Common Podiatric Sports Injuries and Their Treatments: An Alternative Medical Perspective

By Steven L. Rosenberg
|  Tuesday, Jun 30, 2009  |  Updated 6:38 PM EDT
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Today, alternative medicine is becoming another treatment option in many medical specialties including podiatric medicine. Patients are now accepting and incorporating nontraditional types of treatment from doctors as part of their overall treatment plan. There is more information available to patients through newspaper and magazine articles, books, Web sites, television specials, and medical news coverage. Since alternative medical information is so readily available, patients are now beginning to ask doctors, "How about this remedy," or "Have you ever heard of this herb?" or "Will this supplement now being advertised help my problem?"

Patients are also more active today and exercise has become a way of life for them. They are now participating in all types of sports, and therefore, the chances of injury have definitely increased. When you consider the types of people getting injured, everyone from teenagers to weekend warriors, competitive athletes, or anyone who exercises, fits into that category.

A podiatrist is a foot specialist who plays a very important role in evaluating and treating lower leg and foot injuries. Podiatrists watch the way patients walk, evaluate the uneven wear patterns on the soles of their shoes, look at the funny lumps and bumps on their feet and explain why those things happen. They take into consideration their patients predisposed hereditary factors, structural variations in the lower extremity, abnormal foot biomechanics, muscle imbalances, and external factors such as shoes and non shock-absorbing floor surfaces, which enables the doctor to make the appropriate diagnosis. Patients are then given treatment options on the various types of modalities available, which could be surgical, nonsurgical, or an alternative medical way of treating the problem.

Treatment Options
Homeopathy is a system of medicine using pharmaceuticals manufactured according to homeopathic standards. The remedies are designed to stimulate the body's own regulation and defense system in case of acute chronic disorders. Homotoxicology is a bridge between classical homeopathy and conventional pharmacy using complex homeopathic medications to treat conventionally diagnosed conditions. There are many benefits using alternative medicine such as homeopathy. There is an extremely low incidence of side effects, apparent non-drug interactions, and they usually cost less than allopathic drugs. They are patient-friendly and can be found in tablet, liquid, or injectable forms. So, when a patient walks into his or her podiatrist's or doctor's office because of a sports-related injury, alternative therapeutic medical treatments can now be in the patient's overall medical treatment game plan.

The Anatomy of an Injury
Injuries can occur when the soft tissue in a specific area of the body is unable to stabilize unstable bony segments (e.g., joints) during exercise. The contributing factors that can cause exercisers to injure themselves are poor technique, fatigue, structural variation, repetitive stress—which causes an overuse-type injury—and muscle imbalances in the body due to an over-exaggeration of one particular exercise movement or sport. When you factor in the wrong exercise shoes for that activity as well as hard, unyielding floor surfaces such as concrete, injuries can occur easily.

When an injury occurs during exercise, a sharp acute pain sensation is initially followed by an inflammatory response phase (swelling). The purpose of the inflammatory response phase in injured tissue such as muscles, tendons, ligaments, and bones, is to remove damaged, dead, or unwanted cellular debris from that injured body part and repair the defect. If the injury is minor, the patient will usually experience self-recovery within two to three days and will be back exercising very quickly. However, when the injury continues to linger and appears chronic, patients will experience constant pain during or after their workouts. Chronic pain is much more difficult to treat because many patients typically ignore the pain and continue to participate in their exercise activity without seeking timely medical treatment, hoping the pain goes away on its own.

Common Sports and Exercise Injuries
The more common types of sports- and exercise-related injuries that podiatrists see in their offices are ankle sprains, shin splints, muscle strain, lower leg and feet tendonitis, plantar fasciitis, which is an injury to the long plantar ligament in the medial longitudinal arch of the foot, and stress fractures.

Ankle sprains
A 45-year-old female visited my office with a severely sprained left ankle after falling off a horse. The patient stated that while riding her horse on a sandy trail, the horse all of a sudden became spooked and began to gallop out of control. She was not able to control the horse and decided to bail out because she began to fear for her life. She could not recall exactly how the injury occurred, but thinks she caught her left foot and ankle in the stirrup, which caused her ankle to twist when she hit the ground. She immediately experienced severe pain in the ankle, which began to swell at once. She immediately put ice on that ankle and contacted my office to make an appointment.

