Active Feet

Aerobics

It's a good idea to see a podiatrist specializing in sports medicine before beginning an aerobics regimen. Because aerobics involves quick lateral movements, jumping, and leaping for extended periods of time, proper care of the foot plays a crucial part in keeping the entire body fit to endure the "pain" that precedes the "gain" of a more fit physique and efficient heart and respiratory system.

The podiatrist will perform a biomechanical or gait analysis to assess your risk of injury. If your feet suffer from excess pronation or supination (your ankles tend to turn inward or outward too much), it's especially important to see a podiatrist, who may recommend controlling the sometimes harmful motions with prescription orthotics (custom-made shoe insert).

Proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability. Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot.

Because of the many side-to-side motions, shoes need an arch design that will compensate for these forces, and sufficiently thick upper leather or strap support to provide forefoot stability and prevent slippage of the foot and lateral shoe breakdown. Make sure shoes have a toe box that is high enough to prevent irritation of toes and nails.

The old sneakers in your closet are not proper shoes for aerobics. Major shoe companies today have designed special shoes for aerobics, which provide the necessary arch and side support; they also have soles that allow for the twisting and turning of an aerobics regimen.

Running shoes, perhaps the most popular athletic shoes, lack the necessary lateral stability and lift the heel too high to be considered proper for aerobics. They also often have an acute outside flare that may put the athlete at greater risk of injury in sports, like aerobics, that require side-to-side motion. Running shoes are not recommended by podiatrists for aerobics.

Once you've found the proper shoes, tie them securely around the arch, but not too tight, in the toe box to allow toes to spread. Double-tie the laces to prevent accidental slippage in mid-routine.

Purchase shoes in the afternoon, when the feet swell slightly. Wear the same socks that you will wear in training. Podiatrists recommend athletic socks made of an acrylic or wool blend.

Prevention of Injuries

In a physically challenging sport such as aerobics, injuries are common, and often involve the foot, ankle and lower leg. (Other susceptible parts of the body are the knee and back.)

Podiatrists say most injuries from aerobics result from improper shoes, surfaces or routines, and overuse of muscles through too vigorous a regimen.

New, properly tied, well-fitted aerobic-specific shoes will address the first problem, and common sense will help with the others. The key to injury prevention is proper conditioning, which will provide muscles the flexibility and strength needed to avoid injury.

If you are attending an aerobics class, make sure it is led by a certified instructor. Hardwood floors, especially with padded mats, are the best surfaces possible. If you can, start with a multi-impact class, where you can start at a low-impact level and work your way up as your conditioning improves.

If your routine is at home with a video, be very careful. Read the label to determine whether the video is produced by certified aerobics instructors and whether you can handle the degree of impact. While it's safe to do low-to-moderate impact aerobics on the living room carpet, that's not a proper surface for high-impact routines.

In addition, make sure the video includes a proper warm-up period. Make sure there are no rapid, violent movements. Do not bounce or use ballistic stretching, or stretches known as the Yoga plow or hurdler's stretch. Knees should always be loose during warm-up. A static stretch held for 30 seconds can help avoid over-stretching injury.

As you work out, monitor your heart rate to stay near the target heart range (start with 220, subtract your age, then multiply by 0.8 to find target heart range). You should be within five of the target range. Monitor pulse at peak and after final cool-off and compare. The difference is known as your cardiac reserve.

Drink lots of water to avoid dehydration during workouts; dehydration can cause nausea, dizziness, muscle fatigue and cramping.

Don't underestimate the importance of the cool-off period. It burns off lactic acid (which makes muscles feel tired) and adrenaline, while keeping blood from pooling in the extremities.

While fitness professionals exercise vigorously six times a week, it's best to start slower. Although it varies by the individual, it's safe to start exercising twice a week for several weeks, then gradually increase to a maximum of five times a week. Remember to pace yourself, and listen to your body. If you feel pain, stop. Don't attempt to exercise through pain, or you may aggravate an acute injury into a chronic or even permanent one. If you continue to be bothered by pain more than 24 hours after exercising, see a physician.

Common Aerobics Injuries

Plantar fasciitis (arch pain) - Arch pain is often caused by frequent stress on the plantar aspect, or bottom of the foot, in an aerobics routine. When the plantar fascia, a supportive, fibrous band of tissue running from the heel to the ball of the foot, becomes inflamed, pain on the bottom of the foot results. Forefoot and rearfoot instability, with excessive pronation, may result in plantar fasciitis. Shoes with proper support in the arch often prevent plantar fasciitis; if not, see your podiatrist for a custom orthotic device or a recommendation for another shoe.

Heel spurs - Heel spur syndrome, related to plantar fasciitis, occurs after calcium deposits build up on the underside of the heel bone. Heel spurs form gradually over many months. Both plantar fasciitis and heel spurs can be avoided by a proper warm-up that includes stretching the band of tissue on the bottom of the foot.

Sesamoiditis - Sometimes referred to as the ball bearings of the foot, the sesamoids are a set of accessory bones found beneath the large first metatarsal bone. Incredible forces are exerted on the sesamoid bones during aerobics, and inflammation and fractures can occur. Proper shoe selection and custom orthotic devices can help avoid sesamoiditis.

Shin splints - Aside from ankle sprains, shin splints are perhaps the most common injury to the lower body, as the muscles attached to the shin bone bring the foot up and down. The pain is usually an inflammation of the shin muscle and tendon due to stress factors. Treat shin pain with cold compresses immediately after the workout to reduce inflammation. Proper stretching before the workout should prevent the onset of shin splints. Strengthening of muscles also helps reduce shin splints.

Achilles tendon and calf pain - The frequent rising on the toes of an aerobics routine often creates pain and tightness in the large muscles in the back of the legs, which can create pain and tightness in the calf and inflammation of the achilles tendon. Again, stretching the calf muscles gently and gradually before and after the workout will ordinarily help alleviate the pain and stiffness.

Stress fractures - Probably the most common injuries to aerobics instructors, stress fractures are caused by poor shoe selection, hard surfaces, and overuse. Women are more likely to develop stress fractures, usually in the lesser metatarsal bones, than men. When swelling and pain surface, see a podiatrist. X-ray evaluation and early treatment can prevent a disabling injury.

If you experience any of these injuries, see a podiatrist, who will prescribe treatments to alleviate the pain, and make recommendations to prevent recurrence of any discomfort. As foot specialists trained in all aspects of foot care, podiatrists are also qualified to perform foot surgery if the condition requires it.

The Bottom Line

The bottom line when undertaking an aerobics program is to be careful and responsible. Aerobics may even provide a more vigorous workout than jogging, and injuries will inevitably occur if you don't listen to your body and exercise your common sense as well as your muscles.

Remember there are good aerobics programs and bad ones. Use discretion in choosing both a class to attend or home video to purchase that is right for you. Always pace yourself, and stop if you feel pain. Remember, foot pain is not normal, so don't ignore it. Chances are, a successful aerobics regimen will bring out the body you've always dreamed of, and a better feeling about yourself both physically and mentally.

Source: American Podiatric Medical Association

Baseball

Like all vigorous exercise, baseball and softball should be played sensibly and safely. Improper preparation and technique can lead to injury, especially to the lower extremities, which take us around the bases and under fly balls.

Before the First Pitch

Many children begin playing organized T-ball, softball or baseball in early elementary school. If a child is in generally good health and has no pre-existing physically compromising conditions, baseball is relatively safe with proper instruction in the game's fundamentals.

Weekend warriors who pick up the sport again in adulthood are less apt to be in optimum condition than younger athletes, and should take it slow before jumping right into a game. Anyone who is more than 40 years old, diabetic, a smoker, or has any physical disability should see a family physician before taking the field. People with existing foot problems should see a podiatrist specializing in sports medicine, who can perform a gait analysis and assess any risk inherent in a sports regimen.

Because baseball and softball involve quick starts and stops, it's important to loosen up before the game. Even the youngest children should make sure to do some simple stretching, running and playing catch before the game to avoid muscle pulls or other problems.

Before playing pickup games, make sure the field is free of hazards like holes on the base path, which could cause a foot or ankle injury. Sticks, rocks, and other debris on the field cause players to trip, risking injuries, and should be removed.

Shoeing Up for Baseball

For children under the age of 10, sneakers will suffice for baseball, although kids probably will pine for cleats long before that. There's no real danger in them wearing cleats, but they should be gradually introduced before being worn in a game. A young player needs to get a feel for cleats, which should not be worn off the field.

While the improved traction of cleats may enhance play, it also leaves the ankle more susceptible to twists and turns. Any child with pre-existing foot conditions should see a podiatrist before putting on cleats. Never put a child in hand-me-downs; ill-fitting cleats increase the danger of ankle injuries. When sizing cleats, make sure the feet are measured by a footwear technician, and always wear a game-size sock when trying them on.

In some competitive baseball leagues, the use of metal spikes is often permitted for players more than 13 years old. Spikes must be understood as dangerous weapons on the base paths; they require a certain level of maturity to be worn safely. They are not necessary for casual play, and should not be worn unless in league competition.

