COMMON GOLF LOWER LIMB INJURIES
What is plantar fasciitis?
The most common cause of heel pain is plantar fasciitis. This is pain and inflammation of a band of fibrous tissue (the plantar fascia) within the arch of the foot that attaches into the heel bone.
Signs and symptoms
Plantar fasciitis may present as pain anywhere along the length of the plantar fascia, most commonly at the heel where the plantar fascia attaches to the calcaneus (heel bone). Sharp pain is often felt immediately after rest, particularly first thing in the morning. Symptoms may improve as the area warms up but may then become worse again towards the end of the day, especially if you have been on your feet for a long time.
What are the causes of plantar fasciitis?
Plantar fasciitis is thought to be caused by repetitive stress on the tight bands of the plantar fascia which result in micro tears as it extends from the heel. Because these tears usually do not occur from a single traumatic event, an immediate healing reaction is not triggered. A chronic irritation or inflammatory process thereby begins which increases with activity. Any sudden weight gain, sudden changes in the intensity and type of activity, poor foot mechanics (over pronation or "rolling-in"), inappropriate footwear and standing, walking or running on hard surfaces can all lead to plantar fasciitis. Plantar fasciitis is quite common among golfers due to the long duration spent on the feet, and the addition of the rotational movements unique to the game.
What can I do?
Effective treatment of plantar fasciitis involves first identifying why it has occurred and what factors have contributed to this. A thorough assessment by your Podiatrist is very important to help you get on the path of healing. There are, however, several simple exercises that may help reduce the pain. These exercises include:
Stretching your calf muscles (this is done simply by standing on a step and gently lowering your heels off the ledge of the step);
Massaging your heels and arches with a golf ball;
Gently stretching your arch (this is done by gently pulling your toes back towards you);
Using a bottle filled with ice water and rolling your foot on the bottle for several minutes;
Rolling your foot/feet on a tennis ball or tin-can before you stand up in the morning;
Thoroughly warming up and stretching before playing or practicing.
Plantar fasciitis can become a chronic issue if it is not addressed, it is important to get it assessed as soon as symptoms occur.
What is Achilles Tendinopathy?
Achilles Tendinopathy is an overuse condition affecting the large tendon that connects the calf muscles to the back of the heel.
Signs and Symptoms
The main symptoms of Achilles Tendinopathy include general pain and stiffness felt around the Achilles tendon. These symptoms are often worse when you first wake up in the morning, or following the round of golf. It may be painful when you touch the area around your Achilles tendon, and in some cases, swelling may be present.
Severe pain that comes on suddenly may be indicative of a tear or rupture, and medical advice is recommended as soon as possible.
What are the Causes of Achilles Tendinopathy?
Achilles tendinopathy is most commonly caused by repetetive stress to the area, resulting in tiny injuries (microtrauma) to the Achilles tendon. Due to the constant stress placed on the tendon, the injuries do not heal completely, and over time, the damage may build up and result in the tendinopathy occurring.
Some of the factors that may lead to this stress include:
Overuse of the Achilles tendon due to excessive exercise/activity;
Incorrect or inappropriate footwear;
Rapid increase to the frequency of your golf games;
Playing on courses regularly that have hard or sloped surfaces;
Inefficient biomechanics of the feet, e.g. excessive pronation (rolling-in) or supination (rolling-out) of the feet
Injury to the Achilles can occur in a single instance, or more commonly, over a period of time, where constant load may result in injury.
What can I do?
The best treatment of Achilles pain is to try and prevent it from occurring in the first place. The introduction of some simple exercises into your daily routine can go a long way to reducing the risk factors of Achilles injury. Stretching of the calf muscles will assist in improving the overall elasticity of the muscles and reduce the tension applied to the tendon, whilst strengthening exercises will improve the ability of the structures to resist the stresses placed upon them.
It is also very important that your shoes (golf shoes and general day-to-day shoes) are correctly fitted to suit your foot type. Ask the advice of your Podiatrist, your pro-shop specialist, or visit a reputable shoe store like The Athletes Foot here in Australia, and don't be afraid to try on several pairs of shoes until you find the right fit.
