Pain Relief For Tennis Players
Is a foot or ankle injury stopping you from playing tennis as much as you would like?
When was the last time you played a full game of tennis without pain?
It does not matter if you are Serena Williams, Raphael Nadal, or just a weekend warrior, everyone who plays tennis is equally prone to injury.
Wearing the proper shoes for tennis is extremely important. The movement in tennis is in all directions: forward, back, and side to side with sudden stops and starts. At higher levels there will also be lots of running and jumping. Court shoes are made with a lateral forefoot phlange to keep you from rolling the ankle laterally.
As I enumerate the most common foot injuries seen in tennis players below; please notice one recurring theme – Custom Molded Orthotics. I would suggest that about 95% of the population would benefit from the proper support that a custom insert can offer. Custom molded orthotics can both prevent and heal most foot ailments. If you have never had them, or have and did not like them, you should consider having a check up to see if this custom made device is the training equipment you lack so that you can achieve your goals and avoid injury.
The Achilles’ tendon is what attaches your calf muscles to the back of your heel and is responsible for extending the ankle and allow your foot to “push off” to propel you forward. This tendon can become inflamed and irritated due to the stress of many sudden stops and starts, weak calf muscles, or tightness in the heel cord. It is most common in low arched individuals, but the high arched can be affected as well. Rest, ice, stretching and anti-inflammatory medications will be necessary to treat the pain. In more severe cases immobilization may be necessary. The key is recognizing there is a problem and not trying to play through it. Once the tendon is healed, preventing re-injury is important and will include stretching the calf muscles before and after tennis along with the proper court shoe.
This is by far the most common complaint in active people. The plantar fascia is a band of tissue that originates at the bottom of the heel fans out across the arch and connects to the base of each toe. The most common pain site is on the inside of the bottom of the heel in the flat footed and in the arch area of the high arched foot type. This is an overuse syndrome that can be brought on by any impact sport such as tennis and is usually progressive. Often x-rays will show a “spur” of bone on the bottom of the heel that reactively grows into the plantar fascia as a result of chronic tension. Treatment revolves around, rest, ice, stretching and, most importantly, custom molded orthotics to properly support the ligament to prevent it from collapsing and pulling on the heel bone.
This problem is specific to children. The calcaneal apophysis is one of the growth centers in the heel bone. The achilles’ tendon inserts on the back of this growth center and the plantar fascia along with many intrinsic foot muscles, insert on the bottom. The two opposing forces can torque the bone resulting in pain and inflammation. This condition is self-limiting as it will resolve when the growth centers finally fuse. If you do not want your child to have to wait that long, I suggest stretching exercises for the achilles’ and plantar fascia, anti-inflammatories, and-wait for it- custom molded orthotics! The orthotics will cushion the heel and support the arch to help neutralize the opposing forces.
There are two muscles on the outside of the leg called the Peroneals which have tendons that run behind the ankle and insert on the midfoot. They are responsible for everting the foot and protecting the ankle against sprains. For this reason these tendons and the bones they are attached to are commonly also injured in severe ankle sprains. When the injury is isolated to the peroneus brevis you will have pain on the outside of the foot- just below and in front of the ankle bone. Overuse and acute trauma such is seen in ankle sprains are the main cause of injury. Athlete’s with high arches are more prone to peroneal problems as lateral instability is inherent in this foot type. Immobilization, ice, and anti-inflammatory therapy will reduce symptoms. Preventing overuse in future can be attained with custom molded orthotics to relieve the stress on the tendons.
A stress fracture is a small crack in the bone that is the result of a low grade repetitive trauma. This occurs due to the shape of the foot and the way that it functions. It cannot be detected on x-ray until it starts to heal-about 2 weeks after the initial pain begins. A stress fracture can happen in any bone of the foot, but the metatarsals are the most common culprits. Rest and off-loading for 6-8 weeks is necessary to keep a stress fracture from becoming a frank fracture, which may require surgical correction. Once the bone is healed and the pain subsides, custom molded orthotics will be needed to remove pressure from the affected bone(s) and prevent re-injury in the future.
The frequent stops, starts, changes of direction, running backward, sideways, and jumping in tennis game play guarantee lots of opportunities for ankle sprains. There are 3 ligaments on the outside of the ankle and one big one on the inside that can be injured with sudden turning in our out of the foot along with internal or external rotation of the leg. Sprains are graded as to severity 1-3 with one being mild and 3 being severe. Sprains can take longer to heal than fractures because the soft tissue around the ankle is very prone to re-injury while healing and because most people don’t consider it to be as serious and try to do too much too soon. Rest, ice, and anti-inflammatory therapy is required for all 3 grades. Immobilization may also be necessary in Grades 2 and 3 along with physical therapy to re-train the ligaments to protect the ankle from re-injury. Ankle bracing will be needed when returning to physical activity which should be started low and slow. Proper court shoes with custom molded orthotics can help prevent further injury.
Underneath the base of your big toe are two small round bones encased in flexor tendons that help stabilize the toe when it is flexed. As tennis players we spend the majority of time on our toes to be ready to move in any direction quickly. Too much stress in the big toe joint can cause inflammation in or around one or both of these bones. Rest, ice, an anti-inflammatories and off-loading the painful area will help relieve the pain. Custom molded orthotics to prevent excessive pressure on under the big toe joint will prevent recurrence of the problem.
The same on your toes ready positon that can lead to sesamoiditis can also lead to an inflamed nerve between your toes called a neuroma. This occurs due to pressure and mechanical trauma to the sensory nerves in the forefoot which will manifest as numbness, tingling, sharp or burning pain. Treatment of this condition may require a series of injections to “shrink” the nerve if the condition is chronic. Acute neuroma may respond to one or more cortisone injections. Whether acute or chronic, custom molded orthotics will be necessary to reduce pressure on the forefoot and prevent recurrence.
Peroneal tendonitis is most common in the high arched folk, posterior tendonitis is most common in the flatfoot folk. The PT tendon originates from a muscle on the back of the leg whose tendon coursed around the inside of the ankle and inserts on the medial midfoot and nearly every bone on the bottom of the foot. This tendon is responsible for inversion of the foot and stabilization during push off forward. If you are flatfooted this tendon is already stretched tight and can be easily injured. Once you have developed medial foot or ankle pain rest, ice, and anti-inflammatories are in order. Depending on the severity temporary use of an ankle foot orthotics may be necessary. Once you have achieved and pain free state, custom molded orthotics will be instrumental to keeping you there!
Now that you know what awaits for you out on court, I cannot stress enough how important it is to wear shoes designed for court sports to reduce your chances of injury. In addition, the protection of a carefully prescribed pair of custom molded orthtoics can help prevent problems before they start.
From a self-professed tennis enthusiast, addict, and obsessive……..I would do anything to prevent an injury that could keep me off the court. If you have a small recurrent nagging pain that bothers you on and off this is the perfect time for a foot evaluation to prevent a severe or chronic problem.
The podiatrists at the Beltsville Foot and Ankle Center specialize in diagnosing and treating sports injuries of the foot and ankle. After treating thousands of patients they know how to get you back to playing pain free as quickly as possible.
Don’t wait until it gets worse. Our schedule fills up very quickly, contact us today to schedule your appointment to have a professional sports injury exam.
Same day appointments are available. Please call 301-937-5666 to make an appointment. If you have any questions at all please feel free to contact us on 301-937-5666 as we are here to help.
