foot.
- Plantar Fasciitis – Affecting nearly 2 million Americans each year, Plantar Fasciitis is when there is an inflammation of the thick band of ligament that extends from the bottom of the heel to the toes (primarily the big toe).
- Calcaneal Bursitis – In the heel, bursitis may cause bruise-like pain mostly on the bottom of the heel, but also at the back of the heel. This pain is most often felt at the end of the day, especially for people who spend much of their time on their feet.
Kurt Gengenbacher, PT, DPT, OCS, SCS, CSCS a Regional Director of Clinical Excellence, gives us some tips to help prevent and rehabilitate foot/ankle injuries:
- Stay Flexible – Make sure to stretch your calves daily. Hold those stretches for at least 30 seconds and repeat 2-3 times.
- Keep Your Foot Strong – Focus on functionally strengthening your foot. The foot must be able to assist in stabilizing the body while standing, so the best exercises are often in a standing position. Try to perform appropriate balancing tasks, standing toe crunches, heel raises, and toe raises.
- Avoid Overtraining – Make sure you vary your exercises and don’t always do the same thing. If you have pain after exercising, stop the activity, rest, ice and elevate your leg.
If you have pain in your foot/ankle that isn’t going away, rehabilitation is a great step to take to improve your functionality. During rehabilitation:
- A Strong Foot Is A Healthy Foot – Working on strength in the small muscles of the foot (intrinsics) can help your ability to walk barefoot and on uneven surfaces.
- Be Balanced – Work on dynamic balance exercises to improve your proprioception and ability to stay upright.
- Don’t Let Tightness Be Your Achilles Heel – Stretching your ankles can help to improve your ability to go down stairs and squat.
- Stay On Your Toes – Strengthening of your calf muscles can help to improve your ability to walk, run, and climb stairs.
- Wear Proper Footwear – It is important to provide appropriate support to your foot.
When weighing your treatment options for foot pain and injuries, consider physical therapy. Physical therapy offers a wide variety of treatment options including strengthening, stretching, and sustainable home exercise programs. Stop in or call any ATI location for a complimentary injury screen or to learn more about how physical therapy can help you overcome your foot pain.
The Nutcracker is the most iconic holiday ballet performed by ballet schools and professional companies around the world.
Between December 10th and December 30th, the Joffrey Ballet Chicago will perform The Nutcracker 27 times. That’s an average of 1.2 shows per day! For optimal performance, it is crucial that dancers are proactive in preventing injuries from occurring and correctly manage injuries when they do occur. Foot and ankle injuries represent 34-62 percent of all injuries reported by dancers. Female ballet dancers are especially vulnerable to these injuries because of the increased demand put on the foot and ankle when dancing en pointe.
To help prevent dancing injuries from happening, consider the following tips:
Overuse injuries are aches and pains that occur due to the repetitive nature of dance movements and lack of adequate rest. Examples of overuse injuries are stress fractures and tendinitis. Fortunately, the risk for these injuries can be decreased through appropriate rest, adequate warm up and nutrition.
Getting Appropriate Rest
Fatigue has been cited as a common reason for injuries in dancers as overall injury rates vary from 0.8 to 2.9 injuries per 1,000 hours of dance training. When fatigued, decreased trunk control and faulty lower extremity alignment results in increased demand on joints and ligaments to provide stability. While you may not be able to alter the amount of time you spend dancing, you can control what you do during time outside the studio. For example, active rest is preferred over complete rest, including gentle movements, stretching, as well as strengthening and stabilizing muscle groups. This helps avoid excessive stiffness throughout the body.
It is also important to note that fatigue-related injuries have been reported to increase when psychological stressors such as work or school conflicts are present. Since performances may induce additional stress, it is important to find strategies to appropriately rest your brain in addition to your body to stay healthy during this time.
An appropriate warm-up primes the body for optimal performance. Morrin et al found that a combination of static and dynamic stretching provided a significant change in hamstring flexibility as well as superior balance and vertical jump values in comparison to a static-only or dynamic-only warm up.
Static stretching involves holding a specific position for a period of time whereas dynamic stretching has an aerobic approach in which the body part is repetitively moved through its available range of motion. Examples of dynamic stretching include leg swings, alternating kick-to-buttocks and scissor jumps.
Low energy availability occurs when a dancer is not consuming enough food for the amount of energy expended during physical activity. Therefore, a dancer will need to eat more as the volume of dance participation increases.
Signs of low energy availability include fatigue, difficulty concentrating and loss of menstrual cycle. Consistently low energy availability can cause sub-optimal bone mineral density and place the dancer at increased risk for stress fractures. High caffeine intake, noted as greater than two cups of coffee per day, can also contribute to low bone mass density. For specific nutrition recommendations, please seek attention from a nutritionist in order to develop a plan based on your individual needs.
Acute injuries occur when a bone, ligament, tendon or muscle is extended past its capability or excessive force is placed onto a region of the body. Examples of acute injuries are ligament sprain and muscle strain.
