Sports and Fitness Medicine of the Lower Extremities
As a Fellow of the American Academy of American Academy of Podiatric Sports Medicine. Dr. Marasco is well versed in the recognition, treatment, rehabilitation, prevention and management of lower extremity sports and fitness injuries.
Sports Related Injuries
Is it a Sprain or a Fracture?
Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your podiatric physician will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to chronic problems.
Anyone who injures an ankle requires prompt medical treatment, whether it's the first sprain or the fifth. Rest, ice, compression and elevation (R.I.C.E.) can reduce swelling and pain until the ankle can be evaluated and treated by your podiatric physician. A sprain may not always be a sprain; the ankle could be fractured. Many athletes develop chronic ankle instability from repeated ankle sprains, causing their ankle to frequently "give way." In some cases these players may require surgery. Early recognition and treatment of this problem will help speed your recovery from ankle ligament injuries. Proper rehabilitation of an ankle sprain reduces the likelihood of developing chronic ankle instability.
Athletes of all skill levels can reduce the risk for ankle sprains by following these three tips from the American College of Foot and Ankle Surgeons:
Perform warm-up stretches and exercises before playing sports.
Wear the right shoes for the sport. For example, don't wear running shoes for sports that involve a lot of side-to-side movement, such as tennis and basketball.
Wear an ankle brace if you're recovering from an injury or have repeatedly sprained your ankle.
Calcaneal fractures - The calcaneus is the bone in heel. Calcaneus fractures can be severe injuries and often lead to problems of chronic pain in the foot. Treatment of a broken heel bone depends on the severity of the fracture
Talus fracture - A talus fracture occurs when the talar bone, one of the important connections between the leg and the foot, is broken. The talus has cartilage that contributes to both the ankle and hind foot joints. A talus fracture often requires surgery, and even with surgical treatment, patients often have long term ankle problems such as arthritis.
Metatarsal stress fracture - A metatarsal stress fracture is a common cause of foot pain, especially when people suddenly increase their activities. This type of injury, notorious in soldier recruits, is also called a "march fracture."
Navicular fracture - A navicular stress fracture is an injury to the midfoot region below the ankle. Athletes who sustain a navicular stress fracture commonly complain of a vague pain in the midfoot that hurts during activity. Treatment of a navicular stress fractures is usually accomplished with a cast.
Other Common Problems
Achilles tendonitis is a painful condition of the tendon in the back of the ankle. Left untreated, Achilles tendonitis can lead to an increased risk of Achilles tendon rupture.
Plantar fasciitis is a syndrome of heel pain due to inflammation of the thick ligament of the base of the foot. A tight, inflamed plantar fascia can cause pain when walking or running, and lead to the formation of a heel spur.
Pronation is a normal movement of the foot through the gait cycle. When this motion becomes excessive, overpronation can cause a variety by altering the normal mechanics of the gait cycle. Prescription orthotics can be helpful for overpronators.
What features do you need in an athletic shoe?
Three things should be checked in all shoes before they are tried on: heel counter, torsional stability, and "shoe break." The heel counter is the portion of the shoe surrounding the heel and should be firm and reinforced for extra stability. Torsional stability (the amount of twist in a shoe) is determined by grabbing the back and front of the shoe and attempting to twist as if one was wringing out a towel. Very little twisting motion should occur. The final feature to establish is where does the shoe "break" or fold sometimes referred to as the "flex point" Attempts to fold the shoe in half should allow folding out near the toes at the most distant quarter of the shoe. Shoes that fold in the middle or near the heel may cause discomfort or even an injury.
The ideal walking shoe should be stable from side to side, well-cushioned and should enable you to walk smoothly. Many running shoes fit all of these criteria and for most people are acceptable for a walking program. However there are shoes specially designed for walking and for running. If you are a serious walker or runner, professional athlete or involved in competitive sports then look to specific footgear designed for such activities.
Most important, whether you are wearing a walking or running shoe, is that it must feel stable to you. Either type of shoe is acceptable if it works well with your foot mechanics, providing cushioning and stability. Shoes should always feel comfortable and fit well in the store. Visit the shoe store late in the afternoon to allow for swelling. Wear the same socks to the store that you will wear while walking.
When the shoes are on your feet, the heel should be snug. If it slides in the store, it will slide while you are walking. You should be able to wiggle your toes in the shoe, and there should be one half to a full thumbs width between the end of the longest toe on your longer foot and the end of the shoe's toe box. Make sure your ankles don't roll in the shoes.
The shoes you try on should feel good immediately; you should never have to 'break in' a pair of athletic shoes. (For that matter, you should never have to 'break in' a pair of dress shoes either!). If you have foot problems, prescription orthotics or other special considerations, consult your podiatrist about the best shoe for you.
Whether you're traveling on a long distance flight or just finished an intensive workout, compression socks can provide relief for muscle aches, inflammation and foot and leg pain. They can work to reduce swelling and help with lymphatic drainage in the muscles and improve stagnant blood flow. For post- surgical patients and people with certain health conditions they can help control edema and reduce the risk of developing blood clots.
Designed to help prevent and control serious medical conditions, today compression socks are becoming the sock du jour for anyone looking for better comfort of the legs and feet with attractive colors and designs that make them a medical fashion statement. But are compression socks for everyone?
First of all what are compression socks? Once known as compression hose or compression stockings, they are specially made, snug-fitting, stretchy socks that gently squeeze your leg. Graduated compression or pressure stockings are tighter around the ankle and get looser as they move up your leg. Compression sleeves are just the tube part, without the foot. The pressure in compression socks is measured in millimeters of mercury (mmHg). A mild pressure rating would be 10-20mmHg or 15-20mmHg.
A firmer pressure rating would be 20-30mmHg. Medically grade custom-fit compression hose prescribed by a physician would go up in numbers, such as 20 to 30 or 30 to 40. When buying compression socks, you'll need to measure your calf and ankle circumference, not your shoe size. It is recommended that you consult with a physician about what pressure rating is best for you. Compression socks should fit tightly but not too tight that they become painful, cut off circulation or impede mobility.
Some athletes wear compression socks and sleeves on their legs and arms believing the support will help prevent tissue damage and help their muscles recover quicker. There are mixed reviews on whether this is so. The majority of the research has not found any statistically significant difference in improved sports performance in athletes wearing compression socks although some athletes are convinced it works for them. However others evidence that compression socks/sleeves may offer a good recovery aid for some athletes under the right circumstances.
Ventilated panels, breathable anti-bacterial fabrics, extra cushioning and attractive patterns and colors make today's compression socks a far cry from your grandparent's Jobst stockings for varicose veins. High end companies like Comrad market them as your go to dress sock that can be worn "from the office, to a wedding, to post workout".
If you are using compression hose on the advice of a health care professional be sure to contact your provider if swelling persists or to discuss other options if you are having trouble wearing the stockings. Although the application of compression stockings can appear simple, inappropriately worn stockings have the potential to cause significant problems. If something doesn't look or feel right, discontinue wearing and seek professional advice.