Foot Injuries and the Martial Arts

Individuals participating in martial arts unfortunately experience injuries when training for an extended period of time. Muscle strains, tendon ruptures, and broken bones become all to familiar to hard working martial artists. When these type of injuries occur, often the practitioner will seek out help immediately, but it is the lesser known injuries, and unfortunately the ones that occur much more often, that often go untreated. 

The purpose of this article is to highlight a few of these ailments so that both practitioners and school owners alike can look out for them, and understand how best to deal with them. A few of the most common conditions include plantar fasciitis, sesamoiditis, and severs disease. The frequency of these three problems is incredibly common in the martial arts world, and can be devastating to a practitioners workout routine.

Plantar Fasciitis
Plantar fasciitis is likely the most common problem for martial artists, especially those just starting out. Plantar fasciitis is inflammation of the plantar fascia, which is a tendinous band of tissue that supports the bottom part of the foot, and it runs from the heel of the foot and extends to the ball of the foot. 

Once this band of tissue becomes inflamed, there is usually pain with walking or standing upon the arch or heel of the foot. Because most martial arts are practiced barefoot, there is no support for the bottom arch of the foot. Jumping and pivoting upon the ball of the foot strains the plantar fascia, causing pain and inflammation. 

Plantar Fasciitis Treatment
Initial treatment of plantar fasciitis is stretching. The proper stretch is to dorsiflex the foot (raise your toes up to your knee) while keeping the knee locked. You can do this standing, sitting, or lying down. Hold the stretch for ten seconds at a time, and repeat as often as possible during the day. The key is to keep the knee locked, otherwise the stretch is not effective. 

Other treatment options are the application of ice to reduce inflammation, and use of in shoe orthotics to support the plantar fascia when walking or standing - but neither one of these modalities should substitute for the stretching. One other aid to use during training is to wrap or tape the central part of the foot, I usually use two to three inch athletic tape around the foot to provide support during training. Of course, seek help from a professional if these methods don’t relieve pain.

Sesamoiditis pain will be pain just beneath the big toe joint. Any form of weight bearing around this site will bring pain to the point of not being able to train. The sesamoids are two accessory bones that form underneath the joint of the great toe. They are free floating bones that are housed within the flexor hallucis tendon, and are part of a mechanism called the plantar plate. They serve multiple functions, but most importantly they protect the first joint of the foot beneath the great toe during walking and standing. 

Overuse will often bring inflammation of that plantar plate area that includes the flexor tendon and the sesamoids. So what this feels like is tendinitis on steroids. The presence of inflammation in the flexor tendons is tendinitis, but the presence of the sesamoids leads to further pain, and what we call sesamoiditis.

Sesamoiditis Treatment
Treatment of this condition is similar to that of tendinitis, ice, rest, and a comfortable and supportive shoe. Unfortunately, there is no good way to tape or strap the foot when this ailment occurs, and along with what I just mentioned, rest is the most crucial. Taking a week or so off will help immensely to reduce the pain and inflammation. Pushing through this pain will often times lead to increased pain and decreased function. Antiinflammatories can help, but it’s not healthy to overdo it on this type of medication. With this type of ailment, being barefoot is your enemy.

Severs Disease
Severs is not a disease, but is inflammation of the growth plate located upon the posterior plantar aspect of your heel. It only effects children - girls between the ages of 8 and 12 and boys between 10 and 14. In can be brought on by direct trauma to the site, or excessive bare foot activities such as martial arts. Especially in arts like Taekwon Do where there is board breaking that involves spinning kicks and striking with the heel. 

Breaking boards with the heel of the foot during this age must be closely monitored. A child who injures this growth plate area will have pain that can be likened to an adult with a broken bone. If you see a child with a painful heel and they can barely bear weight upon that foot, be aware of Severs.

Severs Disease Treatment 
Once a child has this the first line of treatment is again, rest, and ice. Another helpful device are gel heel cups or offloading in shoe orthotics/inserts. Childrens’ motrin is also helpful during the first week of symptoms. Again, as with the other ailments, rest is key. Continued activity will lead to continued pain, and the need to be seen by a professional.

Keep this in mind if you’re in the martial arts world in order to continue your training. As with any injury, seek out the aid of a doctor early to insure you get the proper treatment. We all like to be tough, but for the most part, "powering through the pain" often leads to more pain and more severe injuries.

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