FOOT ISSUES – Not to be taken lightly – They can be the root cause of other injuries.

Foot issues are a common issue in athletes.  Over the course of my career I have seen and treated many foot issues among recreational athletes (people who enjoy walking for exercise to MVP professional athletes).  The various types of issues are not to be taken lightly.  These issues can sideline you for quite some time and make everyday movement a nightmare.  As an equestrian for most of my life, there is a fundamental rule when buying a horse:  First check the feet.  If a horse doesn’t have good feet, walk away.  Poor feet can lead to many issues and correcting those issues can be costly and time consuming.  Below are a few examples of foot issues/injuries I have had to treat & and how they have affected my client’s ability to perform in sport.  You will see below how foot problems can be the root cause of other injuries.

Client #1:  A middle age woman who is a concert pianist who enjoys hiking.  For approximately three years Client #1 suffered from right foot pain, diagnosed as Plantar Fasciitis.  Her desire to continue to hike lead her in many directions from investing in various over the counter insoles and walking/hiking shoes, to Chiropractic, P.T. and acupuncture appointments.  I was her last resort.  Although initially very skeptical as to my treatment she had run the gamut on rehab.  I explained that foot issues especially Plantar Fasciitis can especially be a lengthy recovery period because the feet never stop working.  Also, given her occupation of playing the piano and using the sustaining pedal (which is the most commonly used piano pedal) over time and since childhood, resulted in her Chronic Plantar Fasciitis.  Treating soft-tissue that has had 40 to 50 years of repetitive use was going to take time and progress would be slow.  Reluctantly, she accepted my candor.  I treated her 1 to 2 times per week for 30 minutes each session Applying Deep Trigger Point Therapy and myofascial release, along with cryotherapy and sometimes using Recovery Pump Compression Boots (see website: https://www.backinmotion.info/recoverypump/ ) application.  Her homework was:  To elevate her feet while sleeping, resting, apply Ice after walking/working, keep her feet in comfortable/supportive shoes (no flip flops or open backed shoes) when moving about, and not to allow pain to rise above a “5” on a 1 to 10 pain scale – take an anti-inflammatory.  After 3 to 4 months her average pain level began to drop noticeably.  We reduced her appointments to once every 10 days and she gradually began to increase her recreational walking while still maintaining her busy work schedule.  By the end of 7 to 8 months I was seeing her for a 30-minute session once every 2 to 3 months.  The following year I may have seen her 3 times. Now we have either an annual or bi-annual appointment.  Her at “homework” regime is not as diligent but she still maintains self-care modalities.

More serious athletes have greater risk involved with Foot Injuries – In fact they can lead to sidelining a career if not permanently than certainly for an extensive time. High performance athletes then face the following:  Lengthy Recovery followed by Rebuilding their Career.

Client #2:  A 24-year-old Professional Squash Player currently ranked 8th in the world.  Shortly after the start of her 2nd full year of Professional competition as the highest-ranking US Squash Player in history, Amanda Sobhy returned from France with a sharp specific pain in her right foot.  Diagnosed as a 30% tear of her plantar muscle, Amanda was looking at some down time before mid-January 2017 when the Tournament of Champions in NY would kick off.  In 2016 Amanda lost in the final round of the ToC, but her 2nd place finish catapulted her to then a career high of 7th place on the PSA (Professional Squash Association) world ranking.  Advice from her support staff was mixed as to what her strategy should be for competing in January and the months following.  With her drive and love for her sport Amanda took some time to rehab her right foot before the ToC.  As often is the case recovery interrupts training and Amanda’s rise to the finals in the 2017 ToC fell short of her victory in 2016.  Amanda lost in the round of 16.  Not deterred by her defeat Amanda pushed onward to the Windy City Tournament where she lost out in the quarterfinals to the eventual winner.  With a 10 day break she preceded to Columbia for her next PSA tournament where she was the top seed.  On March 10th, while playing in the semi-finals and match ball up – victory just moments away – IT HAPPENED!   Lunging for a shot, Amanda tore her left Achilles.  Searing pain resonated through her leg and foot as she screamed in anguish.  Just as Jim McKay use to narrate the opening segment of Wild World of Sports with his famous phrase.  “The Thrill of Victory and the AGONY of defeat”.  Years of passion, dedication, training, travel and competing came crashing down on a court in the Ciudad de Floridablanca Open.  Amanda was about to embark on a journey which no athlete is prepared for.  Surgery and Rehab would become her new career for many months to follow.  So why did it happen?  This is a question, I as a Rehab Therapist ask.  In Amanda’s case, my professional opinion is:  Amanda’s right foot, (30% Plantar tear) 5 months earlier lead to her left Achilles Snap Tear. Our human machine is designed to compensate for issues.  One side, of our body, takes on more stress and weight bearing load when there is an injury on the other side (right vs. left).  Amanda is a lefty.  Her left foot is her dominate lead foot when playing squash.  This means, it already is actively working harder during sport.  Adding more demand to her dominate left foot due to a Plantar weakness in her right added a greater load to her left Achilles and it held up for 5 months from France in November – 16’ to Columbia in March of 2017.  The human heal sustains 3X the amount of your body weight when it hits the ground.  In the forefoot phase of movement … the force increases to between 4 and 7 times body weight.  A 150-lb. athlete can be called upon to support a weight of 1000 lbs., It’s at this force that an Achilles ruptures.  Therefore, during a typical day, the feet endure a cumulative force of several hundred tons.  Add the complex and aggressive motion of sport, it is simply amazing what our feet can do.  I am happy to report that Amanda is now 14 weeks post-surgery and she has just begun wearing two shoes, a transition from a splint, cast & walking boot.  Her Physical Therapy is ongoing.  To follow Amanda’s progress back to the Squash Courts, go to: www.amandasobhy.com

