Blog, Sports Care
Netball-related foot & lower leg injuries—and how to avoid them
Guess what? Netballers are three times more likely to sustain lower leg or knee injuries than people playing AFL, soccer or both codes of rugby.*
In addition, Sports Medicine Australia reveals that the rate of injury for netballers is 14 injuries per 1,000 hours played.
Common netball-related foot injuries include:
• Ankle sprains & strains
• Achilles tendinopathy
• Sever’s disease in kids
• Osgood-Schlatter disease (Knee pain) in kids
• Patellar tendinopathy (aka “Jumper’s Knee”)
• Plantar heel pain – incorporating plantar fasciitis, tibialis posterior tendonopathy or abductor hallucis pain
Preventing netball-related injuries
“Awareness of widespread netball-related injuries and knowing how to avoid them can go a long way to ensuring you see out the entire season,” says sports podiatrist and founder of A Step Ahead Foot + Ankle Care, Dr Brenden Brown.
Ankle sprains & strains
“Ankle sprains typically occur as a result of involuntary sliding or twisting of the feet when you step on slippery or unstable ground. The sprain happens when the foot is forced into an unnatural position.
“The intensity at which the ligaments stretch can sometimes be so severe that it causes fracture or serious inflammation and pain.
“An ankle strain is an injury to the muscle or tendon. For example, overstretching the muscle or tendon can result in a complete or partial tear, with symptoms ranging from moderately painful to disabling.
“To reduce the risk of injury netball players need to perform strengthening movements. This refers to strength exercises that focus on the glutes along with balance and co-ordination of the lower limbs, as well as sports-specific exercises,” says Dr Brenden.
Achilles tendinopathy
“We know that the most common cause of achilles tendinopathy is change in load; this refers to sudden alterations in the intensity or frequency of the sport. (It has nothing to do with weight!) Dramatic changes place abrupt pressure on the tendon to over work and this gives rise to achilles-related problems,” explains Dr Brenden.
“Prevention is about increasing the load gradually, over a period of time. Make sure you have a long lead into sports season and ensure you adequately warm up the achilles.”
He adds, “People often don’t recognise that going from wearing high heels to a flat or low heel radically changes the load on the tendon. If you’ve spent most of the year in a corporate environment, walking around in heels then you suddenly change to wearing trainers it’s not uncommon for achilles problems to arise.
“To overcome this, practice wearing flat shoes at home several afternoons a week. Start doing this well before the season begins so that you’re changing the load gradually.”
Patellar tendinopathy
It’s common for patella-related injuries and the associated symptoms to be caused by musclular imbalance. Practicing lower limb stability and strength exercises can be useful.
“It’s important to warm up appropriately and wear the correct footwear for the sport you’re playing,” adds Dr Brenden.
Sever’s disease
Sever’s disease is more of a repetitive strain injury than an actual disease—resulting in inflammation and irritation of the growth plate. There are several causes, including rapidly increasing physical activity in volume, intensity or frequency; doing activity in bare feet, poor foot posture (flat feet) and weak foot muscles.
Sever’s disease should be addressed by ensuring you warm up adequately before playing sport. “Warming up prepares the body for sport by improving blood flow to the area, increasing the muscle temperature and making muscles more pliable,” says Dr Brenden.
“And don’t forget to wear the right shoes for the sport you’re playing!”
Plantar heel pain
Plantar heel pain is often referred to as plantar fasciitis, tibialis posterior tendonopathy, abductor hallucis pain—amongst a number of other conditions that can cause plantar heel pain.
To help ward off plantar heel pain Dr Brenden advises not to change from wearing high heels to low (or flat) heels too quickly.
“Again, rapid changes in frequency, intensity or volume place significant pressure on the tendons, which can cause excessive strain and lead to injury.”
Tips to prevent netball-related lower limb injuries
- Don’t rely on ankle braces! Strong muscles protect you from sprains far more than braces do! Your gluteal muscles – yes your butt — has a major role to play here!
- Make sure you warm up. Cold muscles are less flexible and more prone to injury. Check our Dr Brenden’s ‘warm up to success tips’.
