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SPECIAL FITNESS ISSUE: THE FOOT

Whether you run marathons or walk, injuries are just a step away. Knowing what -- and what not -- to do can help avoid them.

January 01, 2007|Jeannine Stein | Times Staff Writer

FROM the pickup basketball player to the motivated marathoner, all who exercise can suffer the agony of the feet.

During the simple act of walking, the foot absorbs one-and-a-half times the body's weight. In running, it bears two to three times the body's weight. One giant leap to dunk a basketball can ratchet that force up even higher. Because one stress fracture can seriously derail an entire sports career, researchers are continually studying athletes to determine the optimum methods of training and treatment, to both prevent and care for these injuries.

The most common athletics-related injuries, say sports medicine orthopedists and podiatrists, are plantar fasciitis, Achilles tendinitis, neuromas, capsulitis and stress fractures.

Plantar fasciitis

Any activity that involves jumping, plus sudden stops and starts, can lead to plantar fasciitis. And apparently plenty of activities do. This overstretching of the ligament that runs from the heel to the ball of the foot, straight through the arch, affects about 14% of men and women ages 18 to 60, according to the American Podiatric Medical Assn.

For The Record
Los Angeles Times Wednesday January 03, 2007 Home Edition Main News Part A Page 2 National Desk 0 inches; 34 words Type of Material: Correction
Footsteps: An article on the human foot in Monday's Health said that people take an average of 10,000 steps per mile. In fact, the average person would cover about five miles with 10,000 steps.
For The Record
Los Angeles Times Monday January 08, 2007 Home Edition Health Part F Page 5 Features Desk 0 inches; 33 words Type of Material: Correction
Footsteps: An article in the Jan. 1 Health section said that people take an average of 10,000 steps per mile. In fact, the average person would cover about five miles with 10,000 steps.

"It comes on slowly," says Dr. Doug Richie, a Seal Beach-based podiatrist and past president of the American Academy of Podiatric Sports Medicine. "It's not a sudden event. But it's always worst first thing in the morning, and it can be worse while playing the sport."

Cause: The repeated stress of propelling the foot upward strains the ligament, sometimes creating small tears and possibly also causing pain at the arch. Being overweight can exacerbate the condition for the additional load it puts on the foot. The injury is especially common this time of year, when resolution-makers start exercising with a little too much gusto.

Although the pain can be felt in the arch, it's usually felt in the heel in part because that's where the ligament is weakest, says Dr. John Pagliano, a Long Beach-based podiatrist and fellow of the American College of Sports Medicine. "The fascia is nice and broad in the arch, but narrows as it comes into the heel." The heel is also where the foot bears the brunt of impacts.

"It's supposed to be a nice, soft, pliable material," Pagliano says, but after taking a pounding, it can form adhesions and scar tissue, becoming "gristly and hard."

Prevention: Warm up before an exercise routine, and gradually increase your workout intensity over time. Wear shoes with adequate arch support.

Treatment: First, try rest, plus orthotics that lift the arch and take the pressure off the ligament. If that doesn't do it, try a leg splint worn at night to keep the foot at a 90-degree angle, so the plantar fascia is prevented from tightening up. For those prone to plantar fasciitis, physical therapists often recommend exercises to stretch the ligament. For instance, while seated, roll the foot on a tennis ball for about five minutes twice a day. But do the move only when warmed up -- never first thing in the morning when the foot is stiff -- and only on the fleshy bottom of the foot under the arch. A study published last year also showed good results, finding that curling the toes backward while flexing the ankle resulted in less pain and more improvement than those who did an Achilles stretch.

Another therapy could be on the horizon: In a pilot study presented at a meeting last year of the American College of Sports Medicine, 29 men and women recently diagnosed with the injury were given eight weeks of standard care -- ibuprofen, rest and stretching exercises. Half were given glucosamine supplements, and half a placebo. Although all started off with the same severity of pain, six of the 15 who took glucosamine were pain-free after about a month, compared with only one of 14 in the placebo group.

Achilles tendinitis

The tendon that brought down the mythic hero Achilles also fells numerous runners, dancers and gymnasts. Some 6.5% of people suffer from general tendinitis, according to the American Podiatric Medical Assn. In 2002, Washington, D.C.-based sports medicine podiatrist Dr. Stephen Pribut surveyed nearly 10,000 runners via the Internet and found that 7% reported that Achilles tendinitis pain prevented them from running for more than a week.

The Achilles tendon connects the calf muscle to the back of the heel bone. But it's the action of the foot that can cause injury, says Richie -- specifically too much bounding, jumping or fast-paced running.

"The more you get up on the toes, the more that uses the Achilles," he says, "since it's the propulsive tendon of the foot, lifting the heel and driving the body forward over the foot." The less flexible the Achilles, the more strain it endures.

Cause: All that stress can eventually lead to inflammation, strains and micro-tears in the tendon, forming scar tissue that results in even more inflexibility, says Pagliano. That can cause severe pain that shoots like a thunderbolt from the back of the ankle with every step. In extreme cases, the Achilles can completely rupture.

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