Amanda Sobhy and Me

Client #3:  Was a member of the Harvard Men’s Tennis team.  I provide Therapeutic/Sports Massage to members of the team when they have muscular issues/fatigue.  This past season the #1 player Sebastian was diagnosed with a left foot plantar facia strain which occurred during a match in February 17’.  He simply took a bad step and the result sidelined him from practice & play for 3 weeks.  When Seb’s issue was brought to my attention he was days away from leaving for California for training and the Mission Valley Spring Classic.  Seb was itching to play in the Classic, as a senior and Co-Captain this was his last year of Intercollegiate sport.  Being the #1 player on the team, his participation was critical.  When a high ranked team member can’t play due to injury, all other team members must move up in ranking.  As a result, all are playing an opponent above their skill level. This fact increased the risk for injury for all team members.  As seen in Amanda Sobhy’s case, I was concerned for Seb’s wellness.  Seb’s left foot is his serving landing foot and his plantar strain will cause a greater stress load on the rest of his body, not to mention risking further injury to his foot.  I had to find a way to minimize the load on his injured foot, which would permit him to play.  I called my neighbor/business partner Dr. Richard Vallon.

Custom made Orthopedic Plantar Pad used by Sebastian to disperse pain in Plantar muscle

Dr. Vallon is an Orthopedic Podiatrists.  After examining Seb’s foot extensively, Dr. Vallon devised a custom orthopedic pad which would be secured in his tennis sneaker.  The pad dispersed his pain from the specific injury site allowing Seb to play tennis with minimal to no pain during the West Coast tournaments.  After trying the foot pad the day before leaving for California, all seemed well and Seb was happy he would be able to play.  In his first singles match (in a month) during the Mission Valley tournament in San Diego, Sebastian lost.  After that match, his right shoulder was difficult to lift.  In fact, for the rest of the trip Sebastian served underhanded do to the discomfort and weakness in his right shoulder.  When he returned to Harvard he was examined and given an MRI to determine his injury.  The finding was a “Right Bicep Tear” which would require surgery.  His left plantar muscle strain along with 3 weeks of not serving prior to west coast trip was the catalyst for the Bicep tear.  As stated above in Amanda Sobhy’s case:  Our human machine is designed to compensate for issues.  One side, of our body, takes on more stress and weight bearing load when there is an injury on the other side. In Sebastian’s case, his Left foot injury lead to Right Bicep tear.  At this point, I was upset that Sebastian was injured for the remainder of his season, especially because it was his last year of college tennis.  But to my surprise Sebastian wanted to finish playing out the season for a few reasons:  1.  He was never going to play tennis at this level again.  2.  His shoulder pain was not so high.  He could hit by keeping the elevation of his arm under 90 degrees.  He could not serve overhand, he could only serve underhanded, this fact did not give him any personal strategic advantage when playing in a singles match – he mainly wanted to play for his teammates.  3.  As Co-Captain he did not want to put the burden of competition on his team mates for the rest of the season and especially during the Ivy’s which was fast approaching.  All these reasons increased his risk of injuring his shoulder even more which could lead to him needing immediate surgery.  But after weighing all factors, Sebastian decided to take a personal risk to push forward and play the remainder of the season.  He desperately wanted to help his team do the best they could do in the Ivy Championships.  Harvard Men’s 2016-2017 team entered the Ivy’s in 7th place out of 8 teams.  Sebastian lost all matches as the #1 single player on the team.  However, as the self-imposed “Sacrificial Lamb” his team mates rallied.  In the end, Harvard tied Columbia and Cornell for the 2017 Ivy Championship.  The Thrill of Victory (for all) because of (Sebastian’s personal) Agony of Defeat!