- Don’t rapidly increase physical activity in volume, intensity or frequency. If you’re not all that active outside of netball season you need to allow a longer lead time.
- Always wear the appropriate footwear for your sport. Choose Netball shoes – its hard to go past the Asics Netburner range (See Dr Brenden’s article ‘Your guide to choosing the best netball shoe’ or head over to our YouTube channel for his Netburner reviews).
- If your pain or problems continue, visit a sports podiatrist to check your foot posture. Addressing foot posture prevents muscles from over compensating, leading to less ongoing problems.
- Ensure your footwear fits you properly (loose netball shoes can cause falls, increasing risk of ankle injury).
- Take the time to cool down. Slow stretching can reduce post-sports muscle tightness and soreness and may help reduce future risk of injury. An easy method is “Walk it out”. Don’t jump straight in the car and head home; allow yourself 10 minutes of moderate walking to cool your muscles down.
- If you know you have weak foot or ankle muscles, or you have poor foot posture, seek professional advice – All the stretching in the world wont get you better if your foot posture is continually meaning your muscles are over compensating. A trip to a podiatrist can help address the underlying foot posture issue.
- Ensure rehab is tailored to your needs. Netballers have specific groups of muscles they use – make sure your rehab is based around these muscles and your individual activity – Netball!
Next steps…
If this sounds all too familiar, we’d like to help. Perhaps this is something that a friend or relative may benefit from. If that is the case, we’d love you to share this article with them so they can find relief!
A Step Ahead Foot + Ankle Care is based in Western Sydney. We have multiple practitioners with loads of experience in this area. It’s our passion!
If you’d like more information, please contact our helpful front desk team. They are brilliant at working through what help you need, guiding you to the appointment that is right for your family, running through costings and then reserving your appointment time. Call us today on +61 2 9673 2987. We look forward to helping you.
Related articles:
About us
A Step Ahead Foot + Ankle Care is one of Sydney’s leading foot and ankle clinics. Principal podiatrist and founder of A Step Ahead Dr Brenden Brown (AKA Dr Foot) has been taking care of people’s feet for more than 20 years.
With a background in sports medicine and having served as a former president of the Australasian Podiatry Council, Brenden is a wealth of information when it comes to foot and ankle care.
Sources: * Australian Institute of Health and Welfare (December 2014)
Blog, Uncategorized
Morten’s neuroma Vs plantar plate
If you’ve ever suffered from pain in the ball of your foot you’ll know only too well how annoying and debilitating it can be. However, addressing the cause of the pain starts with the right diagnosis.
Two widespread causes of forefoot pain are Morten’s neuroma and plantar plate trauma. While plantar plate tears are less well known and identified, they are clinically prolific.
Morten’s neuroma
A Morten’s neuroma is a nerve injury. The joints around the metatarsal bones rub together causing irritation and swelling, which encroaches on the nerves. The nerves can become damaged and thickened resulting in the shooting, stabbing pain and burning sensation linked with a Morten’s neuroma.
The nerves in the intermetatarsal spaces (between the 2nd-3rd and 3rd-4th toes) are most commonly affected leading to pain in the ball of the foot.
Symptoms of Morten’s neuroma
- A sharp, shooting pain in the ball of the foot (usually between third and fourth toe)
- A burning pain in the ball of the foot that may spread or shoot down towards the toes
- Toes may feel numb or tingle
- Pain is intensified when wearing tight shoes or high heels
Podiatrist and founder of A Step Ahead Foot + Ankle Care Dr Brenden Brown explains, “Wearing high heels or tight fashion shoes compresses the nerve and creates that electric, shooting pain.
“People with foot deformities, such as hammertoes, bunions, flat feet or high arches, are at higher risk of a Morten’s neuroma because these defects generally cause the foot to widen, making it more difficult to find shoes that aren’t tight.”