Spikes, which technology has made lighter and more flexible these days, perform the same function as cleats, but engage the ground differently. They too should be worn on a limited basis until the feel of how they engage the turf is understood. Unfamiliarity with spikes can lead to ankle twists and turns in a competitive situation.

When wearing cleats or spikes for the first time, watch for irritation, blisters, or redness, which could indicate a biomechanical problem in the legs or feet. Pain is a clear indicator of a problem. If cleats cause pain, discontinue wear for two to three days; if it returns, see a podiatrist specializing in sports medicine for evaluation.

Preventing Baseball Injuries

One of baseball's most exciting moments comes when a batter stretches a single into a double by beating the tag in a dust-kicking slide. Sliding is a fun part of the game at all levels, but proper technique is crucial to avoiding foot and ankle injuries, especially when bases are firmly secured to the infield. Coaches at all levels should make sure their players are well schooled in proper sliding. Careless slides can result in sprains and even fractures of the lower leg and feet.

Pitchers also need to be coached on the proper way to come off an elevated mound with their back foot and land on an incline with the front foot. The repetitive motion of pitching can lead to overuse injuries to the feet and ankles. Pitchers experiencing pain in their windup should take a few days off before returning to the mound.

Catchers too are susceptible to overuse injuries by squatting behind home plate for every pitch. Again, coaches should teach their catchers how to alter their stance to vary weight displacement.

Lower Extremity Injuries and Treatment

Contusions - A baseball will inevitably make contact with a player's foot and ankle, whether it's a pitched ball, foul tip, or line drive, and sliding base runners often run headlong into an infielder's legs. Usually this contact results in contusions, which are not often serious injuries. Ice packs and a few days' rest will usually help the contusions, or bruises, feel better.

Sprains and fractures - Stretched or torn ligaments, known as sprains, can occur from running the bases, or pivoting to make a play. Sprains may cause extensive swelling around the ankle just like a fracture. Immediate treatment from a podiatrist is crucial to quick healing. Fractures, where the bone has cracked or broken, often require casting. After a sprain or fracture, a podiatrist can prescribe a rehabilitation regimen to restore strength to the injured area before returning to the sport.

Plantar fasciitis - Catchers are particularly susceptible to arch pain, commonly traced to an inflammation called plantar fasciitis, on the bottom of the foot. A podiatrist can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.

Heel spur syndrome - A related condition, to which catchers are also susceptible, is heel spur syndrome. Often related to plantar fasciitis, heel spur syndrome occurs when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. Many times the ligament pulling on the heel creates the symptoms, and not the spur itself, especially after getting up from resting. With proper warm-up and the use of supportive shoes, strain to the ligament can be reduced.

Achilles tendinitis - The stop-and-start of baseball often creates pain and tightness in the calf, and aggravation of the Achilles tendon. Again, regular stretching of the calf muscles gently and gradually before and after the game will help minimize the pain and stiffness.

Shin splints - Shin splints usually stem from an inflammation of the muscle and tendon attached to the shin, caused by stress factors. Treat shin pain with cold compresses immediately after a game to reduce inflammation. Proper stretching and strengthening exercises should prevent the onset of shin splints.

Source: American Podiatric Medical Association

Basketball & Volleyball

Basketball's essential elements of running, jumping, cutting, stopping and shooting on a hard floor exert tremendous pressure on the foot and ankle. Volleyball is more purely vertical than basketball; there is less running and cutting, but more quick-step reactions from a stationary position.

Without proper shoes and preparation, podiatrists say, injuries will invariably occur.

Two distinct types of injury to the lower extremity can occur in basketball and volleyball: acute injury from a sudden and forceful blow, or chronic injury, which develops slowly and becomes aggravated over an extended period of time.

Most acute foot and ankle injuries, which occur from landing improperly from a jump or twisting while falling, are accidental and difficult to prevent. The most common acute injuries include ankle sprains, torn ligaments, muscle pulls, tendon ruptures and fractures.

Chronic, or overuse, injuries can be caused by inadequate warm-up, poor conditioning, improper and ill-fitting shoes, worn out shoes, or biomechanical deformities that causes undue stress on the foot and ankle. Common chronic injuries sustained in basketball and volleyball include stress fractures, plantar fasciitis, shin splints, achilles tendinitis, patellar tendinitis, sesamoiditis, and blisters.

Different playing surfaces can also have an effect on injuries. Indoor wood courts offer the most shock absorption and are considered the safest courts, while outdoor courts of asphalt are more dangerous. Concrete courts are the hardest and most dangerous courts in relation to lower extremity injuries.

Preventing Injuries

Some acute injuries occur following mid-air collisions, erratic lunges for a rebound or spike, or scrambles after a loose ball, and can't be helped. But chronic injuries can be averted with proper conditioning, equipment and good sense on the court.

Podiatrists recommend stretching exercises and gradual warm-up before beginning vigorous play. A separate weight-lifting regimen of both upper and lower body muscles helps minimize the impact of chronic injuries before they happen.

Another means of preventing injuries while playing basketball or volleyball is a proper shoe.

There are shoes designed specifically for basketball, with lots of ankle support and shock absorption. Some high-topped shoes offer more ankle support than others and are preferred by many podiatrists. Shoes should fit well and be replaced before the soles become smooth, or before the uppers begin to tear or come apart. A typical basketball shoe should be replaced every two to three months for five days a week worth of play. Acrylic socks should be worn to avoid blistering.

Volleyball-specific shoes should also be worn by devotees to that sport. They are similar to the basketball shoe, but typically are lighter, have less mid-sole support, and a "tighter" sole more responsive to quick starts and stops.

When the Game's Over

Acute injuries require immediate medical attention. After a bad fall or painful twist, the game's over. When an injury occurs, podiatrists advise, get off the court immediately and apply first aid. The best initial treatment for acute injury is ice, rest, compression, and elevation of the injured extremity. See your podiatrist as soon as possible.

When bothered by a chronic injury, reduce activity level in accordance with the severity of the pain. If nagging pain gets worse in the course of a game, get off the court and apply ice and a compression bandage, and elevate the foot. Over-the-counter anti-inflammatory medications such as aspirin or ibuprofen can be taken at proper dosage for temporary pain relief.

If pain does not subside within three to five days, see a podiatrist, who will explore possible causes of the injury. Chronic pain can often be traced to a biomechanical abnormality that is placing undue stress on a particular part of the foot or ankle.

Biomechanical imbalances can be corrected by prescription orthotic devices - specially constructed shoe inserts that redistribute the body's weight evenly on the foot and ankle.

Selective stretching and strengthening programs, shoe modifications or strapping of the foot and ankle can also correct biomechanical problems. Lower extremity structural problems that often lead to injury include high arches, flat feet, bowlegs and tight calf muscles.

Getting Back on the Court

Basketball is one of the most demanding sports, physically and mentally, and is especially rough on the foot and ankle. Volleyball can also be extremely demanding. Understand that competitive basketball and volleyball put the entire body under stress and at risk of injury.

When injury to the foot or ankle does occur, the injured part must be given time to get over the acute inflammatory phase of healing. Then, adequate support with shoes or splints and/or tape may be necessary.

Finally, and just as important, is the need to strengthen the injured part back to its pre-injury condition. If not, it will continue to remain weak and predispose the athlete to re-injury.

Source: American Podiatric Medical Association

Contact Sports

Football, lacrosse and rugby require miles of running - with quick stops and starts - per game. Competition is usually on grass fields, which "give" so players may change direction quickly. It also provides a soft landing surface on which to crash. Just by the nature of these games, injuries are inevitable. The lower extremities - an athlete's steering, accelerator and braking systems - are particularly susceptible. But with proper conditioning, equipment, and technique, competitors in contact sports have successful, healthy playing seasons.

Podiatrists are specialists in care of the lower extremities. Not only do they treat injured athletes and get them back into competition as soon as safely possible, but they also help athletes get into a condition that minimizes their risk of injury to the foot and ankle.

Preventing 'Overuse' Injuries

The time a football, lacrosse or rugby player spends in an actual game represents only a tiny fraction of time spent in practice, conditioning for competition. Practice involves hours of running, repetitive drills and scrimmages every day.

While conditioning exercises in practice will strengthen and improve flexibility in the lower extremities, the repeated stress of practice may bring on chronic, or "overuse" injuries. These injuries can nag at a player and hamper, if not end, a season of competition.

Overuse injuries also come from faulty biomechanics of the feet - how the lower extremity physically adjusts to the ground. If an athlete has flat feet, which tend to pronate (out-toe), or excessively high arches, which often supinate (in-toe), extensive running and cutting can produce chronically strained ankles.

Before taking the practice field, it's wise to be examined by a podiatrist specializing in sports medicine, who will identify any biomechanical abnormalities that increase the chance of injury. The podiatrist may recommend specific exercises to strengthen and improve flexibility of the foot and ankle, or recommend taping or padding of the foot or ankle before practice and competition. A podiatrist may also prescribe orthoses, customized shoe inserts that correct biomechanical problems by redistributing the body's weight.