She arrived at my office with a severely swollen and bruised (ecchymotic) left ankle. There was significant pain upon palpation over both the top and bottom of the left ankle. The pain and swelling corresponded to the ligaments that support the ankle joint.

The patient's biomechanical exam revealed pain when the left foot was bent upward. There was also slight pain with resistance to turning the foot inward and turning it outward. The patient had difficulty walking because putting weight on her left foot was extremely difficult.

X-ray views of the patient's left ankle were negative for fractures. My diagnosis: first-degree left ankle inversion sprain with minor tears in the lateral ligament structures.

The ankle sprain was treated with multiple subcutaneous injections of Traumeel, which is a natural anti-inflammatory agent, plus 0.5 cc plain Lidocaine, which is a pain reliever, into the painful soft tissue sites around the ankle. I applied an Unna boot, which is a zinc-impregnated soft gauze material used to form a soft immobilization cast, to the left ankle for stability and to provide constant equal compression to help reduce the soft tissue swelling. The patient recovered from the ankle injury very quickly because of this type of aggressive treatment.

Shin splints
Shin splints are generally considered an overuse injury, caused by excessive repetitive movements such as running, aerobics, and racquet and court sports performed on hard unyielding floor surfaces. Often times, shin splints occur because the exerciser does too much too soon, too quickly, and the lower leg muscles are microscopically pulled away from the bony attachments on the tibia (the bone in the lower leg). The pain will worsen during exercise, and even normal daily activities such as walking can be painful.

Shin splints are most commonly found in the posterior compartment of the back of the lower leg, which are known as the flexor group muscles. The function of this muscle group that includes tibialis posterior muscle, is to maintain the arch of the foot and decelerate pronation, which is the flattening out of the arch of the foot. The second most common type of shin splints is found in the anterior compartment, which is the front part of the lower leg . The muscles involved in the anterior compartment are known as the extensor group muscles. The function of the muscle group, such as the tibialis anterior, is to bend the foot forward at the ankle joint and prevents the foot from flattening out when the heel hits the ground.

Muscle strain
Exercisers frequently strain their lower leg and foot muscles during rapid movement sports such as tennis, basketball, racquetball, running, and sprinting. A muscle strain is defined as either a partial or total tear of muscle fibers in the muscle itself, or the musculotendinous junction of the muscle, or the origin of the muscle. Improper and inadequate warm-up and stretching are some of the contributing factors to this type of injury.

Tendonitis
Tendon injuries are another common type of ankle and foot problem, which results in the exerciser seeking medical attention because of persistent pain. Tendonitis is defined as an inflammation of the tendons and presents with symptoms of pain, redness, heat, and swelling along the course of the tendon as it crosses the ankle joint and inserts into the bones of the foot.

In sports, a tendonitis injury is usually the result of abnormal foot biomechanics, excessive foot pronation, which is the tendency of the arch of the foot to flatten out, and a history of overuse in a specific sports activity, which requires continuous high impact repetitive movements. The injury occurs when there is an accumulation of microtrauma in the tendon, which weakens and breaks down the tendon tissue, eventually causing pain and inflammation. The Achilles, peroneal, tibialis anterior and tibialis posterior tendons in the foot and ankle are most commonly involved in this type of injury.

Plantar fasciitis
Plantar fasciitis is also a common foot problem experienced by exercisers. The cause for this is similar to the ones previously discussed, such as overuses, abnormal foot biomechanics, and pronation. It can be part of a developing heel spur formation or localized to the medial slip of the plantar fascia in the medial longitudinal arch of the foot. The exerciser will initially feel a sharp pain localized in the heel and arch of their foot when they take their first step in the morning. The pain will ease as the exerciser starts to move and the plantar fascia and the muscles begin to stretch. X-Rays taken of the painful foot may or may not show any abnormal bone pathology such as a heel spur. The diagnosis is often times made from the patient's sports activity that requires them to be on the balls of their feet, such as aerobics, ballet, running/sprinting, and clinical evaluations. The treatment for this foot problem is usually conservative. However, surgical intervention is sometimes required.

