Football injuries of the ankle

Why is football so hard for the foot and ankle? Although the question is simple, the answer is no less complex. There are a multitude of specific points that add up and create favorable conditions for trauma and pain in the ankle. Just follow a match and players to understand the source of these foot injuries. Football is a sport where accelerations must be explosive, the wearing of crampons entails major constraints by blocking the foot relative to the rest of the body, hyperflexions and hyperextensions of the ankle hurt the joint, direct contact (tack, etc. ..) can be very violent … In short, the sources of trauma are legion and any self-respecting footballer suffered, sooner or later, problems of his lower limbs.

JOINT CONFLICT (PAIN IN THE ANKLE)

douleur à la cheville - conflit articulaire cheville

The articular conflict is defined by a mechanical blockage of a joint. The causes are numerous but one generally finds bone growths or fibrous scars on both sides of the joint. When the ankle is flexed or extended, these growths come into contact with each other, blocking the movement and causing pain (see image above). 
Scientific studies have shown that forced movements, for example when striking a balloon, impose a violent impact between the bones of the ankle. This leads to microlesions of the bone and bleeding (hematoma) which, although painless, end with years of calcification. It is also quite simple to recognize a young footballer only by looking at his ankle x-rays which often show the development of these growths, also called osteophytes.

Ligament lesions (sprains, for example) can also cause blockage, creating a mass of fibrous tissue in the ankle. It is usually located on the lateral edge of the ankle, with a very specific painful area.

Although these growths are generally asymptomatic, it is sometimes necessary to operate them in case of persistent pain or blockages. The development of ankle arthroscopy has been a real revolution in the understanding and treatment of these lesions.

For more information, find our specific page on ankle conflicts.

 

ANKLE SPRAIN

It is impossible to talk about the trauma of the footballer without looking specifically at ankle sprains . 
The design of football boots is clearly one of the main risk factors for ankle pain. Running with crampons is obviously mandatory on a football field, otherwise the list of trauma would certainly be twice as long! However, the specific moment when the crampons are planted in the ground is a particularly dangerous moment. At this precise moment, the foot is fixed in one position while all the rest of the body is moving. It is then enough that the movement is modified to cause extreme forces at the articular level. It is usually at this time that ligamentous lesions of the knee, ankle sprains, or fractures occur. There are other important risk factors such as a lower extremity axis defect, ligament laxity, a hollow foot, etc.

Ankle sprain is an injury to the ligaments stabilizing the bones. Distended, torn or broken, they can no longer play their role and make the ankle unstable or painful chronically . It is important to train the muscles of your ankle well and perform regular balance exercises (proprioception) to reduce the risk of sprains or ankle pain. Also make sure of the maintenance and choice of your football boots see the addition of custom soles.

 

 

ANKLE OSTEOARTHRITIS

douleur à la cheville - Cheville normale vs arthrose de cheville

This is a common question and concern for footballers, professionals or amateurs. Unlike other joints such as the hip or knee, ankle osteoarthritis is usually post-traumatic, that is, osteoarthritis develops in the aftermath of a major ankle injury, even an old one. Classically, an ankle, astragalus or tibia fracture is found in the history of patients with osteoarthritis. It has never been proven that hyper-use of the ankle, as for example in an elite athlete, was itself a source of osteoarthritis. It is obvious that the more an injured joint is used, the faster the damage is, but it is then necessary to present an underlying pathology.

It is known, however, that ankle instability is a common source of osteoarthritis. This particularity is often overlooked and neglected, but it seems very important to us to be aware of the subject.More than 80% of unstable ankles will develop osteoarthritis to a greater or lesser degree! It is therefore essential to follow optimal rehabilitation after a sprain, because many instabilities are due to insufficient treatment after the trauma. In the most advanced cases, it is sometimes necessary to resort to surgical stabilization which resolves the problem of instability and pain in the ankle permanently.

 

Fracture

douleur à la cheville

 

The tackles, best friends of a good defense in bottom of ground, are probably the worst enemies of the bone integrity of the footballer! The load, on a limb blocked on the ground by the crampons, leads to sometimes severe fractures and we all remember these impressive images of fractures during televised matches. The most common bones are the tibia, fibula and metatarsals, but there is a long list of possible fractures. Remember if pain related to sports trauma struggling to decrease.

There is, of course, no real way to protect you from this type of trauma because it is usually the opponent who causes the injury. Nevertheless, be careful and remember that a fall is often much less damaging than a tackle on a blocked leg. If you have been victim of such a trauma and have trouble getting in because of pain in your ankle. It is very likely that you suffer from a fracture. In this case, go to an emergency department for X-rays and a specialized examination.

 

Plantar Fasciitis: Pathology

Author: Dr. Adrien Ray

Thorn in Lenoir

Plantar fasciitis, sometimes called Lenoir’s thorn, is the main cause of talagias (heel pain) and represents 11-15% of specialized consultations. It corresponds to an attack of the plantar fascia (for more information, read our article … ). This fascia is a long fibrous structure, connecting the heel to the toes. The term Lenoir’s thorn is often used when referring to the injuries of athletes such as basketball players, distance runners or footballers. It usually presents as acute pain, very debilitating, increased by activity and particularly pronounced when waking up. The main risk is the chronization and therefore the installation of these pains on a daily basis. Although the existence of this pathology has been democratized, its origin remains poorly understood. The scientific community agrees to recognize multiple causes, related to many factors such as age, weight or heavy work. The consensus ends there, and the discussions remain passionate about its true nature.

