Ankle sprains often result in a loss of foot pronation which in turn disrupts the hip biomechanics necessary for the loading and unloading phases of activities like walking. Because of the disruption of hip biomechanics, the low back must compensate for a loss of normal shock absorption at the hip and a common side-effect is low back pain. Quickly restoring normal foot mechanics is essential for pain free walking and other activities.
The detailed version:
Most ankle sprains are the result of an inversion and plantar flexion movement to an extreme, uncontrolled range. Typically, the anterior talofibular ligament is overstretched and the result is pain and inflammation. It should be noted that if you cannot walk immediately after the ankle injury or meet any of the other Ottawa ankle rules criteria, it is important to visit a doctor who can do an x-ray.
After the typical inversion ankle sprain, foot pronation is lost – specifically, subtalar joint eversion combined with adduction and plantarflexion. Foot pronation allows the tibia to internally rotate which then allows the femur to internally rotate. The result is hip internal rotation, adduction and flexion which are the 3-planes of motion that maximally stretch the glutes and provide those muscles with the optimal ability to help decelerate gravity and reduce shock absorption at foot strike.
The loss of subtalar joint eversion means there will be less ability for the hip to accept ground reaction forces. Instead of the low back experiencing controlled and cushioned motion, it will experience excessive stress. The result is low back pain which may manifest on either side.
Sometimes, the fibular head may shift forward as a result of the sprain and if this occurs, it is essential that functional manual reaction be used to mobilize the foot into pronation while slowing down the fibular head’s forward motion in space. The sooner normal foot pronation and fibular head mechanics are regained, the sooner the ankle will feel better and the normal chain reaction biomechanics will be restored – this will result in an ankle that feels better faster and a back that will stay healthy.
Quickly and safely restore normal ankle motion after a typical inversion ankle sprain:
Dan Benson, DPT, OCS, FAFS, CAFS
CEO Forefront Physical Therapy
Nike Golf Performance Specialist
Forefront Physical Therapy
South Lake Union
2720 4th Ave Ste 115
Seattle, WA 98121
From the Sidelines: Healthy Soccer Feet
Score this as one of my uncomfortable parenting moments. My 12-year-old son’s soccer team was playing in a tournament over the winter. The Spanaway turf was a hard, frozen tundra that morning and my son was going into this game with some foot and knee pains. It had been a long season of both soccer and cross country.
From the stands I watched as his limp got progressively worse. At half-time, I asked if he needed to come out. “We don’t have any subs,” he said, shaking me off. Not wanting, God forbid, to be a Chopper Mom, I sat back and watched between fingers covering my face as he ended the game barely able to walk.
The coach had not noticed his obvious discomfort, but it was my cross to bear. I, after all, had seen it. I hadn’t benched Alex, and the reality is, it’s hard to expect a kid to tell the coach he wants out of a tournament game. They’re smart enough to know that looks weak. Nope, this one was on me.
Orthopedic surgeon Thomas Chi of Proliance Surgeons in Bellevue diagnosed Alex with calcaneal apophysitis, or Sever’s Disease, one of the most common foot injuries in children between 8 and 12 years of age. The repeated pounding or overuse had caused a painful inflammation in the growth plate of my son’s heel. Luckily, his injury would heal with rest. Dr. Chi also recommended a silicone heel insert that would offer more padding once my son was back on the field.
Which begs the question: World Cup-level players may really need that feather-light footwear, but for the hundreds of thousands of American youth soccer players, are their shoes minimalist to a fault?
“Kids have no stress relief in the soccer cleat itself,” says Texas podiatrist Marybeth Crane, a sports medicine expert and mother of three daughters who have played soccer. “Seventy percent of the kids don’t have perfectly normal feet — they might have an arch that’s so high you can drive a truck under it, or they might have such flat feet they need support for that. If there’s any pain, parents need to figure out what’s going on before there’s damage that can last into adulthood.”
Three world-class tips for fitting cleats before pain starts1. Size is everythingChoose cleats with no more than a pinky finger’s distance between the wearer's toes and front of the shoe, even if you think your player can just grow into them.
The width issue is tricker. “Soccer shoes are notorious for being narrow,” cautions Seattle physical therapist Dan Benson, a former collegiate soccer player. “Especially if the kid has wider feet, you need to get a cleat with more room in the toe box so there is space for the metatarsal heads. Some running shoe companies have figured it out, but soccer not as much.” When there is not enough space, a player can experience toenails falling off or even toe fractures.
Crane adds that finding a wide enough cleat is particularly important in children who are slightly heavier: “There is more weight on their feet, pushing down on their arch, so parents need to be aware of width in larger kids.”
2. Know what your cleats are made ofConsider the cleat’s materials, particularly the upper. Benson points out shoes made of kangaroo leather will better stretch to a wider foot than a treated calf-skin or synthetic upper. The downside of kangaroo leather being the spongiest is that it is therefore the most water-absorbent, so rule out the synthetic options first.
Very few cleats, and certainly not the more affordable ones, have liners with any cushion in the foot bed. If your player is primarily running on hard turf with less give than grass, soft over the counter liners or gel heel inserts can be helpful to help reduce soreness or pain from repeated impact.
Benson says unless a mechanical problem exists in the child’s foot, do not automatically add stiff orthotic inserts to your child’s shoe thinking that you are helping them. Not only might your child not need that additional arch support, the rigidity of those inserts can interfere with their normal freedom of motion, sometimes leading to other problems down the line.
Ask the soccer store about their return policy. Ideally your child can wear the cleats around the house to make sure they are comfortable before playing in them.
3. To each his (or her) ownNo matter how tempting, avoid just getting whatever is on sale or using hand-me-downs from siblings or friends. Siblings’ foot shapes vary as much as their personalities. just because they’re related does not mean they should share shoes. Even before more serious injuries might develop, chafing from a misfit cleat can lead to blisters or lost or ingrown toenails. “That’s the number one problem that I see with foot issues from soccer,” says Crane: “Hand-me-downs that don’t fit. Definitely not a good idea.”
By: Hilary Benson
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