Treatment for a Morten’s neuroma
Treatment will depend on the severity of symptoms but first-line treatment options include:
- Appropriate footwear—avoid shoes that are narrow in the forefoot or tight in general
- Soft tissue rehabilitation — Soft tissue massage to the Morten’s region can provide some relief from the associated pain
- Soft cushioned orthotics with a metatarsal dome may help reduce pressure on the nerve
- Injections to reduce inflammation, such as cortisone or Prolotherapy
- Surgical opinion is required if conservative measures are unsuccessful
Plantar plate tear
This is the very start of clawed or hammer toes! A plantar plate injury involves the ligament and cartilage attached to the base of and between our toe bones (phalanges). Injury can involve tears, ruptures or distensions. Conservative treatment for this condition is highly effective.
Symptoms of plantar plate tear
- Dull ache or sharp pain under the ball of the foot
- A “V” sign where the toes separate and form a V shape
- Toe lifts upwards (commonly the 2nd or 3rd toe) and may become swollen
- In acute cases the toe becomes thickened or enlarged. Often described as “sausage like”
- Feeling that you have a small stone in your shoe when walking
- The feeling that there’s insufficient cushioning between the toe bones and the ground
- Small amount of callous develops under the metatarsal heads
- Surgical opinion is required if conservative measures are unsuccessful
Treatment for plantar plate tear
- Conservative treatment for this condition is highly effective if caught within the first 6 – 12 months
- Wearing firm, stiff-soled shoe can help alleviate pressure on the joint and reduce the pain
- Cushioned orthotics with a metatarsal dome (often recommended by orthopaedic surgeons)
- Soft tissue rehabilitation, deep connective tissue therapies to the joint capsules and the spaces around this area.
- Deep connective tissue therapies to the extensor and flexor tendons and muscles of the foot
- Serial strapping or taping to prevent the toes popping up or hold them in alignment
Dr Brenden says, “For years Morten’s neuroma has widely been the most common diagnosis for forefoot pain. Yet I find that in many cases, where there is a dull ache type of pain in the ball of the foot, the cause is a plantar plate tear rather than Morten’s neuroma.”
Radiology
Morten’s neuroma and plantar plate trauma are difficult to distinguish between on diagnostic ultrasound.
“When viewed in ultrasound the two conditions without further discovery and without an experienced radiologist can appear the same. The two conditions will often return a hypoechoic mass finding, hence the need for more detailed clinical symptoms and signs accompanying the request.
“Given that the difference in symptomatology between the two is often the key, clinical symptomatology should be included in the radiological request,” advises Dr Brenden.
Related articles
4 hacks to staying injury free this winter sports season
5 hacks to keep ingrown toenails at bay
Your guide to sock solid ankle stability
About us
A Step Ahead Foot + Ankle Care is one of Sydney’s leading foot and ankle clinics. Principal podiatrist and founder of A Step Ahead Dr Brenden Brown (AKA Dr Foot) has been taking care of people’s feet for more than 20 years.
With a background in sports medicine and having served as a former president of the Australasian Podiatry Council, Brenden is a wealth of information when it comes to foot and ankle care.
Blog, Kids Feet
Knee pain in kids
“Knee pain almost exclusively only affects active kids,” says sports podiatrist and founder of A Step Ahead Foot + Ankle Care Dr Brenden Brown.
“In the majority of cases the knee pain will be related to a specific period of activity.
“Sometimes you have to look back 12 hours before the pain starts to pinpoint the activity that caused it. For example, a child might be sore and suffering from a really painful knee on Sunday yet because they didn’t hobble off the footy field after their game on Saturday the parents don’t relate the pain to playing football.”
Causes of kids’ knee pain
Dr Brenden says knee pain in children is predominantly caused by Osgood-Schlatter disease.
What is Osgood-Schlatter disease?
Osgood-Schlatter disease is characterised by a painful lump just below the kneecap.
According to the American Academy of Orthopaedic Surgeons, ‘Osgood-Schlatter disease most often occurs during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly. Because physical activity puts additional stress on bones and muscles, children who participate in athletics—especially running and jumping sports—are at an increased risk for this condition. However, less active adolescents may also experience this problem.’
Treating knee pain in kids
“The most common treatment approach by practitioners is stretching or advising the child to stop playing sport.
“I disagree,” says Dr Brenden.
