Dr Mark Nelson
Foot & Ankle Specialist
Tennis and Your Feet: Advice from the APMA
A Game for Everyone
For centuries, people of all ages have enjoyed tennis in one form or another. As far back the 1300s, European royalty batted balls across nets on elaborately constructed indoor courts. One court built in 1529 by Henry VIII at Hampton Court Palace outside London is still in use today.
Modern tennis can also be traced to the United Kingdom, where British Army officer Walter C. Wingfield introduced a new, smaller court and simpler set of rules at an 1873 garden party on his Welsh estate. The new game was played outside on a grass court, which eventually made the sport accessible to everyone.
Tennis provides a total aerobic body workout, and regular play is a relatively safe and enjoyable way to stay fit. Children need only be old enough to swing a racquet to play, and seniors need only be mobile enough to get from one side of the court to the other.
It doesn't take a superior athlete to have fun playing tennis, but care must always be taken to avoid injuries to muscles not vigorously exercised off the tennis court.
This is especially true of the foot and ankle, which are put under considerable stress by the continuous side-to-side motion and quick stopping and starting the sport requires. Different court surfaces also stress the foot and ankle in different ways.
Similar racquet sports, such as racquetball, squash, badminton, and
paddle tennis, also leave the foot and ankle susceptible to injury.
Injuries common to tennis and other racquet sports include ankle sprains,
stress fractures, plantar fasciitis and tennis toe, among others. If
they're minor, some of these injuries are self-treatable. But if pain
persists, a doctor of podiatric medicine, especially a sports medicine
specialist, is well-equipped to help you get back on the court as quickly
Don't Forget the Feet
In modern times, maintenance-intensive grass courts have given way to harder, more durable courts. Clay courts, and new crushed stone "fast-dry" courts, which duplicate the softness of clay but require less upkeep, are becoming more popular because players can slide on the soft surface. Clay and fast-dry courts are undoubtedly safest to the foot and ankle.
Outdoor courts are often surfaced with asphalt or concrete, and indoor courts with carpet, none of which allow for sliding. It's becoming more popular to coat the harder outdoor courts with a cushioning surface containing rubber granules. While this coating softens the court and slows down the game, it's no more forgiving to the feet than the concrete or asphalt beneath it.
Popularity of the different court surfaces varies geographically, based on rainfall, humidity, and the age of most of the players (older players tend to prefer the slower, gentler clay or fast-dry court). Regardless of court surface, proper shoes are crucial to injury prevention.
Shoes should be specifically designed for tennis. Unlike running shoes, proper tennis shoes "give" enough to allow for side-to side sliding. Running shoes have too much traction and may cause injury to the foot and ankle. In addition, running shoes don't have padded toe boxes, which leads to toe injuries for tennis players.
Heels should be snug-fitting to prevent slipping from side to side, and both heel and toe areas should have adequate cushioning. The arch should provide both soft support, and the toe box should have adequate depth to prevent toenail injuries. Your podiatrist can recommend a shoe that is best for your foot.
Shop for tennis shoes in the afternoon, when the feet swell slightly. Try on several pairs with tennis socks. Put on and lace both shoes and walk around for a minute or two. Make sure your ankles don't roll in the shoes.
If you have bunions or other special considerations, do not buy shoes
without consulting a podiatric physician. If you already wear prescription
orthotic inserts, make sure that any potential new shoe feels comfortable
with it in place.
An Ounce of Prevention
It's a good idea to have your feet and ankles evaluated by a professional foot care specialist before taking to the court. Your podiatrist can check for excessive pronation or supination (turning inward or outward of the ankles), and if necessary prescribe a custom orthotic device for insertion in the shoe to correct the imbalance.
Because of the stress on calf and hamstring muscles, thorough stretching before a match can prevent common injuries to the leg. Stretching out after a match alleviates stiff muscles.
Basic stretches such as the hurdler's stretch, the wall push-up, and standing hamstring stretch will loosen up the muscles enough to prevent pulls and other injuries. Your podiatric physician can explain how to do these exercises.
Your podiatric physician may advise you as to proper nail care and
warning signs of nail problems. Feet should always be kept clean and dry.
Socks should always be worn -- tennis socks made of either acrylic or a
blend of acrylic and natural fibers are preferable.
Injuries and Treatment
Injuries on the tennis court range from simple to serious. Some are self-treatable, while others will require professional consultation with a physician. The most common injuries in all racquet sports include:
Ankle sprains - They are the most common of all tennis injuries. Ankle sprains usually occur when the foot turns inward, causing swelling and pain on the outside of the ankle. To self-treat a mild ankle sprain, get weight off the ankle, apply ice to reduce swelling, wrap the ankle in a compression bandage, and elevate the ankle. If the sprain does not improve within 3-5 days, consult a podiatric physician.
Plantar fasciitis - Stress on the bottom of the foot sometimes causes arch pain. The plantar fascia, a supportive, fibrous band of tissue running the length of the foot, becomes inflamed and painful. If arch pain persists, consider investing in better shoes, an over-the-counter support, or see a doctor of podiatric medicine for a custom-made orthotic device to insert into the shoe.
Tennis toe - A subungal hematoma, or tennis toe, occurs when blood accumulates under the nail. Tennis toe can usually be traced to improper shoes, and should be drained by a podiatrist for quicker recovery. For slight buildup, cool compresses and ice will provide relief.
Stress fractures and shin splints - Sometimes the long metatarsal bones behind the toes fracture and swell under the stress, causing severe pain when walking. Shin splints, which are microtears of the anterior calf muscles, and Achilles tendon pulls of the posterior calf muscles, are all treatable with rest, ice, and elevation. These injuries tend to occur on harder court surfaces, and should be healed fully before resuming play. Persistent pain should signal a visit to the podiatrist for consultation.
Corns, calluses, and blisters
- Such friction injuries are readily self-treatable, yet care should be
taken to ensure that self-treatment does not aggravate the problem. When
treating corns and calluses, do not try to trim with sharp objects.
Instead, buff problem areas with a pumice stone after bathing. For
blisters, pierce the side with a sterilized needle and drain, then apply
an antibiotic cream. Do not remove the roof of the blister. Application of
a frictionless pad provides relief from blisters.
This Above All
All racquet sports require quick acceleration, twisting, and pivoting, putting the whole body under stress. If you are more than 40 years old, see a general physician before beginning to play tennis or other racquet sports.
Even if you consider yourself generally healthy, ease into a regular schedule of playing time. Whenever you change courts, be sure to get a "feel" for the new surface before serving up a match. Even professional tennis players arrive at tournaments up to a week early to acclimate themselves to the court surface.
Above all, listen to your body. Persistent minor aches and pains are not normal, and will become aggravated if ignored or neglected. Proper care of the whole body, and especially the foot and ankle, will make tennis and other racquet sports a healthy part of life for people of all ages.
Produced in cooperation with the: American Academy of Podiatric Sports Medicine
Reprinted with permission from the American Podiatric Medical Association.
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