Podiatrists say proper stretching and warm-up before and after home workouts, practice, and before games go far to prevent overuse injuries to the supporting structures of the lower extremity. Warm-up and cool-down exercises should take five to 10 minutes and should be conducted in a stretch-hold-relax pattern, without any bouncing or pulling. When muscles are properly warmed up, the strain on muscles, tendons and joints is reduced.

Crashes, Bumps and Bruises

Football players, who today more than ever combine size with speed, experience high-impact collision on virtually every play. Lacrosse players "check" much like hockey players, but wear thin pads on the arms and shoulders. Rugby players wear no padding at all.

The foot and ankle bear the brunt of the crashes, bumps, and bruises of contacts sports. Feet get stepped on, kicked, jammed, twisted, and cut. Quick changes in direction and hard tackling can lead to sprains and fractures of the ankle.

Impact, or "trauma injuries are more serious than overuse injuries, and require recovery time away from the practice and game field. Immediate treatment should include the "RICE" formula: rest, ice, compression and elevation.

Trauma injuries should always be treated by a medical professional such as a podiatrist, and be fully healed before returning to the field. Players who lie about how an injury feels or take painkillers to play through a trauma injury, are not helping their team. They are putting themselves in danger of aggravated or permanent injury.

Footwear

Cleats are the footwear of choice for all contact sports down to the youth leagues. Cleats are generally safe for young ankles. Cleats should be light and flexible, and always fit properly. Uppers should be supple (no hand-me-downs, please), and there should be, and at least a finger's width separation between the tip of the big toe and the end of the shoe. Laces should be tight.

When shopping for cleats, wear the same style of socks you intend to wear in competition. Shop in the afternoon, when the feet are naturally slightly swollen. Investing in proper footwear for a young athlete is much less expensive than medical treatment later.

Artificial Turf

Contact sports are sometimes played on artificial turf, which presents a new set of concerns for an athlete. Some surfaces simulate the texture of grass, and others are little more than carpet. All forms of artificial surface are harder than grass, and make for a faster pace of play. Cross-training shoes or sneakers are the footwear of choice on artificial turf.

Because the surfaces do not "give" like grass, playing on them may be more hazardous to the lower extremities. Players should be well familiarized with the dynamics of running and changing direction on "turf" before competing on it.

Trainers and physicians frequently tape the feet and ankles of their players for added stability, especially on artificial turf. Proper taping can help prevent injuries from occurring, and keep a minor injury from becoming a major one.

Injuries and Treatments

Keeping the lower extremities healthy is so important to an athlete that most all professional football and soccer teams have a team podiatrist, who treats minor problems like corns, calluses, and blisters, to major injuries like fractures and dislocations. The most common injuries suffered in contact sports include:

Turf toe - Turf toe is a painful jam or hyperextension of the big toe. The condition is more common on artificial turf, but can happen on grass as well. Immediate treatment includes the RICE regimen, and wearing a stiffer shoe prevents aggravation of the injury. Splinting the toe or special orthoses can also help.

Ankle sprains Making contact on a firmly planted ankle can forcibly invert the joint and damage ligaments, resulting in a sprain. Immediate treatment using the RICE formula to reduce swelling is important to quick healing. Any sprain that doesn't show improvement in three days should be checked by a podiatrist or family physician.

Fractures - There are two distinct kinds of fractures that require vastly different treatment. Stress fractures are incomplete cracks in bone caused by overuse. Stress fractures heal with complete rest. Fractures are more serious injuries that require immediate medical attention. Casting and sometimes surgery is required to immobilize fractures and set breaks. Requiring 10 to12 weeks for rehabilitation, a fracture or a break essentially ends a season of competition in any contact sport.

Source: American Podiatric Medical Association

Cycling

Besides selecting a bicycle that meets your specific needs, proper shoes are the most important piece of cycling equipment. Cycling shoes must have a stable shank to efficiently transfer power from your feet to the pedals. The lack of shank support in sneakers allows the foot to collapse through the arch while pedaling, which may cause arch pain, tendon problems or burning under the bottom of the foot. A rigid shank protects your feet from the stress of pedaling.

Investing in a cycling-specific shoe is a good idea if you have had pre-existing problems with your feet or wear orthotic shoe inserts. Most orthoses control the arch and heel, and for cycling, usually require critical forefoot balancing. Riders with mild bunions or hammertoes should select a wider, deeper shoe that will accommodate the deformity.

Select a shoe that's right for you among models designed for racing and mountain biking. For the casual rider without known foot problems, cross-training shoes provide the necessary support across the arch and instep in a shoe that can be used for other purposes. They also provide the heel lift that cycling shoes give. Combination cycling-hiking shoes meet the needs of the casual rider well, and have recently become popular.

The use of toe clips, and their degree of sophistication, begin to separate the casual rider from the more serious devotee. Toe clips range from traditional clips to newer shoe-cleat ensembles - "clip-less systems" - that resemble ski bindings.

Proper shoes and clips or cleats working as a unit are important to achieve maximum efficiency in transferring power generated by the hips to the foot. For most efficient pedaling, shoes should extend fully under the ball of the foot.

Biomechanics and Cycling

Biomechanics, the study of external forces on the living body, plays a crucial role in efficient, satisfying cycling. For example, when seated on a bike with hands on the handlebars, the hands, shoulders and front axle should all be in line.

By enhancing the biomechanics of the foot, podiatrists specializing in sports medicine can improve the mechanical functions of related body parts. If, for example, an experienced cyclist's knees hurt after a 50-kilometre ride, the problem may be a biomechanical imbalance. A podiatrist can alleviate the pain by correcting that imbalance through prescription orthotic shoe inserts. Training and conditioning methods should also be evaluated.

To preclude pain before it starts, podiatrists advise stretching the major muscle groups used in cycling - the gluteals, the quadriceps, calves, and hamstrings - before and after getting on the bike. Riders should start slowly and work up to normal cadence, or rate of pedaling. The seat is at the proper height when knees are slightly flexed and hips are over the knees.

Podiatrists recommend the use of a pulse monitor for a cycling-based training regimen. Some models strap around the chest, while smaller units wrap around the wrist or the thumb and display the pulse rate as you ride.
Ask your podiatrist about an appropriate pulse rate while you ride. Usually, the same criteria applies as with running: your pulse should be 60 to 70 per cent of the maximum for efficient training.

Injuries and Treatment

Every day, podiatrists treat cyclists who have sustained overuse injuries by pushing themselves beyond their limitations. Here are some of the most common cycling injuries and their causes. As with all athletic injuries, pain that is persistent indicates a need to seek treatment from a sports medicine specialist familiar with cycling injuries.

Knee pain - Some intrinsic knee problems like swelling, clicking, or popping should be immediately evaluated by a sports medicine specialist. Cartilage irritation or deterioration, usually under the kneecap, can be caused by a biomechanical imbalance, improper saddle height or faulty foot positioning on the pedals. Riding in too high a gear, too far uphill or standing on the pedals all may aggravate the problem. Cleated shoes or touring shoes with ribbed soles that limit side-to-side motion can cause knee pain if the knees, feet and pedals are misaligned.

Shin splints - Pain to either side of the leg bone, caused by muscle or tendon inflammation. This may be related to a muscle imbalance between opposing muscle groups in the leg. It is commonly related to excessive foot pronation (collapsing arch). Proper stretching and corrective orthoses for pronation can help prevent shin splints.

Achilles tendinitis - Irritation and inflammation of the tendon that attaches to the back of the heel bone can be caused by improper pedaling, seat height, lack of a proper warm-up or over-training. This condition is usually seen in more experienced riders, and can be treated with ice, rest, aspirin or other anti-inflammatory medications. Chronic pain or any swelling should be professionally evaluated.

Sesamoiditis - Sometimes known as the "ball bearings of the foot," the sesamoids are two small bones found beneath the first metatarsal bones; the sesamoids can inflame or rupture under the stress of cycling. Sesamoiditis can be relieved with proper shoe selection and orthoses.

Numbness - Impingement of small nerve branches between the second and third or third and fourth toes can cause swelling that results in numbness, tingling, or burning or sharp shooting pains into the toes. Wider shoes, or loosening toe straps or shoe laces can alleviate the problem. If the problem persists, try a clipless system. Numbness or tingling with leg pain may represent a serious problem known as "acute compartment syndrome," which requires immediate medical attention.

Competitive Cycling

Undertaking a successful cycling regimen frequently results in the desire to match skills with others. There are four categories of competitive cycling. Category I denotes world-class competition - with conditions and strategies an average cyclist would not be able to navigate. Category II is also advanced, and employs such techniques as drafting, and involves certain "courtesies" of cycling etiquette.

Categories III and IV offer opportunities for fit cyclists to go out and test their mettle against other enthusiasts of the sport. No special equipment is required, only the desire to compete and an adequately trained, biomechanically tuned body. See your local bike shop for schedules of races in your area. As with all competition, start at a low level and work your way up the categories. Remember, put safety first, and enjoy yourself.

Before beginning any exercise program, be sure to check with your physician.

Source: American Podiatric Medical Association

Golf

First, your weight is placed lightly on the balls of your feet, balanced between your front and rear foot. Then there is a slight shift to the back foot, then another shift back to the front. Sound like dance steps? These intricate movements actually describe what goes on below the knees during an ordinary golf swing.

