Foot and Ankle Injuries in the Barefoot Sports

Understanding the Cheerleader as an Orthopaedic Patient: An Evidence-Based Review of the Literature

Cheerleading is a highly popular youth sport in the United States and has been increasingly recognized in recent years for its athleticism and competitive nature. The sport has changed dramatically since its inception. When the sport of cheerleading was first developed, its primary purpose was to entertain crowds and support other athletes. Today, cheerleaders are competitive athletes themselves. Cheerleaders, most of whom are in the pediatric age group, and their parents commonly approach orthopaedic surgeons and sports medicine physicians with questions regarding the risks associated with participation in the sport. Appropriate clinical guidance is especially important for athletes returning to the sport after an injury. However, unlike other popular sports (eg, football, basketball, and volleyball), the intricacies of cheerleading are not well-known to those outside the sport, including many health care providers. Previous studies have reported on the epidemiological patterns of injuries associated with cheerleading and how such aesthetic sports affect the body, finding that fractures and concussions are prevalent and that catastrophic injuries are more common than in most other sports. Here, we provide an evidence-based discussion of 10 pertinent topics regarding cheerleading and its risks to the musculoskeletal system. The purpose of this review is to provide a comprehensive resource for orthopaedic surgeons and sports medicine physicians who care for these athletes.

Martial arts injuries: a longitudinal study about judo, karate and wushu carried out in the Community of Madrid, Spain

BACKGROUND

Martial arts are currently being practiced throughout the world by about 100 million people. Considering that sports injuries account for 20% of all emergencies treated in hospitals, this is an issue that should be further studied. Our objective was to determine the prevalence and type of injuries in wushu, judo, and karate practitioners in Community of Madrid, Spain.

METHODS

A descriptive epidemiology study was carried out. A questionnaire was used to collect data from 457 men and women practicing karate, judo and/or wushu, including injuries from the past five years, type of injury and occurrence during training or competition.

RESULTS

Injuries that disrupted training occurred in 56% of judokas, in 36.7% of karatekas and in 38.9% of wushu practitioners (WP). For judokas, the most common injury site was "shoulder/arm/elbow" (13.43%), for karatekas, it was "lower leg/foot/ankle" (9.95%), and for WP it was "groin/hip/thigh" (9.45%) (P=0.000). The most common injuries in judo and karate were "ankle sprains and joint injuries" (4.98% and 3.98%), while for WP the most common injury were "hamstring strains" (5.47%) (P=0.008). There was no relationship between occurrence of a first injury and sex, age or belt rank.

CONCLUSIONS

Judo is the martial art with the highest percentage of injuries, followed by wushu and then karate.

Beach Feet: A Sand-associated Thermal Injury to the Soles of the Feet and the Plantar Aspect of the Toes

Athletes may develop sports-related dermatoses. Indeed, participants of aquatic-associated sports can experience dermatologic conditions that affect their feet when they play barefooted on the beach. These disorders are variable in etiology and include traumatic injury to the unprotected feet and toes, penetration of organisms (such as hookworm larva and schistosomiasis cercaria) into the feet and toes, and ultraviolet radiation-related maladies such as an acute phototoxic reaction (sunburn) and thermal injury from contact with hot sand. Indeed, exposure to hot sand can result in first-degree, second-degree or rarely third-degree burns. A 27-year-old man developed painful erythematous patches on the plantar feet and toes after running barefoot on the sand during a hot August afternoon on a dog beach in Del Mar, California. To emphasize both the injury-causing environment and the affected location, beach sand-associated thermal injury to the soles of the feet and the plantar aspects of the toes is referred to as beach feet.

Beach Soccer Injuries During the Japanese National Championships

Background:

The frequency and severity of injury in beach soccer are unknown.

Purpose:

To estimate the incidence rates, characteristics, and risk factors for injuries associated with beach soccer.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The same sports physician examined and recorded injuries incurred during the Japanese National Beach Soccer Championships in 2013 and 2014. Posttournament follow-up was made for all injuries. Match exposure for each player was recorded through video review to examine individual risk factors.

Results:

A total of 58 injuries were recorded during 54 matches. The overall injury rate was 179.0 (95% CI, 138.4-231.6), and the time-loss injury rate was 28.2 (95% CI, 14.7-54.1) per 1000 player-hours. The foot/toe (34.9%) was the most frequently injured area, followed by the lower leg (22.2%) and thigh (11.1%). There was only 1 ankle injury (1.6%). The most frequent injury type was contusions (60.3%), followed by lacerations/abrasions (14.3%) and sprains/ligament injuries (6.3%). Only 4 injuries resulted in ≥30 days of time-loss (7.4%). After adjusting for age, a previous history of severe injury and longer experience of beach soccer were significantly associated with injury risk.

Conclusion:

The time-loss injury rate in this study was comparable to the rates reported during the matches of soccer or futsal tournaments. However, a greater incidence of foot/toe injury and lacerations/abrasions as well as a lower incidence of ankle injury distinguished beach soccer from soccer and futsal, possibly related to the specific playing conditions of being barefoot on a sand surface.