Stress fractures
Stress fractures are another example of an overuse injury and can occur in the bones of the lower legs and feet. A stress fracture is due to microscopic cracks in the bones caused by an accumulation of small amounts of repetitive stress and microtrauma. Localized pain, swelling and redness is present in the affected areas.

In the lower leg, the tibia and fibula can be affected. The tibia, found in the lower leg, is most commonly affected. In the feet, the second and third metatarsal bones (long, narrow bones) and sesamoid bones, which are two small bones found underneath the ball of the foot, are most commonly involved. The predisposing factors for an injury like this to occur are abnormal foot biomechanics and pronation, hard unyielding floor surfaces and repetitive high intensity movements that put an increased impact load on the exercisers feet and legs over a prolonged period of time.

The treatment for this problem is usually a flat nonflexible wooden shoe, a foot cast or a below-knee walking cast. It will take approximately six weeks for a stress fracture to heal.

Traditional to Homeopathic Treatment Options
Anyone who exercises is vulnerable to getting injured. Exercisers and their podiatrist have many treatment options now available to them. They range from the traditional RICE protocol (rest, ice, compression, and elevation) and treatment modalities such as injection therapy, physical therapy anti-inflammation medications, functional foot orthotics, and possibly surgical intervention, to alternative medical treatments incorporating homeopathy and homotoxicology.

Homeopathy
Homeopathy is a system of medicine using microscopic amounts of plants, animals, and minerals to make remedies that are manufactured by homeopathic standards and guidelines. The remedies have been approved as safe and nontoxic medicine by the FDA since 1938. Approximately 75 percent of remedies come from botanical sources. They are designed to stimulate the body's own immune response defense and repair systems, for acute and chronic medical problems, as well as for sports injuries. Homeopathy treats patient's ailments and symptoms simultaneously using "The Law of Similarity"—"like cures like." An example of The Law of Similarity is a flu vaccine. People receive a flu vaccine to prevent the flu. The flu vaccine has small doses of flu in it and your body actually develops resistance to a particular strain.

Homotoxicology
Homotoxicology can be defined as a bridge between homeopathy and traditional pharmaceutical medicine using a combination of complex homeopathic remedies in tablet or liquid form to treat traditionally diagnosed medical conditions.

There are many benefits to using alternative medicine such as homeopathy. There is an extremely low incidence of side effects, and they usually cost less than prescription drugs. They are patient-friendly and can be found in tablet, liquid, or injectable forms. The tablets can be taken by placing them under the tongue and allowing them to dissolve naturally. They can also be crushed and dissolved in liquids. The liquid remedies can be taken by placing six to ten drops underneath the tongue or in an eight-ounce glass of juice or water.

The homeopathic remedies I traditionally use in my office for sports injuries in the lower extremity are:

  • Traumeel: a natural anti-inflammatory agent. This remedy is indicated for injuries of all kinds such as shin splints and ankle sprains that cause pain and swelling of the injured soft tissue. It is the aspirin and Tylenol of homeopathy. Some of the ingredients in Traumeel are:
    • Arnica, which stimulates the healing of wounds, fractures, dislocations, nerve injuries.
    • Calendula helps promote wound healing.
    • Chamomilla is an anti-inflammatory agent and promotes healing of wounds and ulcers.
    • Echinacea stimulates the immune system to increase its defenses.

    •  
  • Lymphomyosot is another common complex homeopathic remedy. I traditionally use this for swelling after sports-related injuries such as ankle sprain. This remedy is a homeopathic diuretic for acute and chronic injuries that cause swelling.

Conclusion
So, when a patient walks into their podiatrist's or doctor's office because of a sports-related injury, alternative therapeutic medical treatments can now be a part of patient's overall medical treatment game plan and not thought to be a form of hocus pocus, quackery, or simply luck.

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