Excess physical activity can lead to foot and ankle problems

AOFASDec 29 2009

Are you one of the millions of Americans who will resolve to exercise more in the New Year? If so, take advice from the American Orthopaedic Foot & Ankle Society (AOFAS) and take it slowly. Too much activity too quickly can cause a multitude of foot and ankle problems including stress fractures, ruptured tendons, or plantar fasciitis.

According to the AOFAS, stress fractures happen with a sudden increase in physical activity. Stress fractures appear as tiny cracks in the bone surface and frequently occur in the bones of the forefoot that extend from the toes to the middle of the foot. Pain is the typical symptom of a stress fracture; it may be sudden or it may gradually increase over several days. Swelling of the foot and lower leg may also occur. Treatment includes modification of physical activity and use of a stiff-soled shoe for several weeks. Immobilization in a cast or use of crutches may also be required.

Keith L. Wapner, MD, clinical professor of orthopaedic surgery at Pennsylvania Hospital and President-Elect of the AOFAS, sees many patients with overuse injuries and he offers the following advice, "Plantar fasciitis, tendonitis and stress fractures are the most common overuse injuries. These can be avoided by remembering to include a stretching protocol prior to your workout and following the 'rule of tens' by not increasing your exercise amount by more than ten percent per week."

Achilles tendonitis (inflammation of the tendon) is another common overuse injury. Achilles tendonitis may occur when rapidly increasing running mileage or speed, starting up too quickly after a layoff, or when adding hill running or stair climbing to a training routine. Symptoms of Achilles tendonitis include: mild pain after exercise that gradually worsens; a noticeable sense of sluggishness in the leg; episodes of diffuse or localized pain, sometimes severe, along the tendon during or after exercise; morning tenderness above the point where the Achilles tendon is attached to the heel; and stiffness and swelling or pain in the back of the heel where the tendon attaches to the bone. Treatment for Achilles tendonitis includes rest, which may require withdrawal from exercise for a week, or simply switching to a different type of exercise such as swimming, that does not stress the Achilles tendon; and non-steroidal anti-inflammatory medication. Devices used to help support the muscle and relieve stress on the tendon, such as a heel pad or shoe insert, may also be used.

Another overuse injury is plantar fasciitis, a painful injury affecting the sole of the foot; it typically starts gradually with mild heel pain. The pain classically occurs with the first step in the morning. Treatment options include stretching exercises and modifying activities until the initial inflammation goes away. Ice application to the sore area for 20 minutes three or four times a day may also relieve symptoms. Non-steroidal anti-inflammatory medication may also be prescribed.

The best way to avoid these foot and ankle injuries is to know your limits and to follow a sensible program when exercising. Preventative measures include:

-- Select the proper footwear for the specific type of exercise -- Start out slowly when beginning an exercise program following a layoff period -- Walk and stretch to warm up gradually before running or walking -- Focus on stretching and strengthening the muscles in the calf -- Increase running or walking distance and speed gradually, in increments no greater than 10% per week -- Avoid unaccustomed strenuous sprinting -- Take the time to cool down properly after exercise

By adhering to these simple measures you may avoid painful overuse ankle injuries and achieve success with your New Year's resolution. For more information on overuse injuries as well as resources on foot and ankle care go to the AOFAS website www.aofas.org. The site also features a surgeon referral service that makes it easy for patients to find a local orthopaedic surgeon specializing in foot and ankle care.