Good foot action is the mark of an accomplished golfer. "All timing, distance, and direction comes out of the lower body with the feet leading the way," golf legend Jack Nicklaus has said. Nicklaus or any professional will tell you that problems with the feet, even a painful corn or callus, can impede timing and balance to the point where it's reflected on the scorecard at the end of the day.

Millions of Canadians enjoy golf on an amateur level. Above and beyond the satisfaction of competition, a full round of golf affords the opportunity for a six- to eight-kilometre workout that can reduce stress and improve cardiovascular health.

Be Prepared

Before taking to the links, your body needs to be prepared for the workout involved in walking the whole course. (If the pros can walk, so can you!) Anyone older than 40, or having any problems with weight, respiration, blood pressure, pulse rate, or cholesterol, should check with a doctor before playing. The same goes for smokers and people with diabetes, pre-existing injuries or a history of heart trouble.

Your podiatrist, a foot and ankle specialist, knows the importance of wearing proper golf shoes. Once driven by fashion, golf shoes began as wing-tip oxfords with spikes. Today, shoes are constructed using basic principles of athletic footwear. Some even incorporate advanced technological innovations such as graphite shank reinforcements, which keep them light and add strength.

Don't wear anything on your feet that wouldn't be comfortable if you were taking a good long walk. Make sure shoes fit well in the store before purchasing them. It's best to shop for them in the afternoon when the feet are slightly swollen. Try on shoes with the same socks you'll wear on the course. Tie both left and right shoes tightly, and walk around your store or pro shop a few minutes before deciding on a make and model.

Some simple stretching exercises are important before taking to the first tee and after leaving the last. Consult a podiatric physician who specializes in sports medicine for a light stretching regimen that will help alleviate stiffness after a day of golf.

The Ideal Swing

Biomechanics, the application of mechanical laws to living structures such as the feet, play a crucial part in developing the ideal golf swing. The lateral motion and the pivoting intrinsic to the golf swing can be functionally impeded by certain biomechanical conditions. Faulty biomechanics can inhibit proper foot function and your game will suffer.

The anatomy of a biomechanically sound swing goes like this: During set-up, your weight should be evenly distributed on both feet with slightly more weight on the forefoot as you lean over, and slightly more weight on the insides of both feet.

Maintenance of proper foot alignment on the backswing is critical for control of the downswing and contact position. During the backswing, weight should be shifted to the back foot. It should be evenly distributed on the back foot or maintained slightly on the inside. Shifting weight to the outside leaves you susceptible to the dreaded "sway," a common error in swing. Without an exact reversal of the sway in the downswing, swaying will result in improper contact with the ball.

As the back foot remains in a solid position on the back swing without any rolling to the outside, the front foot is in turn rolling to the inside. The front heel occasionally comes off the ground to promote a full shoulder turn. Completion of the backswing places the weight on the back foot, evenly distributed between forefoot and rearfoot, with the weight left on the front foot rolling to the inside.

The downswing involves a rapid shift of weight from back to front foot; momentum brings the heel of the front foot down, and follow-though naturally causes a rolling of the back foot to the inside and the front foot to the outside. Golf should always be played from the insides of the feet.

Like the great Nicklaus said, "lively feet" are critical to a successful golf game. Having healthy, biomechancially stable feet is the first prerequisite for achieving that goal.

Orthoses: Preventing Pain, Improving Game

For the foot that is not able to function normally due to biomechanical conditions such as excessive pronation (rolling in) or supination (rolling out), a state of optimal biomechanics can be achieved through the use of orthoses, custom shoe inserts that can be prescribed by a podiatrist. Orthoses not only allow the feet to function as they ought to, but can alleviate the predisposition to injury brought on by biomechanical imbalances.

If you already wear orthoses in your street shoes, by all means transfer them to golf shoes. Podiatrists who specialize in sports medicine say there are cases when orthotic devices optimally designed for golf shoes will be different than those designed for street shoes.

If biomechanical problems are present in your swing, they will invariably cause symptoms when walking the links as well. Addressing biomechanical problems in walking may therefore result in the secondary benefit of an improved swing through proper foot function.

If a round of golf is painful on the feet, first assess the quality of your shoes. Any time pain is not adequately resolved with good, stable, golf shoes, and is present for more than two or three consecutive rounds, it's time to visit a podiatric sports physician. He or she can diagnose and treat any problems, and help make your feet an asset, not a liability, to your golf game.

Other Injuries and Treatment

The torque of a golf swing can strain muscles in the legs, abdomen, and back. The fact that the game is usually played on hilly terrain increases these forces, which in turn leads to injury. Proper warm-up and stretching exercises specific to golf can help in injury prevention. A sports podiatrist can recommend a suitable warm-up regimen.

If biomechanical imbalances are present, these existing stresses will overload certain structures, and predispose the golfer to overuse of muscles and strain on ligaments and tendons. Orthoses will equalize the weight load on the lower extremity, and in essence rest the overused muscle.

Other problems, such as tendinitis, capsulitis, and ligament sprains and pulls , can also keep a golf enthusiast back at the clubhouse. Improper shoes can bring on blisters , neuromas (inflamed nerve endings) and other pains in the feet. Podiatrists see these problems daily and can treat them conservatively to allow for a quick return to the sport.

When injured, participation is no substitute for rehabilitation. Injured body parts must be thoroughly treated and rehabilitated to meet the full demands of golf or any other sport. If you are injured, your return should be gradual. As much as you may want to get back to your game, take it slow. A healthy body makes for a more enjoyable game, and possibly a better scorecard at the end of the day.

Source: American Podiatric Medical Association

Hiking

Hiking is a great way to keep fit and explore the great outdoors. But excessive moisture and friction on the skin from improper socks and shoes can cause foot pain and lead to injuries that will stop you in your tracks. Before you climb your next peak, consult your local podiatrist to make sure you are using the right footwear for your hiking adventures. Whether you are going out for a short walk or for a multi-day trek, there are specific shoes and socks you should be buying to avoid discomfort and possible injury. Here are some helpful tips on hiking gear that will keep you going mile after mile.

Socks

Step #1: Picking the right sock

The right hiking sock depends on the type of trip you have planned and the weather conditions you expect. Here are the basic categories you have to choose from:

Liners - Sock liners are thin, lightweight wicking socks designed to be worn right next to your skin and under your socks. These liners wick sweat away from the surface of your foot to keep you dry and more comfortable.
Lightweight hiking/backpacking socks - Designed for warm conditions and easy trails. These socks are thicker, warmer and more durable than liners alone and provide extra cushioning.
Mid-weight hiking/backpacking socks - These socks provide cushioning and insulation in moderate to cold conditions. Many models have extra padding built into high-impact areas like the heel and the ball of the foot for maximum comfort. They should be worn with liners.
Mountaineering socks - These are the thickest, warmest and most cushioned socks available. They are designed for long trips, tough terrain and cold temperatures.

Step #2: Choosing a fabric

Cotton - 100% cotton socks are not recommended for backpacking. Cotton absorbs sweat, dries slowly, provides no insulation when wet that can lead to discomfort and blisters out on the trail. However, a cotton blend sock (with wool or other wicking and insulating fibers) is perfect for light summer hiking.
Wool - Wool is warm, cushioning, and retains heat when wet. Unfortunately, it can take a long time to dry and it can be scratchy next to your skin. To get the best wool has to offer, choose a sock that combines wool with synthetic materials.
Synthetic materials - Synthetics trap warmth like wool, but are softer on the skin. They also dry more quickly, are more comfortable and are available in a variety of sock styles and thicknesses.

Step #3: Test run

Take a quick walk in the sock styles you are considering for your hike to get a feel for how much cushioning they have. Be sure you buy the right size - bunched up sock material can make any backpacking trip an uncomfortable one.

Footwear

Podiatrists agree that choosing the right hiking footwear is the key to happy feet. Your hiking shoes and boots need to be comfortable, durable and protective. Here are some helpful tips for purchasing hiking footwear:
Step #1: Consider the hike
Begin your search for the right boots or shoes by choosing the category that best matches your hiking trips:

Lightweight hiking - These boots and trail shoes are designed for day hiking and very short overnight trips only. They stress comfort, cushioning and breatheability. As a result, they are less supportive and durable than the options below.
Mid-weight hiking/backpacking - These boots are designed for on- and off-trail hiking with light to moderate backpacking loads. They are more durable and supportive than lightweight hiking boots, but still intended for mainly short to moderate trips over easy to moderate terrain.
Extended backpacking/mountaineering - These boots are designed for on- and off-trail hiking with moderate to heavy backpacking loads. Durable and supportive, they provide a high degree of ankle and foot protection for multi-day trips.

Step #2: Keeping you dry

Moisture can cause abrasions when hiking so be sure to differentiate between the following:

Waterproof leather -This is leather that's been treated to be waterproof. It's great stuff to have, but remember -- leaks may still occur depending on how well the boot is made.
Waterproof (or water-tight) construction -This refers to construction techniques designed to keep leaks out such as seam-sealing, special stitches and precise design. Water-tight construction is typically combined with waterproofed materials.
Waterproof liners -These are the special waterproof barriers described above that are built right into the boot to protect you from whatever leaks make it through the boot materials. These liners typically do a great job of keeping you dry. But remember, they don't last forever.