Imaging of sports-related midfoot and forefoot injuries

Sports-related injuries of the foot are common and may result in significant morbidity, particularly if inaccurate or delayed diagnosis leads to improper management. While less common than injuries of the ankle, sports-related foot injuries account for 2% to 18% of athletic injuries. Injury may occur as a result of acute trauma or chronic overuse, and high-impact sports that involve running, jumping, or contact place the athlete at higher risk for injury. Accurate and timely diagnosis of injury is the key to proper management, and diagnostic imaging studies often play a critical role in this regard. While radiographs, computerized tomography scans, and ultrasound are useful in the evaluation of the foot, magnetic resonance imaging provides superior tissue contrast as well as the ability to detect stress reaction in bone that precedes discernible fracture line on radiographs, allowing accurate detection of both osseous and soft tissue pathology. This review focuses on imaging of common sports-related injuries of the midfoot and forefoot, including osseous, ligamentous, and tendinous pathology, with emphasis on magnetic resonance imaging diagnosis.

Can Taekwondo footwear affect postural stability in young adults?

BACKGROUND

This study aims to investigate the effect of taekwondo footwear on unilateral stance stability and use of postural control strategies and to determine whether taekwondo footwear influences the somatosensory inputs for postural stability and postural strategies in young adults.

METHODS

A quasi-randomized crossover trial was conducted on 33 healthy young adults at a university research laboratory. Independent variables, including shoe conditions (shoes on and shoes off) and visual conditions (eyes open and eyes closed), were taken into account. The center of gravity (COG) sway velocity in unilateral stance and the strategy scores in the sensory organization test were measured. No intervention was given to the participants.

RESULTS

There was no significant interaction between the two factors (the shoe and visual conditions) for COG sway velocities (P = .447) and strategy scores (P = .320). The shoe condition was not significant in either COG sway velocity (P = .484) or strategy score (P = .126). The visual condition was significant for COG sway velocity (P < .001) but not for strategy score (P = .573). The mean ± SD COG sway velocity with eyes open was 0.7° ± 0.2°/sec and with eyes closed was 1.7° ± 0.6°/sec (P < .001).

CONCLUSIONS

Taekwondo footwear is unlikely to affect somatosensory inputs and balance performance in young adults.

Barefoot stubbing injuries to the great toe in children: a new classification by injury mechanism

OBJECTIVE

This study was conducted to categorize barefoot stubbing injuries to the great toe in children by injury mechanism to differentiate benign stubbing injuries from more complex injuries necessitating surgery.

DESIGN

Prospective clinical series of consecutively treated patients.

SETTING

Tertiary university hospital setting.

PATIENTS

Forty-one children who had sustained an indirect injury to the great toe during barefoot sports activities between January 2001 and December 2009 were included.

INTERVENTION

Conservative or surgical treatment was done according to clinical and radiological findings.

MAIN OUTCOME MEASUREMENT

Information regarding injury mechanism was collected from patients, parents, and coaches using skeletal models and assessed by a pediatric orthopedic surgeon. Mechanisms of injury were identified and grouped as follows: hyperabduction-flexion, hyperflexion, hyperabduction-extension, hyperextension, and hyperextension-adduction.

RESULTS

Hyperabduction-flexion was the most common mechanism (n = 16), in which interphalangeal joint dislocation and skin disruption was noted in most cases. The second most common mechanism was hyperabduction-extension (n = 14) in which avulsion fracture of the lateral volar condyle of the proximal phalanx was noted in most cases. This avulsion fracture had the worst prognosis after conservative care.

CONCLUSIONS

Based on these results, we have created a grading system and treatment protocol for indirect hallux sports injuries in children. Avulsion fracture of the lateral condyle of the proximal phalanx, a result of hyperabduction-extension, is a high-risk sign of nonunion and should be aggressively treated, contrary to previous guidelines.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Triathlon: running injuries

The running portion of the triathlon represents the final leg of the competition and, by some reports, the most important part in determining a triathlete's overall success. Although most triathletes spend most of their training time on cycling, running injuries are the most common injuries encountered. Common causes of running injuries include overuse, lack of rest, and activities that aggravate biomechanical predisposers of specific injuries. We discuss the running-associated injuries in the hip, knee, lower leg, ankle, and foot of the triathlete, and the causes, presentation, evaluation, and treatment of each.

Footwear and orthopaedics

Footwear is the oldest known fashion accessory in use. Footwear is often implicated in orthopaedic problems affecting lower limbs and back. Hence footwear modifications have a major role in management of these pathologies as well. This review explores footwear and its role in causation and management of orthopaedic problems. Based on our observations we recommend that children with flexible flatfeet should be encouraged to walk barefoot to help in developing their arches. Women with risk factors for secondary arthritis of knee or back pain may be advised to avoid heels. Commercial shoes which decrease hind foot loading may be used in symptomatic management of hindfoot and mid foot problems. Similarly shoes which decrease forefoot loading may be useful in managing forefoot pathology. Flip-flops should be avoided by diabetics as they do not protect from injuries.

The anatomy and biomechanics of running

To understand the normal series of biomechanical events of running, a comparative assessment to walking is helpful. Closed kinetic chain through the lower extremities, control of the lumbopelvic mechanism, and overall symmetry of movement has been described well enough that deviations from normal movement can now be associated with specific overuse injuries experienced by runners. This information in combination with a history of the runner's errors in their training program will lead to a more comprehensive treatment and prevention plan for related injuries.