Today's News

Saturday, February 24, 1996

Prevention is best for common foot, ankle problems

Sprains, neuromas, bunions, hammertoes and plantar fasciitis are all common causes of visits to the orthopaedist's office but all can be prevented. Carol Frey, MD, Associate Professor, University of Southern California and Chair of the Public Relations Committee of the American Orthopaedic Foot and Ankle Society, discussed prevention of these injuries as part of a Friday press conference on common foot and ankle problems.

Ankle sprains

Dr. Frey noted that sprains are the most common presentation in an orthopaedic practice and also the most common reason for emergency room visits. There are about 27,000 sprains per day in the United States, accounting for 45 percent of basketball injuries, 31 percent of soccer injuries, and 24 percent of volleyball injuries. However, Dr. Frey said there has not been a consensus on ankle sprain treatment, although most of the recent literature has agreed that there is no evidence that surgery is a better option, even for complete tears or the worst sprains.

Most orthopaedists have been faced with the question of how to protect the athlete who has never had a sprain or the athlete who has had a sprain and is returning to sports. Available options include taping, bracing, doing nothing and adjusting the height of the shoe tops. Taping restricts extreme motion, shortens the reaction time of the peroneals and improves the proprioception of the ankle.

"You see the best improvement in an unstable ankle as opposed to a normal one," Dr. Frey said. "If you consider the large number of sprains per year, then it seems to be worthwhile for most people."

Unfortunately, taping has its downsides: skin is mobile and the skin and tape will move around, reducing function, taping may limit subtalur motion, and the cost is prohibitive. "Tape is about $2 per roll, which doesn't sound like much but it averages to about $2 to $3 per player per game for an entire season," she said. "Particularly for a high school, that's a lot of money." Tape also loosens and can lose 40 percent strength within 20 minutes, and needs to be applied by someone experienced.

Dr. Frey recommends one of the available over-the-counter braces. Braces are readily available, do not impede performance, are easy to apply, cost less over time, improve balance and don't loosen. "Some studies show they are more effective than shoe type or tape," she said. "But remember that no type of support can eliminate sprains."

The most important component of sprain prevention is proper shoewear. "The most important advice, especially for high school players, is make sure they're lacing the shoes all the way to the top," Dr. Frey said. "It sounds simple, but you'd be surprised how many are not properly lacing." Studies indicate that high tops are better than low tops at resisting inversion, they also are most effective when combined with tape. For football, one study found a low-top shoe with a lace-up brace to be most effective.

For players with a varus heel, the physician may want to consider using an orthotic device that tilts the heel back in.

"Regardless of the best treatment you can provide, about 20 percent of ankle sprains end up with residual problems," Dr. Frey said. "Incomplete rehabilitation is the most common cause of chronic problems, so make sure the injured athlete wears the brace or tape until the ankle is at 100 percent strength."

Dr. Frey noted that it may be safest to keep the brace after complete healing. Much of the research on proper shoe fit and sprain prevention comes from the shoe manufacturers and has been done on elite players at the college or professional level. "You have to remember that the elite players are getting a new pair of shoes almost every game," Dr. Frey said. "You can't really compare that to a high school player who's wearing the same shoe all season."

Shoe fit and women

Dr. Frey warned, "beware of the shoe company that says they have a woman's shoe or shoe division. Because what has happened, at least until the last few years, is that they've taken the men's model and followed a process called grading. With grading, they take a man's last and make it proportionally smaller, change the cosmetics and call it a woman's shoe." Dr. Frey said that, although many manufacturers have begun to develop a woman's last, most are still using a smaller version of a man's shoe to create the woman's model. Even companies who have developed a female last, such as Nike, have found that it doesn't sell well, mainly because a lot of female athletes believe the men's model is better and because the selection of shoes based on a female last is limited.

"They've limited the women's last to 'traditionally female' sports; just last year they introduced the first woman's basketball shoe. Track and field is still a man's last. So when your patient is looking for shoes, you need to ask the shoe companies, are you using a female last? And for what sports?"

Dr. Frey observed that a woman's foot is shaped differently than a man's foot. The main difference is in the heel, which is proportionately smaller than the rest of the foot. Women also tend to pronate a bit more. "Realistically, there's no reason a woman's foot should be shaped like a man's," she said. "No other part of their body is."

Shoes are the cause of the majority of foot injuries and deformities, especially in women, Dr. Frey said. The greatest factor is the ill-fitting shoe, which can cause hammertoes, hallux valgus, bunionettes, corns, calluses and neuromas. One study found that 80 percent of women reported foot pain related to shoewear. Sixty percent noted an increase in shoe size after age 20, but few had had their feet measured in five years. Seventy -six percent had one or more foot deformity and 88 percent were wearing shoes close to two full width sizes smaller than their feet.

"Women in general need to be instructed in proper shoe fit, and properly fitting shoes need to be made available to them," she said. "We have just started a shoe fit campaign at the Academy, "If the Shoe Fits, Wear It." We have a brochure available that help make women, children and athletes informed consumers on shoe fit."

Dr. Frey said orthopaedic surgeons can help their patients prevent new injuries and alleviate old injuries just by teaching them shoe selection. With the increase in shoe technology and the popularity of athletic shoes, comfortable shoes no longer have to be ugly. "Good-looking shoes that fit well are available today, we just need to help our patients become educated consumers."

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Last modified 27/September/1996