Step #3: Test for Fit

Once you've narrowed down your options to a handful of boots or shoes, the best way to decide between them is to try them on. Here are some helpful sizing tips:

Sizing - Have an experienced salesperson measure both of your feet and use these measurements as your starting point. If one foot is larger than the other, which is quite common, fit your larger foot first. You may need to use extra socks or an insert to take up additional space in the other boot.
Wear socks - Try your footwear on with the type of socks and liners you'll be using out on the trail.
Check the initial fit - Lace up the boots and stand up. They should feel snug around the ball and instep of your foot, but loose enough that flexing your foot forward is not uncomfortable. Your heel should be held firmly in place.
Test your boots- Take a walk and check for any looseness, foot movement and/or heel lift. Good-fitting boots will hold your feet firmly in place without binding or pinching them. After a quick walk across a flat surface, step onto an incline facing downhill to check for slippage. Your feet should not slide forward easily, nor should you be able to move your heel from side to side.
Know your options - Try on a number of boot models before you decide on a single pair, even if the first pair feels good.

Injuries and Treatment

Hiking puts an enormous amount of stress on your lower extremities and can result in a number of foot related injuries. While some ailments can be self-treated, it is always best to see a podiatrist to ensure a small foot problem doesn't turn into a serious injury. Here are some common problems that hikers may experience.

Problems to Watch For

Frostbite - It's impossible to overstate the importance of understanding symptoms of frostbite. Skin-colour changes, from blue to white, can't be seen under a boot, but if toes are extremely cold for a prolonged period, feel burning or numb, there is a danger of frostbite. People with a history of frostbite often get it again in the same place.

Blisters - Friction in hiking footwear often causes blisters. Do not pop a small blister, but if it breaks on its own, apply an antiseptic and cover with a sterile bandage.

Neuromas - Enlarged benign growths of nerves between the toes, called neuromas, are caused by friction in tight footwear and can result in pain, burning, tingling, or numbness. Neuromas require professional treatment, including an evaluation of shoes.

Sprains and strains - The stress of hiking can result in sprains and strains of the foot and ankle. They can be treated with rest, ice, compression, and elevation (RICE). If pain persists, seek medical attention.

Subungal hematoma - Pressure in the toe box of a hiking boot can result in bleeding under the toenail known as a subungal hematoma or "blackened toenail." See a podiatrist to help prevent the loss of a toenail.

Corns and calluses - Such friction injuries are readily self-treatable, yet care should be taken to ensure that self-treatment does not aggravate the problem. When treating corns and calluses, do not try to trim with sharp objects. Instead, buff problem areas with a pumice stone after bathing.

Source: B.C. Association of Podiatrists, American Podiatric Medical Association

Hockey & Skating

High speeds attained on skates make for exhilarating sports, but expose the body to injuries. Healthy feet and ankles, which act together as accelerators, steering, brakes and shock absorbers in winter sports, are not only crucial to success in competition, but also help keep the body upright and out of the emergency room. Any problems with the foot or ankle could have serious repercussions for winter sports participants.

Preventing Cold Feet

Without warm, dry clothes, any wintertime outdoor activity is a potential health risk. Skates and socks are also important. While often ventilated, most ice skates are not built to allow perspiration to escape. Podiatrists recommend a single pair of thick socks or two thin socks made from a blend of acrylic or wool fibres that "wick" away moisture.

Feet "soaked" in snow should get back indoors quickly. In sub-freezing temperatures, soaked feet are in immediate danger of frostbite, a serious, painful condition that can result in loss of toes.

Impact Trauma

Skating puts tremendous stress on the ankle. Hockey players change direction at speeds near 30 miles per hour, and even casual figure skating requires quick turns and stops negotiated by the lower extremities.
Having enough protection in a hockey skate is also important. An errant slapshot can easily injure a foot in a less-protected skate.

If any pre-existing foot conditions, such as corns, calluses, bunions or hammertoes are present, see a podiatrist, a specialist of the foot and ankle, for evaluation before lacing up. A medical examination is also important if you have any pre-existing circulatory problems, such as Raynaud's Disease or diabetes.

Before taking to the ice in cold weather, it's important to loosen up the muscles by stretching. Stretching helps to prevent muscle pulls and tears, and prepares the muscles for the flexing required by the constant "forward lean" stress of skating.

Skates: A Perfect Fit, Please

Podiatrists specializing in sports medicine say properly fitted skates are the single most important factor in safe and successful skating. Without a snug (but not too tight) and accurate fit, the quick turns of skating will surely result in discomfort or injury.

If skates are too loose, toes quickly get irritated in the toe box. If they are too tight, pressure leads to blisters and abrasions that result in a host of painful problems and keep you indoors or, worse, compromise control and lead to an accident.

Tight footwear also may inhibit circulation of the blood vessels of the lower extremity and cause cold feet, which both compromises performance and presents danger in the cold.

Do not put children in hand-me-downs unless they fit perfectly. Skates that are too large or too small will cause blisters, inflammation of the foot or nail irritation. The lack of proper ankle support in a too-large skate will leave the ankle susceptible to sprains, strains or fractures. Whatever the style, skates should be laced snugly, using all the eyelets.

If you are not sure your skates fit properly, or if an apparently proper-fitting pair still hurts, take them to a podiatric physician, who can evaluate the fit and make recommendations to improve both comfort and performance on the ice.

Biomechanics of Skating

Keeping the ankle perpendicular to the ground and straight up and down while skating brings out the best performance. Users of custom orthoses (shoe inserts) should transfer them to skates or buy orthoses especially made for skates to help maintain the best possible position.

Common side-to-side wobbling in the heel area can be remedied with "shims," or pads, in the heel. Shims can also be added to the counter area, or middle of the skate, for a more snug fit.

Problems to Watch For

Frostbite - It's impossible to overstate the importance of understanding symptoms of frostbite. Skin-colour changes, from blue to white, can't be seen in the skate, but if toes are extremely cold for a prolonged period, feel burning or numb, there is a danger of frostbite. People with a history of frostbite often get it again in the same place. Wools socks and new exothermic packs are also effective in keeping the extremities warm and preventing frostbite.

Blisters - Friction in winter sports footwear often causes blisters. Do not pop a small blister, but if it breaks on its own, apply an antiseptic and cover with a sterile bandage. Wearing two pairs of thin socks may help reduce friction.

Neuromas - Enlarged benign growths of nerves between the toes, called neuromas, are caused by friction in tight footwear and can result in pain, burning, tingling or numbness. Neuromas require professional treatment, including an evaluation of skates and boots.

Sprains and strains - The stress of skating can result in sprains and strains of the foot and ankle. They can be treated with rest, ice, compression and elevation (RICE). If pain persists, seek medical attention.

Subungal hematoma - Pressure in the toe box skate can cause bleeding under the toenail known as a subungal hematoma or "blackened toenail." See a podiatrist immediately to help prevent the loss of a toenail.

Bone problems - Bunions and tailor's bunions, bony prominences at the joints on the inside or outside of the foot, often become irritated in skates. Pain at these joints may indicate a need for a wider or better-fitting boot. Other pre-existing conditions, such as hammertoes and Haglund's Deformity (a bump on the back of the heel) can be irritated by an active winter sports regimen. If pain persists, consult a podiatrist. Fractures caused by trauma require immediate medical attention.

Source: B.C. Association of Podiatrists, American Podiatric Medical Association

Running

It is a good idea for a beginning jogger to visit a podiatrist before starting an exercise program. Your podiatrist will examine your feet and identify potential problems, discuss conditioning, recommend the best style of footwear for your feet and, if needed, prescribe an orthotic device that fits into a running shoe.

Frequent joggers ought to see a podiatrist regularly to check for any potential stress on the lower extremities. During a 10-mile run, the feet make 15,000 strikes at a force of three to four times the body's weight.

If you are more than 40 years old, see a family doctor before starting any exercise regimen. The doctor may perform an electrocardiogram, check for any breathing problems, high cholesterol levels, and high blood pressure before giving the go-ahead for a vigorous exercise program.

Anyone, regardless of age, should check with a doctor if a cardiac condition, weight problem, or other medical complication already exists.

To learn more about foot motion and orthotics, watch the Sun Run InTraining TV video clip:
high speed medium speed low speed

Training Tips

Systematic exercises must progress slowly from easy to rigorous to prevent debilitating muscle strain or more serious injury. The best and safest way to start a running program is with a four-day-per-week conditioning program for 12 to16 weeks.

Begin with two sets of two-minute jogs interspersed with five minutes of fast walking. If your muscles are stiff, walk only. Have an "easy day" if you're in pain. As the weeks progress, gradually increase the number of minutes jogged per set to 20 minutes. Spend at least five workouts at each new level attained. To maintain interest, vary the location of your training and bring a friend along.

