The Fragile Feet: A Gymnast Story (Part II)Foot and Ankle
Remember last week’s post? Surprisingly enough, gymnasts share a lot in common with ballerinas, especially in terms of injuries of the feet.
Both gymnasts and dancers place a tremendous amount of stress on their feet for a significant amount of time per week – often greater than 10 hours a day. Because of this combination of stress and time, stress fractures are common. Stress fractures can occur almost anywhere in the foot or ankle, but the most common locations are the metatarsals, navicular, tibia, calcaneus, and fibula. A key to avoiding stress fractures is proper nutrition, avoiding disturbances in the menstrual cycle, and proper technique and amount of training. A gymnast who trains 4 hours a week that increases the workload to 10 hours a week in preparation for a performance without any ramp up is a setup for stress fractures. A better way to ramp up training would be to increase the workload by approximately 25% per week, or going from 4 hours a week to 5 hours a week and so forth. The treatment of stress fractures varies depending on the location and character of the fractures. It also depends on the patients demands and expectations. In most situations a period of immobilization and rest is all that is necessary.
Young gymnasts often complain of various painful lumps and bumps on the feet. Some of these are calluses, which are the bodies response to repetitive force on areas of weight bearing. Another extra bone in the foot – the accessory navicular, also thought to exist in about 10% of all people – can be a troublemaker for gymnasts in particular. It is a tender prominence on the inside of the ankle. Flatfooted patients will sprain or strain the ligaments that attach to the accessory navicular. Continued activity worsens the symptoms and the first line treatment is a period of immobilization to allow it to heal. When that fails, the extra bone is excised, and the damaged tendons and ligaments on the inside of the ankle are repaired or reconstructed.
Many of the problems in both ballet and gymnastics results from the nature of the sports – long hours and repetition in little to no footwear. These patients are predisposed to develop certain problems based on the alignment or posture of the feet. Feet come in two general shapes – flat and high arched. In reality it is a spectrum. So many problems can be treated simply by accommodating or adjusting a patient’s flat or high arch with a specific type of shoe or insert (orthotic). Unfortunately, the competitive gymnast and dancer cannot wear athletic shoes or orthotics. Some may be able to train in orthotics or custom shoes and that is important to keep in mind.
Want to learn even more? Dr. Yakavonis will be giving a seminar on “Solutions for Foot and Ankle Pain: Beyond a Foot Massage.” The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.