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Soccer season: Prime time for foot, ankle injuries

Soccer season is in full swing and the Podiatrists at strongly urges parents and coaches to think twice before coaxing young, injury-prone soccer players to "play through" foot and ankle pain.

Skeletally immature kids, starting and stopping and moving side to side on cleats that are little more than moccasins with spikes -- that's a recipe for foot and ankle sprains and worse, cautions Dr. Mike Daniels, a member of the American College of Foot and Ankle Surgeons.

Kids will play with lingering, nagging heel pain that, upon testing, turns out to be a stress fracture that neither they, their parents, nor their coaches were aware. By playing with pain, they can't give their team 100 percent and make their injuries worse, which prolongs their time out of soccer and other activities.

In extreme circumstances, we have actually had to show parents x-rays of fractures before they'll take their kids out of the game. Stress fractures can be subtle -- they don't always show up on initial x-rays, and it is unlikely that the pain will just go away.

Symptoms of stress fractures include: pain during normal activity and when touching the area, swelling without bruising, or an inability to do a particular activity, like standing on your tiptoes, or running.. Treatment usually involves rest and sometimes casting.  Some stress fractures heal poorly and require surgery, such as a break in the elongated bone near the little toe, known as a Jones fracture.

Soccer is a very popular sport in our community, but the constant running associated with it places excessive stress on a developing foot. The pain from overuse usually stems from inflammation, such as around the growth plate of the heel bone, more so than a stress fracture. Growth plates in kids are still open, and bones continue to grow and mature until they're about 13 to 16.  Rest, ice, and in some cases, immobilization of the foot should relieve that inflammation.

Other types of overuse injuries are Achilles tendonitis and plantar fasciitis (heel pain caused by inflammation of the tissue extending from the heel to the toes).

Quick, out-of-nowhere ankle sprains are also common to soccer players. Ankle sprains should be evaluated by a physician to assess the extent of the injury. If the ankle stays swollen for days, and is painful to walk or even stand on, it could be a fracture.

Collisions between soccer players take their toll on toes. When two feet are coming at the ball simultaneously, that ball turns into cement block and goes nowhere. The weakest point in that transaction is usually a foot, with broken toes a possible outcome. The toes can swell up so much, that  the player can't get a shoe on, which is a good sign for young athletes and their parents:  If they are having trouble just getting a shoe on, they shouldn't play.

The podiatrists at offer these suggestions as the fall sports season starts:

1. Have old sprains checked by a doctor before the season starts. A medical check-up can reveal whether your child's previously injured ankle might be vulnerable to sprains, and could possibly benefit from wearing a supportive ankle brace during competition.

2. Buy the right shoe for the sport. Different sports require different shoe gear. Players shouldn't mix baseball cleats with football shoes.

3. Children should start the season with new shoes. Old shoes can wear down like a car tire and become uneven on the bottom, causing the ankle to tilt because the foot can't lie flat.

4. Check playing fields for dips, divots and holes. Most sports-related ankle sprains are caused by jumping and running on uneven surfaces. That's why some surgeons recommend parents walk the field, especially when children compete in non-professional settings like public parks, for spots that could catch a player's foot and throw them to the ground. Alert coaching officials to any irregularities.

5. Encourage stretching and warm-up exercises. Calf stretches and light jogging before competition helps warm up ligaments and blood vessels, reducing the risk for ankle injuries.

6. What seems like a sprain is not always a sprain; in addition to cartilage injuries, your son or daughter might have injured other bones in the foot without knowing it. Have a qualified doctor examine the injury. The sooner rehabilitation starts, the sooner we can prevent long-term problems like instability or arthritis, and the sooner your child can get back into competition.

For further information about various foot conditions, contact Drs. Daniels, Felton, Curione and Matthews at (410) 363-4343 or visit, for more information.

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