By the 16th week, you should be able to run two sets of 20 minutes each, with a five-minute walk before, between, and after. Make adjustments for heat and altitude, and don't be frustrated if you think your pace is too slow. Remember, a disciplined regimen will decrease your chances of injury.

Proper foot hygiene can also prevent injuries. Keeping feet powdered and dry is important, especially to the jogger suffering from blisters. Blisters can be prevented by application of petroleum jelly or creams to the feet where they occur or wearing two pairs of running socks.

The Importance of Stretching

Before beginning an exercise regimen, warm-up and proper stretching is essential. If muscles are properly warmed up, the strain on muscles, tendons, and joints is reduced.

Stretching exercises should take five to10 minutes, and ought to be conducted in a stretch-hold-relax pattern without any bouncing or pulling. It is important to stretch the propulsion muscles in the back of the leg and thigh (posterior); do not forget the anterior muscles. Do not forget the all-important stretching after your walk or run as well.

Some effective stretching exercises include:

The wall push-up - Face a wall from three feet away, with feet flat on the floor, and knees locked. Lean into the wall, keeping feet on the floor and hold for 30 seconds as the calf muscle stretches, then relax. Do not bounce. Repeat five times.
The hamstring stretch - Put your foot, with knee straight, locked, on a chair or table. Keep the other leg straight with knee locked. Lower your head toward the knee until the muscles are tight. Hold to a count of 30 then relax. Repeat five times, then switch to the other leg.
Lower back stretch - In a standing position, keep both legs straight, feet spread slightly. Bend over at the waist and attempt to touch the palms of your hands to the floor. Hold the stretch for 30 seconds and repeat.

Proper Footwear

Shoe choice should be determined by weight, foot structure and running regimen. Keep in mind that all shoes have a different shape, and sizes and widths are not uniform from shoe to shoe.

Consider whether an orthotic device will be placed in your shoe, and whether your running style is flat-footed or on the balls of the feet. Shoes should provide cushioning for shock absorption, and ought to be able to fully bend at the ball of the foot area. Visit the shoe store in the afternoon, when the feet are slightly swollen, and wear thick running socks when trying shoes on.

Aches and Pains of Running

Even with the best preparation, aches and pains are an inevitable result of a new jogging regimen. If the pain subsides with slow easy exercise, you may continue, but if it gets worse, stop the activity and rest. If it persists, see your podiatrist.

The most common pain associated with jogging is known as runner's knee, a catch-all for jogging-related knee pain. One of the most common causes of runner's knee is excessive pronation, or rolling in and down, of the foot.
Orthoses (shoe inserts or "orthotics") prescribed by your podiatrist can be an effective way to alleviate the problem. Occasionally, rubber pads in the arch of the shoe may help.

Shin splints, which appear as pain at the front and inside of the leg, are caused by running on hard surfaces, over-striding, muscle imbalance or overuse. Treatment includes changing running technique or insertion of an orthotic device in the shoe.

Winter Running

Dedicated runners hate to give up their passion during the winter months. Remember, however, that muscles take longer to warm up in the cold, and the body is much more susceptible to muscle pull and tear injuries. Proper stretching is essential.

Whether consciously or unconsciously, runners may change their foot-strike pattern to protect themselves, which can lead to muscle strain or other overuse injuries. To increase traction, runners may land on slippery surfaces with the whole foot instead of the natural rolling action of the heel-to-toe strike. Lateral slippage could result in a painful groin pull.

It's best to avoid running on icy areas, but if that's impossible, podiatrists give a qualified endorsement to the use of spikes slipped over running shoes. Spikes, however, have their own problems, so don't use them in winter if you're not familiar with their use on a running track.

Even though your feet are in motion while running, they're still susceptible to frostbite in thin nylon running shoes. Feet will sweat while running, and cold will permeate the thin material, inviting the condition. If shoes are too tight, there is an even greater chance of frostbite.

Problems to Watch For

Sprains and strains - The stress of winter running can result in sprains and strains of the foot and ankle. They can be treated with rest, ice, compression, and elevation (RICE). If pain persists, seek medical attention.

Subungal hematoma - Pressure in the toe box of a running shoe can result in bleeding under the toenail known as a subungal hematoma or "blackened toenail." See a podiatrist to help prevent the loss of a toenail.

Bone problems - Bunions and tailor's bunions, bony prominences at the joints on the inside or outside of the foot, often become irritated. Pain at these joints may indicate a need for a wider or better-fitting shoe. Other pre-existing conditions, such as hammertoes and Haglund's Deformity (a bump on the back of the heel) can be irritated by an active winter sports regimen. If pain persists, consult a podiatrist. Fractures caused by trauma require immediate medical attention.

Source: American Podiatric Medical Association

Skiing & Snowboarding

High speeds attained on skis and snowboards make for exhilarating sports, but expose the body to injuries.
Healthy feet and ankles act together as accelerators, steering, brakes, and shock absorbers in winter sports. Not only are they crucial to success in competition, but they also help keep the body upright and out of the emergency room. Any problems with the foot or ankle could have serious repercussions for winter sports participants.

Preventing Cold Feet

Without warm, dry clothes, any wintertime outdoor activity is a potential health risk. Properly insulated footwear is as important as coats, hats or gloves in the outdoors during the winter.

Socks are also important. Podiatrists recommend a single pair of thick socks or two pairs of thin socks made of a wool blend or acrylic blend fibres that "wick" away moisture caused by perspiration in the boot.

Feet chilled in snow should get back indoors quickly. In sub-freezing temperatures, soaked feet are in immediate danger of frostbite, a serious, painful condition that can result in loss of toes.

Impact Trauma

In skiing, particularly at an intermediate or advanced level, high speeds and force of gravity place tremendous levels of impact trauma on the lower extremities, especially on steep and bumpy runs.

If any pre-existing foot conditions, such as corns, calluses, bunions, or hammertoes are present, see a podiatrist, a specialist of the foot and ankle, for evaluation before buckling up. A medical examination is also important if you have any pre-existing circulatory problems , such as Raynaud's Disease or diabetes.

Before taking to the slopes in cold weather, it's important to loosen up the muscles by stretching. Stretching helps to prevent muscle pulls and tears, and prepares the muscles for the flexing required by the constant "forward lean" stress of skiing and snowboarding.

Ski Boots: Finding the Perfect Fit

Podiatrists specializing in sports medicine say properly fitted ski boots are the single most important factor in safe and successful skiing. Without a snug (but not too tight) and accurate fit, the pressure exerted by the constant forward motion and lateral movement of skiing will surely result in discomfort or injury.

If boots are too loose, toes quickly get irritated in the toe box. If they are too tight, pressure leads to blisters and abrasions that result in a host of painful problems and keep you indoors or, worse, compromise control and lead to an accident.

Tight footwear also may inhibit circulation of the blood vessels of the lower extremities and cause cold feet, which both compromises performance and presents danger in the cold.

Ski boots are available in a forward-entry variety, a rear-entry style for easier entry and more comfort, or "hybrids" that incorporate both designs. Modern systems of cables and buckles make it possible to alter the boots to a near-perfect fit.

If you are not sure your ski boots fit properly, or if an apparently proper-fitting pair still hurts, take them to a podiatrist, who can evaluate the fit and make recommendations to improve both comfort and performance on the ice or slopes.

Cross-Country Skiing

The motion of cross-country skiing is quite distinct from downhill, and involves the entire body.

Cross-country footwear is more like a bicycle shoe than a downhill boot. Bound to the ski only at the ball of the foot, cross-country boots should not irritate the balls of the feet.

As with running in winter, proper stretching is vital before cross-country skiing. In cross-country, the heel goes up and down constantly. Without proper loosening up first, the motion can result in painful Achilles tendinitis and plantar fasciitis, among other problems. A podiatrist can recommend proper stretching exercises.

Biomechanics of Winter Sports

Keeping the ankle perpendicular to the ground and straight up and down while skiing brings out the best performance. Users of custom orthoses (shoe inserts) should transfer them to skis or buy orthoses especially made for their boots to help maintain the best possible position.

Skiers with minor biomechanical imbalances may encounter a frustrating phenomenon known as "edging," in which the ski rolls to the inside or outside edge, inhibiting control going down the slopes.

Ski boots can be "canted" internally to adjust the relationship between the boot and leg. For cases of rolling-in of the foot, or pronation, or rolling-out (supination), caused by flat feet or high arches, cants may be applied directly to the skis or within the boot. This improves edging and enhances performance and control, making the sport safer and more enjoyable.

Ski shop technicians can work in conjunction with podiatrists on specific biomechanical adjustments to improve performance and safety.

Snowboarding

In recent years, skiers have shared the slopes with more snowboards - wide single skis that zigzag down the slopes. The feet are bound perpendicular to the board.
Podiatrists say large, sturdy, insulated snowboard boots flexible enough to accommodate the twisting of the lower body are best to safely control the board. Most popular with young people, snowboarding has become a bona fide alpine sport, and more snowboarders will share the slopes with skiers in the future.