When an acute injury occurs, the body releases chemicals to create an inflammatory response around the damaged structure. The inflammation assists with promoting new cell growth, defending the body against harmful substances, and disposing of damaged tissue. However, this process results in swelling, redness, warmth, pain and loss of function at the area of injury. The following steps should be taken after an acute injury:
Relocate to a safe space away from additional danger such as fellow dancers continuing to perform and provide support to the region of injury.
Avoid painful movements with involved body part as continual stress may increase injury and delay healing.
Apply ice to the injured area for 20 minutes every 2 hours for the initial 2-3 days. Ice will decrease blood flow to the area, slow conduction of painful nerve impulses, decrease abnormal accumulation of fluid, and lower temperature.
Utilize an elastic compression bandage to wrap the area. If you experience sensation of pins/needles, numbness or change in skin color, the bandage is too tight. Start away from the heart using a figure 8 pattern with a gradual decrease in tightness as you pass the site of injury. Avoid gaps in bandage that expose skin as swelling will accumulate here.
Raise the injury area above the heart to increase return of blood and therefore remove waste products away from the area.
All acute injuries should be evaluated by a health-care professional for advice regarding appropriate next steps, especially if not resolved with “PRICE” or unable to bear weight. Choosing a health-care professional who has a specialty working with performing artists will be helpful to allow for a gradual, safe return to dance.
Basic First Aid for the Foot
Although blisters, cramping, split skin and bruising will not likely take you out of a performance, they can be a source of discomfort when participating in a higher volume of dancing.
Blister – Blisters are caused by a combination of friction and moisture at bony prominences of the feet. It may be a sign that shoes should be re-sized as the structure of the foot can change over time. Petroleum jelly or tape placed on more vulnerable spots can decrease friction. In addition, using less absorbent material for tights or pointe shoe padding can decrease moisture. Blisters will heal independently and should avoid being popped due to risk for infection. If a blister does pop, it is important to cover with an antibiotic ointment and bandage that will stay secured in shoes.
Cramps – A muscle cramp is a strong, painful tightening of a muscle that occurs involuntarily. Another name that is commonly used to describe a cramp is a “Charley horse.” To avoid cramping, stay hydrated and perform an adequate warm up as well as cool down. Stretching the cramped muscle can assist with relieving symptoms faster.
Split Skin – Split skin often occurs in the area of a callous, particularly on the ball of the foot. Prevent skin from splitting by using a fat-based balm such as coconut oil over areas of tough, dry skin. If a skin split does occur, be sure to keep the area clean to decrease risk for infection. There are some over-the-counter products that help to seal the split skin together to promote healing.
Bruising – The best prevention for bruising is to wear padding and control descents to the floor during choreography. Avoid heating pads or warming topical creams, as this will bring more blood to the bruised region and delay healing.
By following the above recommendations, you are now ready to tackle the Nutcracker season injury free! If you experience an injury, please contact your physician or set up a screen with a performing arts physical therapist at a conveni ent Athletico Physical Therapy location.
Episode 16.33 with Hosts Steve Kashul and Dr. Brian Cole. Broadcasting on ESPN Chicago 1000 WMVP-AM Radio, Saturdays from 8:30 to 9:00 AM/c.
Segment One: Dr. Simon Lee from Midwest Orthopaedics at Rush discusses sprains, achilles and other foot and ankle injuries; bracing vs taping. According to the American Academy of Orthopedic Surgeons (AAOS), 25 percent of all injuries from sports are to the foot and ankle. Athletes who play certain sports with sudden foot movements, such as hockey, basketball, football and tennis, are at a greater risk of ankle injuries. However, The Clinical Journal of Sports Medicine reports that the sports that cause the most ankle injuries are boys’ and girls’ basketball and girls’ gymnastics.
For dancers, the rate of ankle injuries is even higher than for those who play sports. A full 50 percent of dancers’ injuries are to the foot or ankle. Dancers’ feet and ankles endure twists, turns and heavy load during practices and performances. In addition, they are under pressure to stay thin and may eat too few nutrients, exacerbating injuries by weakening their bones and muscles. A minor injury to the ankle will leave athletes or dancers sidelined for at least two weeks. However, a major ankle injury, like a severe sprain or Achilles rupture, can take months to heal. If an athlete doesn’t allow enough time for recovery, they are at risk of sustaining a re-injury.
While there is a rising number foot and ankle injuries in athletes and dancers, research shows that these injuries can be prevented by performing ankle balance, stretching and strengthening exercises and alternating with another sport. This is why the Midwest Orthopedics at Rush (MOR) and the Illinois Athletic Trainers Association (IATA) have teamed up to promote awareness and prevention of ankle injuries. “Ankles for Life” aims to provide essential information regarding specific ankle injuries and tips for preventing these injuries in the future.