“Telling kids to stop playing sport is not a treatment modality. It’s simply avoiding the cause of the pain. Once they start activity again, BOOM the pain re-appears!
“Similarly, stretching alone will not, in most cases, cure the underlying problem. I see children who are given stretching routines by their healthcare professionals time and time again, season after season. If knee pain is an ongoing problem for the child, we should be evaluating their foot posture in order to find the core problem and a positive long-term solution.”
Dr Brenden adds, “There are far too many viable treatment options available which can address the underlying issue of knee pain and keep children active.
“Advising a child to stop playing sport is no longer necessary and is in fact detrimental to child’s long-term health”
Tips to prevent knee pain in kids
—Warm up properly. Before you “warm up” with a jog, try walking at a moderate to brisk pace 4 times around the football field (8 times around a netball court). Start slow, increase as you progress—NEVER run!
—Ensuring you’re wearing the right footwear can help protect the knees. Wear good, supportive, sports-specific shoes (not the trendiest runners you can find!).
“Choosing appropriate footwear that’s specific to the sport being played would likely reduce the amount of foot-related injuries we see by at least 25%,” says Dr Brenden.
—Work on improving the leg muscle strength and flexibility. Isometric strength exercises are readily accessible and can be performed anywhere—even when in pain!
Related articles:
Warming up for sports…why bother?
What’s causing your child’s heel pain?
Common kids’ foot complaints
ABOUT US
A Step Ahead Foot + Ankle Care is one of Sydney’s leading foot and ankle clinics. Principal podiatrist and founder of A Step Ahead Dr Brenden Brown (AKA Dr Foot) has been taking care of people’s feet for more than 20 years.
With a background in sports medicine and having served as a former president of the Australasian Podiatry Council, Brenden is a wealth of information when it comes to foot and ankle care.
Blog, Heel Pain, Sports Care
Isotonic versus isometric movements for heel pain
“It’s becoming much more widely recognised and accepted that stretching is not good for tendon pain. Instead, we should be looking at building muscle and tendon strength,” says sports podiatrist and founder of A Step Ahead Foot + Ankle Care Dr Brenden Brown.
Professor Jill Cook, from La Trobe University’s Sport and Exercise Medicine Research Centre, has a wealth on knowledge about tendon injury. She says, “Aside from the load on your tendon when you play sport, there are compressive loads on your tendon when it is at its longest length, adding stretching to most tendons only serves to add compressive loads that we know are detrimental to the tendon. Stretching while you are standing can be especially provocative to your tendon.”
Isotonic Vs isometric
Isotonic contractions generate force by changing the length of the muscle and tendon
[For example, going up and down on your toes (calf raise)]
Isometric contractions generate force without changing the length of the muscle or tendon.
[For example, going up on your toes and holding in the upward position]
“People are familiar with isotonic exercises, particularly for the pain associated with Achilles Tendinopathy. There was a well know technique called the ‘Alfredson technique’, in which people would stand on edge of a step and lower their heels up and down over the back of step.
“This has long been therapists’ go-to exercise, for heel pain in particular. However, we now know this only serves to irritate and aggravate this condition, yet it doesn’t have to be so,” says Dr Brenden.
“We need to graduate the building of strength and to do this we start with isometric movements, rather than rushing straight into isotonic movements.”
Isotonic versus isometric movements for heel pain
For the majority of people the process involves moving from isometric holds with quite heavy loads of body weight or beyond.
After we’ve developed significant load and reduced the symptoms, including pain, we begin to move into the next phase, which includes isotonic movements.
From there we move to more functional strength exercises that are specific to your activity or sport.
This means the exercises can’t just be calf raises, they need to be aligned to the individuals activity so that their tendon is ready for the activity they’re about to re-enter into.
“I like to refer to isometric loading as ‘progressive muscle loading’. Gradual loading is such a vital part; if people are not progressing they won’t get back healthy strong tendons,” says Dr Brenden.
Common mistakes people make when performing isometric exercises
- They don’t loading heavy enough. Remember, tendons are built for strength so they can take quite a bit of weight.