Problems to Watch For

Frostbite - It's impossible to overstate the importance of understanding symptoms of frostbite. Skin-colour changes, from blue to white hues, can't be seen under a boot, but if toes are extremely cold for a prolonged period, feel burning or numb, there is a danger of frostbite. People with a history of frostbite often get it again in the same place. Wool socks are an effective way keep feet warm and dry. New battery-powered heated ski boots or new exothermic packs are also effective in keeping the extremities warm and preventing frostbite.

Source: American Podiatric Medical Association

Soccer

Soccer, which fills huge stadiums the world over, is among the most popular youth sports in Canada. With the increase of soccer athletes, there has been an increase in the frequency of injuries to the foot and ankle.

Soccer requires miles of running - with quick stops and starts - per game. Competition is usually on grass fields, which "give" so players may change direction quickly. It also provides a soft landing surface on which to crash.

The lower extremities - an athlete's steering, accelerator, and braking systems - are particularly susceptible. But with proper conditioning, equipment, and technique, competitors in contact sports have successful, healthy playing seasons.

Podiatrists, specialists in care of the lower extremities, not only treat injuries athletes and get them back into competition as soon as safely possible, but also help athletes get into a condition that minimizes their risk of injury to the foot and ankle.

Preventing 'Overuse' Injuries

The time a soccer player spends in an actual game represents only a tiny fraction of time spent in practice, conditioning for competition. Practice involves hours of running, repetitive drills and scrimmages every day.

While conditioning exercises in practice will strengthen and improve flexibility in the lower extremity, the repeated stress of practice may bring on chronic, or "overuse" injuries. These injuries can nag at a player and hamper, if not end, a season of competition.

Overuse injuries also come from faulty biomechanics of the feet - how the lower extremities physically adjust to the ground. If an athlete has "flat" feet, which tend to pronate (out-toe) or excessively high arches, which often supinate (in-toe), extensive running and cutting can produce chronically strained ankles.

Proper stretching and warm-up before and after workouts, practice and before games go far to prevent overuse injuries to the supporting structures of the lower extremity. Warm-up and cool-down exercises should take five to10 minutes and should be conducted in a stretch/hold/relax pattern, without any bouncing or pulling. When muscles are properly warmed up, the strain on muscles, tendons and joints is reduced.

Making Contact

Though technically soccer is not a contact sport, players of any age will tell you that high-speed collisions, kicks in the shin and body contact happens all the time.
The foot and ankle bear the brunt of the crashes, bumps and bruises of contacts sports. Feet get stepped on, kicked, jammed, twisted, and cut. Quick changes in direction and hard tackling can lead to sprains and fractures of the ankle.

Impact or trauma injuries are more serious than overuse injuries, and require recovery time away from the practice and game field. Immediate treatment should include the "RICE" formula: Rest, Ice, Compression and Elevation.

Trauma injuries should always be treated by a medical professional such as a podiatrist, and be fully healed before returning to the field. Players who lie about how an injury feels, or take pain-killers to play through a trauma injury, are not helping their team by doing so, but rather putting themselves in danger of aggravated or permanent injury.

Footwear

It's important for athletes of all ages to pay careful attention when selecting any type of athletic shoe including soccer cleats. If heel pain or any other type of foot pain is experienced, consulting a podiatrist is recommended. Not only can the podiatrist help you select the proper shoes, but treat any foot problems that may occur.

For adults, cleats are generally a good footwear choice, provided they fit properly. Cleats should be light and flexible. Uppers should be supple and at least a finger's width should separate the tip of the big toe and the end of the shoe. Laces should be tight.

For children, the design of soccer cleats can contribute to injury in young athletes, according to a study published in the journal "The Foot," the official publication of the Journal of the American College of Foot and Ankle Orthopedics and Medicine.

Many children are playing soccer year-round, often three or more times a week. Over time, the frequency of play could put a young soccer player at risk for calcaneal apophysitis (Sever's Disease), the most common cause of heel pain in children between the ages of eight and 16. Sever's Disease results from stress placed on the growth plate of the heel bone. Excessive amounts of running or jumping causes inflammation to the growth plate of the heel bone, which causes pain and limits a young soccer player's ability.

The study found that a soccer shoe doesn't have the same shock absorbency quality as a running shoe. A cleated shoe places the foot in a position where the heel is lower than the toes (it's similar to walking uphill). This causes pressure to be focused on the heel, causing stress that can result in inflammation and pain.

Artificial Turf

Soccer is sometimes played on artificial turf, which presents a new set of concerns for an athlete. Some surfaces simulate the texture of grass, and others are little more than carpet. All forms of artificial surface are harder than grass, and makes for a faster pace of play. Cross-training shoes or sneakers are the footwear of choice on artificial turf.

Because the surfaces do not "give" like grass, playing on them may be more hazardous to the lower extremity. Players should be well familiarized with the dynamics of running and changing direction on "turf" before competing on that surface.

Injuries and Treatments

Keeping the lower extremity healthy is so important to an athlete that most all professional soccer teams have a team podiatrist, who treats minor problems like corns, calluses, and blisters, to major injuries like fractures and dislocations. These are the most common injuries suffered in contact sports:

Heel pain - Calcaneal apophysitis (Sever's Disease), the most common cause of heel pain in children between the ages of eight and 16. Sever's Disease results from stress placed on the growth plate of the heel bone. Excessive amounts of running or jumping causes inflammation to the growth plate of the heel bone, which causes pain and limits a young soccer player's ability.

Ankle sprains - Making contact on a firmly planted ankle can forcibly invert the joint and damage ligaments, resulting in a sprain. Immediate treatment using the RICE formula to reduce swelling is important to quick healing. See a podiatrist for any sprain that doesn't show improvement in three days.

Stress fractures - There are two distinct kinds of fractures that require vastly different treatment. Stress fractures are incomplete cracks in bone caused by overuse. Stress fractures heal with complete rest.

Fractures - Fractures are more serious injuries that require immediate medical attention. Casting and sometimes surgery is required to immobilize fractures and set breaks. Requiring 10 to12 weeks for rehabilitation, a fracture or a break essentially ends the soccer season.

Source: American Podiatric Medical Association

Tennis

It doesn't take a superior athlete to have fun playing tennis, but care must always be taken to avoid injuries to muscles not vigorously exercised off the tennis court.
This is especially true of the foot and ankle, which are put under considerable stress by the continuous side-to-side motion and quick stopping and starting the sport requires. Different court surfaces also stress the foot and ankle in different ways.

Similar racquet sports, such as racquetball, squash, badminton, and paddle tennis, also leave the foot and ankle susceptible to injury. Injuries common to tennis and other racquet sports include ankle sprains, stress fractures, plantar fasciitis, and tennis toe, among others. If they're minor, some of these injuries are self-treatable. But if pain persists, a podiatrist, particularly one specializing in sports medicine, is well equipped to help you get back on the court as quickly as possible.

Don't Forget the Feet

In modern times, maintenance-intensive grass courts have given way to harder, more durable courts. Clay courts and new crushed stone "fast-dry" courts, which duplicate the softness of clay but require less upkeep, are becoming more popular because players can slide on the soft surface. Clay and fast-dry courts are undoubtedly safest to the foot and ankle.

Outdoor courts are often surfaced with asphalt or concrete, and indoor courts with carpet, none of which allow for sliding. It's becoming more popular to coat the harder outdoor courts with a cushioning surface containing rubber granules. While this coating softens the court and slows down the game, it's no more forgiving to the feet than the concrete or asphalt beneath it.

Popularity of the different court surfaces varies geographically, based on rainfall, humidity and the age of most of the players (older players tend to prefer the slower, gentler clay or fast-dry court). Regardless of court surface, proper shoes are crucial to injury prevention.

Shoes should be specifically designed for tennis. Unlike running shoes, proper tennis shoes "give" enough to allow for side-to-side sliding. Running shoes have too much traction and may cause injury to the foot and ankle. In addition, running shoes don't have padded toe boxes, which leads to toe injuries for tennis players.

Heels should be snug-fitting to prevent slipping from side to side, and both heel and toe areas should have adequate cushioning. The arch should provide both soft support, and the toe box should have adequate depth to prevent toenail injuries. Your podiatrist can recommend a shoe that is best for your foot.

Shop for tennis shoes in the afternoon, when the feet swell slightly. Try on several pairs with tennis socks. Put on and lace both shoes and walk around for a minute or two. Make sure your ankles don't roll in the shoes.

If you have bunions or other special considerations, do not buy shoes without consulting a podiatrist. If you already wear prescription orthotic inserts, make sure that any potential new shoe feels comfortable with it in place.

An Ounce of Prevention

It's a good idea to have your feet and ankles evaluated by a professional foot care specialist before taking to the court. Your podiatrist can check for excessive pronation or supination (turning inward or outward of the ankles), and if necessary prescribe a custom orthotic device for insertion in the shoe to correct the imbalance.

Because of the stress on calf and hamstring muscles, thorough stretching before a match can prevent common injuries to the leg. Stretching out after a match alleviates stiff muscles.

Basic stretches such as the hurdler's stretch, the wall push-up and the standing hamstring stretch will loosen up the muscles enough to prevent pulls and other injuries. Your podiatrist can explain how to do these exercises.

