Too Much of a Good Thing Can Cause Overuse Injuries of the Foot
Painful stress fractures, tendonitis can be avoided by easing in to sports activities.
Being physically active has long been applauded as an ingredient for good health, but, according to surgeons at the American College of Foot and Ankle Surgeons, doing too much too soon can wreak havoc on the feet and can cause painful overuse injuries: tendonitis, ruptured tendons and stress fractures, to name a few.
A key strategy for preventing these common injuries is to let your body adjust to increased activity, explains Derrick McKay, DPM, AACFAS, a Massachusetts foot and ankle surgeon and member of the American College of Foot and Ankle Surgeons.
"Our bodies adapt to our level of activity, but if we haven't worked out in a while, not only do our muscles get weaker but also the tendons and bones that support the muscles, and that can lead to injuries," says Dr. McKay. Slowly increasing your level of activity, rather than doing it aggressively, enables the body to adapt and strengthen through a natural process called remodeling.
Overuse injuries occur in many different sports. Tendonitis (painful inflammation of a tendon) is most commonly associated with the side-by-side or jumping motions performed in activities, such as tennis, soccer and dance. Tendon ruptures (tears in the tendon) are typically linked to sports that use swift, abrupt movements, such as basketball, football and soccer. Stress fractures—small breaks in the bone—are often seen after too vigorously starting a walking routine or in sports that involve running. But any of these injuries can happen with any sport.
The good news is that overuse injuries of the foot can usually be easily avoided. Because easing into the activity is critical, experts advise following the "10 percent rule," which calls for increasing the activity by only 10 percent each week.
"I've treated many patients who developed a stress fracture because they decided to train for a marathon and suddenly went, for example, from running three miles to 10 miles a week," says Dr. McKay. "That's a recipe for disaster. Instead, they should have gone from three miles to 3.3 miles during their first week of training and continued increasing the mileage each week about 10 percent."
While some people can progress faster, the 10 percent rule is a good place to start. It is always best to consult a foot and ankle surgeon for a more custom plan that will fit your goals.
Some people are prone to getting overuse injuries because of anatomical factors, such as flatfeet or a longer second toe. In these individuals, custom orthotic shoe inserts prescribed by a foot and ankle surgeon can be helpful in preventing overuse injuries.
Another preventive tool is to listen to your body. "All pain is not gain," says Dr. McKay. "If you feel discomfort that differs from how you normally feel after a workout, your body is telling you to slow down and rest, to allow your body to adjust and restore itself."
In fact, rest is crucial when an overuse injury develops. Doctors recommend that you stop the activity, rest, elevate the foot, apply ice and take over-the-counter nonsteroidal anti-inflammatory medication. This gives the injured tissue the opportunity to heal.
If the pain does not improve in three to seven days, however, it is time to see a foot and ankle surgeon. Diagnosing an overuse injury is usually straightforward because typically the injury occurred after a sudden increase in activity.
Treatment, on the other hand, can be challenging if a person is training for an upcoming event. "This situation calls for finding a balance between letting the injury heal through rest and maintaining stamina to perform well in the future," says Dr. McKay. "In these cases, we try to find an alternate activity for the patient while recovering." That may mean, for example, that the patient is fitted with a protective boot that permits use of a stationary bike. Swimming might be another option for maintaining strength while the injury is healing.
Some tendon injuries are so severe they require surgery. However, most overuse injuries will resolve through rest, and most are prevented by setting realistic, common-sense goals—and that calls for refraining from doing too much too soon.