A real inflammatory pathology?

When you find the suffix -ite at the end of a word, it corresponds to an inflammation. Conjunctivitis (conjunctiva), tendinitis (tendon) or sinusitis (sinus) are classic examples. The word fasciitis means “inflammation of a fascia”. This pathology has long been considered as such and described as a cascade of inflammatory phenomena due to local stress. However, it is difficult to explain that this “inflammation” does not resorb after a few days of rest, like most acute inflammations. Biopsies have been made on this structure and show little inflammation. Plantar fasciitis is not an inflammatory disease. We must then turn to a degenerative process.

Microtrauma and tissue damage

Studies of Achilles tendon or other tendons have led to a better understanding of the phenomenon responsible for fasciitis. Repeated shocks cause microcracks or tears in the tendinous structures. It is then a delicate balance between the occurrence of these traumas and the ability of the body to heal. As long as the balance is preserved, the foot is painless. When the balance tilts in favor of the traumas, one notes a degeneration of the tissue concerned, a progressive destruction which can lead to a complete rupture and the calcification of the lesions (hence the appearance of a bone spine). Fasciitis is therefore a degenerative and non-inflammatory pathology.

Role of the calf and its contracture

The most exciting discussions about plantar fasciitis or Lenoir’s spine are currently focused on the role of the Achilles tendon. The latter is formed by the confluence of two calf muscles: the gastrocnemius and the soleus. These two muscles, very powerful, allow the flexion of the ankle. When the gastrocnemius is too short or too tense (short gastrocnemius syndrome), it leads to a cascade of retractions and in particular that of the plantar fascia. It is therefore intimately linked to the calf by a complex of structure called gastro-calcaneo-plantar system, so dear to the Spanish surgical school. Short gastrocnemius syndrome is common and seems to be responsible for a considerable number of foot pathologies. The DiGiovanni team showed in 2009 that 85% of patients with plantar fasciitis have a calf muscle retraction. These findings show that this very common pathology is perhaps the tip of a much more complex iceberg and that more extensive management should be offered to patients, focusing not only on the fascia, but also on the rest of musculature and statics. To learn more about plantar fasciitis …

How to choose your sports shoes

Author: Dr. Adrien Ray

1. GET PROFESSIONAL ADVICE

We can not stress this point enough. Choosing the right shoe for the right foot is a job. Being at the top of the design is good, do not have to stop his season because of an avoidable injury, it’s better! Each foot is different and requires a suitable footwear. Some brands, for example, are perfectly suited to a fine foot, while others will work much better with a wider foot. Pronator foot, supinator, slider, … there is a terminology sometimes difficult to understand for the neophyte and proposed corrections depend not only on the shape of the foot but also the style of race.

Equip yourself with your usual socks, make an appointment in a specialized store and let you advise according to your goals and your morphology.

Of course, if you notice the development of pain under the forefoot or under the heel, it is advisable to consult a specialist doctor.

2. CATEGORIES OF SPORTS SHOES

We usually group sports shoes in 4 categories: running, fitness, walking and specific.

So select your shoes according to their function.

  • Race: emphasis will be placed on shock absorption, flexibility, heel control and maintenance, light weight, and propulsive and breathable properties.
  • Walking: Pay attention to the flexibility of the textile and the absorption properties of the sole.Be very careful of seams that need to be flexible and unresponsive. Finally, the shape of the outsole must allow a good pace when walking.
  • Fitness: Comfort, lightness, breathability and absorption properties are the most important elements.
  • Specific: football, golf, dance, … some sports have a specific range of shoes. Do not forget that there is a good reason for this and expect injuries if you play a football game on wet and crampon-free ground!

If you play 3 or more times a week, plan to buy a pair of specialized shoes. They have been specially designed to ensure maximum safety in this specific type of activity.

 

3. CHOOSING THE RIGHT SIZE

As technical as a shoe, it will bring only discomfort see injuries if it is not perfectly adapted.

  • With both feet of slightly different sizes, always trust your widest foot.
  • Do not choose according to your usual size. Made to measure your foot and choose only after having tried your shoes on both feet.
  • It is better to test the shoes at the end of the day, when your feet are wider.
  • If you are a woman with a wide or long foot, feel free to try men’s shoes.
  • Wear your socks normally used for sports.
  • If you are wondering if a shoe is too small when you try it, you have your answer. It is not for you.

4. COMFORT

You must feel comfortable as soon as you try your new pair of shoes. Unlike city shoes, do not tell yourself that your sneakers will gradually adapt to your foot. They are designed to be immediately portable without pain.

You must feel a good hold of your heel in the shoe. A stub that is not stabilized is often synonymous with future injuries.

The problem is even more obvious if you suffer from deformities of the foot like a hallux valgus (also called onion) or hammertoe . The inflammations of the insertion of the Achilles tendon, marked by a bump on the back of the heel, also represent a pathology imposing a strict footwear.

5. CHANGES

Many sports foot problems can be offset by warming up, stretching or changing shoes. Yet you have chosen a suitable and comfortable shoe, but after several races will feel new pain in the knee or foot? Sometimes your foot requires a fine adjustment of the shoes to allow you to run safely. It is impossible for designers of sports shoes to predict every anatomical or biomechanical situation and they strive above all to adapt to as many people as possible. 
Internal modifications such as customized soles or retro-capital supports, can be beneficial for the health of your foot. If you are a great runner, or suffer regularly from your feet, this is an option to consider. The additional cost will be largely offset by the profit.