If you feel that you may be developing some of the symptoms of Achilles tendinopathy, make an appointment to see your Podiatrist or Physiotherapist as soon as possible.
What is a Morton's Neuroma?
A morton's neuroma is an enlargment of the intermetatarsal plantar nerve, most commonly between the base of the 2nd and 3rd, or 3rd and 4th toes.
Signs and Symptoms
The most common reported symptom of Morton's Neuroma is a burning pain in the ball of the foot, with some patients reporting an ache or a shooting pain also. It will often occur in the middle of a run or at the end of a workout, and commonly the patient will seek relief by taking off their shoes and rubbing their feet. Tight fitting footwear and higher heels may exacerbate the pain also.
What are the Causes of a Morton's Neuroma?
There are several factors which may contribute to the development of a Morton's neuroma. The first, and possibly the most common, is poorly fitted footwear. Footwear that is too narrow or too small will cause compression of the metatarsal bones in the forefoot. As the intermetarsal nerve runs between these bones, it will also become compressed and, over time, will result in the protective sheath around the nerve to become thickened, and ultimately painful. Another common factor, is excessive pronation of the feet (fallen/collapsed arches). Pronation of the foot can cause the metatarsal heads to rotate slightly, pinching and irritating the nerve between the metatarsals. As the irritation increases, the enlargement of the nerve will result in greater pressure between the metatarsal heads, and the symptoms may increase also.
What is the Treatment of a Morton's Neuroma?
There are a number of successful treatments of a Morton's Neuroma, all dependant upon the cause of the irritation. Correct advice and fitting of footwear is very important. Getting assessed by your Podiatrist, or fitted by a footwear specialist, will ensure that your shoes, including your golf shoes, are the correct choice for your foot type, ultimately improving your comfort and foot health.
What are shin splints?
Shin splints is a broad term to describe two main areas of pain. Anterior shin splints is pain located in the front area of the shin, whilst posterior shin splints (or Medial Tibial Stress Syndrome) is pain located a little lower down, on the inside of the shin area.
Signs and Symptoms
Anterior shin splints presents as pain in the front of your shin, often in the top third of the shin area. Pain will generally be worse when raising the toes/front of foot, while keeping the heel on the ground, and will often be felt when walking up hill, long distances, at a fast pace, or on uneven terrain.
Posterior shin splints more commonly presents as pain in the lower region of the shin, towards the inside of the leg. Symptoms will often be present during running, longer walking, walking on uneven terrain, or jumping sports, and may be exacerbated by poorly supported footwear or barefoot.
What are the Causes of Shin Splints?
As a general explanation, shin splints are caused by consistent overstraining of the muscles involved, the Tibialis Anterior for anterior shin splints, and the Tibialis Posterior for posterior shin splints. The most common (but by no means conclusive) causes of shin splints are tight calf muscles (anterior shin splints), and feet that pronate (roll-in) excessively (posterior shin splints). Other common factors can include incorrect/inappropriate footwear, excessive levels of activity, weight gain, working/playing sport on hard surfaces, or starting a new activity with no "settling in" period.
What is the Treatment for Shin Splints?
The best treatment for shin pain is conclusive diagnosis from your Podiatrist, Physiotherapist, or other lower limb health professional. There are many different factors that lead to shin pathologies, so it is important to ensure you are applying the right treatment modalities and exercises to the matching diagnosis. Generally, regular calf and hamstring stretching will assist in reducing the discomfort of most shin pain, while the use of good quality foot orthoses will assist in reducing the amount of pronation experienced by the feet. Acute treatment, such as the use of ice and massage, especially after exercise, should be started as soon as the symptoms are felt. Once again, if you feel you may be developing shin pain, go and get a professional assessment done by your health professional.
Plantarfasciitis, Achilles Tendinopathy, Morton's Neuroma and Shin Splints are only four of many conditions that can commonly affect active golfers. Other conditions, such as metatarsalgia, bunions, hammer toes, plantar plate injuries, knee pathologies, blisters, or ankle pain, can all be commonly experienced by golfers of all ages and abilities. The above information should be used purely as a guide only.
If you believe you may be experiencing any of these conditions, please consult your Podiatrist or Physiotherapist and get treatment early.