- They don’t load for long enough
- They don’t progress. Instead they plateau out. At all times, on a day-to-day basis moving through to a week-to-week basis you should be progressively increasing time and load to develop the tendon’s and muscle’s strength and capacity.
Related articles:
Warming up for sports—why bother?
10 things you should know about heel pain
A Step Ahead Foot + Ankle Care is one of Sydney’s leading foot and ankle clinics. Principal podiatrist and founder of A Step Ahead Dr Brenden Brown (AKA Dr Foot) has been taking care of people’s feet for more than 20 years.
With a background in sports medicine and having served as a former president of the Australasian Podiatry Council, Brenden is a wealth of information when it comes to foot and ankle care.
Blog, Sports Care
4 hacks for staying injury free this winter sports season
Regular physical activity is an essential part of living a healthy life and yet a sports injury can see you on the sideline (and in agony) for months.
Sports podiatrist and founder of A Step Ahead Foot + Ankle Care Dr Brenden Brown says there are several strategies you can take to help stay injury free during sports season.
“Grief associated with injury, particularly for children with pain related to Osgood–Schlatter and Sever’s Disease, could be greatly reduced with a few simple practices.
“We see many people significantly reduce the intensity of their discomfort and injury once they start implementing the following 4 hacks for staying injury free.”
Dr Brenden’s top tips for warding off injury
1. Focus on warming up. “WALK, before you run!”
Many kids arrive at their sports training session and their coach says, “Right, go for a run”. This is way too much sudden change for the muscles (this rings true for both adults and children).
Br Brenden advocates the ‘Two footy fields or eight netball courts’ approach…
- Start slowly walking around the outside of 2 footy fields, end-to-end or side-to-side. For court sports, this equates to approximately 8 laps of the court!
- As you walk further SLOWLY pick up the pace. “NEVER get to a run!”
- You will do 2 complete laps of the 2 fields or 8 laps of the courts.
- NOW you are ready to look at further warm up exercises and maybe that coach’s run!
2. Make sure you wear the right footwear for the activity you’re doing. Sounds simple, but the wrong footwear can result in serious damage.
“Choose the shoes that have been specifically designed for YOUR sport. This means wearing netball shoes for netball not cool minimalist runners with uber trendy logos worn by athletes from an entirely different sport!” says Dr Brenden.
3. Take a long-term approach. Yes, you can cram the night before a big exam but we all know it’s the long-term work you put in that really gets the results.
This means doing regular muscular work in order to build muscular strength for the activity you’re participating in. Doing regular muscle work over a long period of time is much more likely to stop you getting an injury, than warm ups alone.
“Don’t get me wrong; warm ups are important – but we know that to stay injury free, being strong in your activity is going to greatly reduce the likelihood of injury and so building muscular strength is key.
“For example, if you’re a netball player, glute strength is vital to reduce ankle sprains. Soccer and rugby players will benefit from working on their quad strength, while runners should focus on their sprint ability,” advises Dr Brenden.
4. Perform activity-specific warm ups and training. I often see netballers shooting hoops and running straight up and down the court in their warm-up and training sessions, but it’s far better to do side-to-side jumps, high jumps and lands, as well as cutting movements. This is much more specific to what they’ll likely to be doing on the court.
If you think about it, there are only two goal shooters on each team; if training involves the entire team standing around the netball hoop trying to shoot goals, everyone, apart from the two goal shooters, is wasting their time.
Related articles:
Warming up for sports — why bother?
Winter sports’ greatest enemy….ankle sprain
Your guide to choosing the right football boot
Your guide to choosing the best netball shoe
A Step Ahead Foot + Ankle Care is one of Sydney’s leading foot and ankle clinics. Principal podiatrist and founder of A Step Ahead Dr Brenden Brown (AKA Dr Foot) has been taking care of people’s feet for more than 20 years.
With a background in sports medicine and having served as a former president of the Australasian Podiatry Council, Brenden is a wealth of information when it comes to foot and ankle care.
Dr Brenden’s White paper report on the “6 Reasons You Won’t Beat Heal Pain” outlines what’s stopping you from beating this and tips on how to stop it in its tracks!