Your podiatrist may advise you as to proper nail care and warning signs of nail problems. Feet should always be kept clean and dry. Socks should always be worn - tennis socks made of either acrylic or a blend of acrylic and natural fibres are preferable.

Injuries and Treatment

Injuries on the tennis court range from simple to serious. Some are self-treatable, while others will require professional consultation with a physician. The most common injuries in all racquet sports include:

Ankle sprains - They are the most common of all tennis injuries. Ankle sprains usually occur when the foot turns inward, causing swelling and pain on the outside of the ankle. To self-treat a mild ankle sprain, get weight off the ankle, apply ice to reduce swelling, wrap the ankle in a compression bandage, and elevate the ankle. If the sprain does not improve within three to five days, consult a podiatrist.

Plantar fasciitis - Stress on the bottom of the foot sometimes causes arch pain. The plantar fascia, a supportive, fibrous band of tissue running the length of the foot, becomes inflamed and painful. If arch pain persists, consider investing in better shoes, an over-the-counter support, or see a podiatrist for a custom-made orthotic device to insert into the shoe.

Tennis toe - A subungal hematoma, or tennis toe, occurs when blood accumulates under the nail. Tennis toe can usually be traced to improper shoes, and should be drained by a podiatrist for quicker recovery. For slight build-up, cool compresses and ice will provide relief.

Stress fractures and shin splints - Sometimes the long metatarsal bones behind the toes fracture and swell under the stress, causing severe pain when walking. Shin splints, which are microtears of the anterior calf muscles, and Achilles tendon pulls of the posterior calf muscles, are all treatable with rest, ice, and elevation. These injuries tend to occur on harder court surfaces, and should be healed fully before resuming play. Persistent pain should signal a visit to the podiatrist for consultation.

Corns, calluses and blisters - Such friction injuries are readily self-treatable, yet care should be taken to ensure that self-treatment does not aggravate the problem. When treating corns and calluses , do not try to trim with sharp objects. Instead, buff problem areas with a pumice stone after bathing.

For blisters, pierce the side with a sterilized needle and drain, then apply an antibiotic cream. Do not remove the roof of the blister. Application of a frictionless pad provides relief from blisters.

This Above All

All racquet sports require quick acceleration, twisting, and pivoting, putting the whole body under stress. If you are more than 40 years old, see a general physician before beginning to play tennis or other racquet sports.

Even if you consider yourself generally healthy, ease into a regular schedule of playing time. Whenever you change courts, be sure to get a "feel" for the new surface before serving up a match. Even professional tennis players arrive at tournaments up to a week early to acclimate themselves to the court surface.

Above all, listen to your body. Persistent minor aches and pains are not normal, and will become aggravated if ignored or neglected. Proper care of the whole body, and especially the foot and ankle, will make tennis and other racquet sports a healthy part of life for people of all ages.

Source: American Podiatric Medical Association

Walking

For a healthier, happier lifestyle, try walking - the most popular form of exercise. It's easy, safe and inexpensive. It's also relaxing and at the same time invigorating, requires little athletic skill, and does not call for club membership or special equipment other than sturdy, comfortable shoes.

Race walking is a very specific technique that's used by walkers for both fitness and competition. It has greater aerobic benefits than health walking, since it is faster and increases the heartbeat rate. If you get to the point where you think race walking is for you, there are clubs that can be contacted in most cities.

The results of walking are physically rewarding - a trim, fit body better able to enhance general health and add enjoyable years to your life. But to truly enjoy walking, your feet need to be healthy and free of pain.

Walking Footwear: Comfort and Fit

Choose a good quality, lightweight walking shoe with breathable upper materials, such as leather or nylon mesh. The heel counter should be very firm; the heel should have reduced cushioning to position the heel closer to the ground for walking stability. The front or forefoot area of the shoe should have adequate support and flexibility.

Fit is very important. Go to a reputable store and have both shoes fitted for length and width with the socks you'll be using. Shop late in the afternoon, since your feet do swell enough during the day to affect your shoe size.
Here's what to watch for when fitting your shoes:

Make sure the shoe is snug, but not too tight over the sock.
The shoe should have plenty of room for the toes to move around.
Check on the shoe width; it must comfortably accommodate the width of the ball of your foot.
Make sure you get good arch support.
See that the top of the heel counter of the shoe is properly cushioned and does not bite into the heel or touch the ankle bones.

Your choice of athletic socks is also important. Sports podiatrists frequently recommend appropriately padded socks of acrylic fibre. Your feet have 250,000 sweat glands and can produce four to six ounces of perspiration a day or even more. Acrylic fibres tend to "wick" away excessive perspiration.

Do You Need A Check-up?

If you are free of serious health problems, you can start walking with confidence. Walking is not strenuous; it involves almost no risk to health. You should, of course, exercise good judgment, not exceed the limits of your condition and not walk outdoors during extreme weather periods until you have a good walking program established.

You should, however, consult your family or podiatric physician before you begin a walking regimen. A check-up is suggested, particularly if you are over 60 years old, have a disease or disability or are taking medication. It is also recommended for those who are 35 to 60, substantially overweight, easily fatigued, excessive smokers or have been physically inactive.

One of your physicians will help you determine your proper walking heart rate. Heart rate is widely accepted as a good method for measuring intensity during walking and other physical activities. The formula says that subtracting your age from the number 220 yields your maximum heart rate (beats per minute), and that the proper walking rate is 60 to 70 per cent of that number. For a 50-year-old, that's 220 minus 50 equals 170; 60 per cent of that is 102 and 70 per cent is 119. Other factors should be considered, though; a physician's advice is the best indicator of your correct rate.

You are now ready to begin a walking program. It is a prescription for a healthier, happier life.

Walking: There's an Art to It

Before you start walking, some simple warm-up exercises - but not strenuous, advanced stretching - can give your muscles added flexibility. Body twists at the waist, in a slow hula-hoop motion, and a few toe-touching or knee-bend exercises are appropriate. When you're ready to begin, the best way to start is walking 20 uninterrupted minutes at least three times a week. Walk at a comfortable pace, slowing down if you find yourself breathing heavily. Don't tire yourself. If 20 minutes is too much, cut back to 10 or 15 minutes. You can gradually increase your time and pace as your body adapts to the exercise.

There are several ways to measure your pace. One is to walk on routes that you have pre-measured with your car's odometer. Perhaps the simplest is to use a wristwatch. Count the number of steps you take in a 15-second period; if you're taking 15 in that time, you're walking about two miles an hour. At about 23, you're probably going three miles an hour, and at 30, the pace is close to four miles an hour.

You may want to keep an activity log, in which you jot down the dates, times, and estimated distances of your walks, plus other notes, such as routes, milestones and incidental experiences.

Some Walking Tips:

Move at a steady pace, brisk enough to make your heart beat faster. Breathe more deeply.
Walk with your head erect, back straight and abdomen flat. Keep your legs out front and your knees slightly bent.
Swing your arms freely at your sides.
As you walk, land on the heel of your foot and roll forward to push off on the ball of your foot.
At least at the beginning, confine your walks to level stretches of flat surfaces, avoiding excessively steep hills and embanked roadways.
If you're walking in the evening, be sure to wear clothing with reflective material sewn in, or otherwise attached.
Cool down after a long, brisk walk to help pump blood back up from your legs to where it's needed. Here's where some stretching exercises can be helpful. A good one is standing about three feet from a wall, with your hands flat on the wall. Then take five or six small steps backward, maintaining your hand contact with the wall. Repeat the exercise five to 10 times.

The Benefits of Walking

For those with a long history of inactivity, problems with obesity, or who just don't like strenuous activity, walking is an excellent way to begin an exercise program. You can start slowly, then increase your speed and maintain a steady pace. A good conditioning program begins with moderation and dedication.
Podiatric and family physicians recommend walking to ease or ward off a number of physically related ills. Walking can help you:

Strengthen your heart and lungs, and improve circulation.
Prevent heart attacks and strokes.
Reduce obesity and high blood pressure.
Boost your metabolic rate.
Favourably alter your cholesterol.
Improve muscle tone in your legs and abdomen.
Reduce stress and tension.
Reduce arthritis pain; stop bone tissue decay.

However, you may experience some problems with your feet.

Injuries and Treatment

Every day, podiatrists hear of people who have been "putting up with" foot pain, thinking it is normal. Your feet should not hurt and walking should not be painful.
Here some of the most common complaints of foot pain and their causes. Foot pain that is persistent indicates a need to seek treatment from a podiatrist.

Blisters - Friction in footwear often causes blisters. Do not pop a small blister, but if it breaks on its own, apply an antiseptic and cover with a sterile bandage.

Bone problems - Bunions, bony prominences at the joints on the inside or outside of the foot, often become irritated by narrow shoes. Pain at these joints may indicate a need for a wider or better-fitting shoe. Other pre-existing conditions, such as hammertoes and Haglund's Deformity (a bump on the back of the heel) can be irritated by an active walking regimen. If pain persists, consult a podiatrist.

Sprains and strains - Walking on uneven terrain can result in sprains and strains of the foot and ankle. They can be treated with rest, ice, compression, and elevation (RICE). If pain persists, seek medical attention.

Source: American Podiatric Medical Association

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