Segment Two: Steve and Dr. Cole discuss the recent bone bruise injury suffered by Michael Carter Williams of the Chicago Bulls. Definition, causes, diagnosis, treatment, recovery and decisions on when to return to play.
Bulls guard Michael Carter-Williams will miss four to six weeks with a left knee bone bruise. Carter-Williams suffered the injury while taking a hard fall on defense. An MRI revealed no ligament damage in his knee, the team said.
Segment Three: Brett Wapotish from Athletico specializes in pelvic floor disorders in men and describes the causes, symtoms and treatment. Chances are you have heard the month of November referred to as “Movember” several times over the last few years. While the first thing that comes to mind is probably mustaches, it is important to know that there is a bigger cause behind the Movember movement.
Movember brings awareness to common men’s health issues, such as cancer and heart disease, as well as highlights the benefits of living a healthy lifestyle. Athletico has supported the Movember movement for three years via our AthletiMo team, which anyone can join to help raise funds and spread the word about men’s health.
Learn more about how you can participate with the AthletiMo’s
Episode 16.24 with Hosts Steve Kashul and Dr. Brian Cole. Broadcasting on ESPN Chicago 1000 WMVP-AM Radio, Saturdays from 8:30 to 9:00 AM/c.
Segment One: Dr. Cole and Steve discuss the upcoming Chicago Sports Summit to be held at The Hyatt Regency on October 5th. Chicago leaders will join forces during the first-ever Chicago Sports Summit, a forum about the fast-changing world of sports and issues that will affect the future of the industry in Chicago.
The powerful line-up of experts will tackle issues, such as owning and managing teams; building fans and staying profitable; player contracts and injuries; the changing world of college sports and keeping young athletes engaged in sports.
Segment Two: Chip Schaefer talks about the early days at the Chicago Stadium and the biggest changes over the years in the players, training, injury management and new technology. A veteran in the athletic training and sports performance fields, Schaefer returns to Chicago for a second stint with the Bulls having served as the team’s Head Athletic Trainer from 1990-98. Schaefer’s new role with the Bulls will be to implement and integrate a multi-disciplined staff that bridges the sports medicine and sports performance programs.
He will oversee athletic training, strength and conditioning, sport psychology and player nutrition. The 2016-17 campaign will mark his 25th season in the NBA, during which time he has contributed to 11 NBA Championship teams (six with Chicago, five with the Los Angeles Lakers). Most recently, he spent the last three seasons with the Sacramento Kings as the team’s Director of Sports Science. While with the Kings, he assisted the sports medicine and athletic training staffs with injury prevention and health maintenance.
He also created and implemented the team’s strength and conditioning programs. Following his first term in Chicago, he worked 13 seasons with the Lakers (1986-87, 1999-2011). In his last seven seasons in Los Angeles, he was the team’s Director of Athletic Performance/Player Development; while with the Lakers, he also oversaw the transition of the team’s young players into the NBA, as well as their professional development.
Segment Three: With the upcoming Chicago Marathon, Dr. Cole sees a variety of running injuries and discusses sudden injuries in the hip-groin area, foot and ankle injuries, runners knee tibia and stress fractures; signs and diagnosis, when to stop training, when to take action, overuse and recovery; how to prevent more serious injury.
The plantar fascia is a thick band of tissue that covers the bones along the bottom of the foot and connects the forefoot and the heel. And when there is too much inflammation in this vital tissue, it can develop to the condition that’s known as Plantar Fasciitis. Plantar Fasciitis is one of the most common culprits of heel pain in runners and amounts to roughly 10 percent of all running injuries.
Symptoms: Plantar fasciitis manifests as intense pain and extreme tenderness along the bottom of the foot near the heel, particularly within the first few steps after getting out of bed in the morning, getting up after prolonged periods of sitting, or, apparently, while running.
Causes: Some of the of leading causes of the injury include overtraining, and running in the wrong footwear. Extreme pronation and supination can also be culprits to the ailments. In addition, runners with a very high or very low arch are also at greater risk of the injury. Other causes include too much standing on hard surfaces, ramping up running mileage too quickly, and tight and/or weak lower body muscles.
Fix It: For a quick fix, grab a frozen water bottle, then roll it under the sole of your foot backward and forward for five minutes at a time, a couple of times per day. To speed up recovery, make sure to step back from running, and stretch the fascia tissue at least a couple of times per day. If the pain persists, then you should see a physician. They might suggest putting on custom-made orthotic, or a night splint to speed up recovery. These are all viable options to consider if all else fails.
Prevent it: First off, stretch your plantar fascia and calves on a consistent basis—especially if you are about to run in the morning as the fascia tends to tighten overnight. Plus, make sure also to work on developing core strength—especially if you have a bad history of the injury. Furthermore, strengthen your calves with heel raises, toes raises, and eccentric heel drops.
Plus, avoid strapping on high heel or flip-flops, both of which can irritate this band of tissue and shorten the calf muscles.