The feet are a soccer player’s primary tool for playing the game. Like a carpenter’s tools, they are subject to wear and tear and must be maintained properly in order to be used effectively and efficiently. Accordingly, it is essential that players are made aware of the possible problems that their feet may encounter, to recognize them, and then to promptly get treatment. For youth, it is extremely important for parents to check their children’s feet regularly and to instruct the children to immediately tell their parents if they see or feel something different or wrong with their feet. Observation is the key because problems must be quickly identified and treated. A daily inspection routine at bedtime is recommended. Any problem that is allowed to linger untreated can cause more serious difficulty or result in an extended recovery. It could also result in pain or missed playing time.
The following problems are common to soccer players’ feet:
Abrasion (Scrapes) – An abrasion is a scrape of the outer layer of the skin caused by contact with an outside object or rubbing of the shoe. It should be cleaned and treated with an antibiotic cream. It should be covered (dressed) to keep it protected during exercise. If it is painful, an over-the-counter topical anesthetic may be used. If it becomes infected, it should be treated by a doctor.
Athletes Foot – Athlete’s foot is an infection caused by a fungus and usually occurs between the toes. It is typically transmitted in moist areas where people walk barefoot, such as showers or locker rooms. Athlete’s foot can be treated by a number of over-the-counter medications. It is important to continue use of the medication until absolutely certain that the fungus is gone. Keeping the feet and shoes as dry as possible, and avoiding going barefoot on locker room and shower floors help prevent the fungus from starting. Shower shoes or sandals are recommended. If the fungus does not go away, it should be treated by a doctor. This is especially true because there is a small chance that the fungus could become systemic (enter the body).
Blister – A blister is a small pocket of fluid causing a bump within the upper layers of the skin. This is usually caused by rubbing within the shoes. Most blisters are filled with a clear fluid, however, they can fill with blood or with pus. The body creates the blister in an attempt to protect the skin underneath. Blisters are common with new shoes. New shoes need to be “broken in” gradually over a period of time. Blisters need to be padded in the hope that the body can reabsorb the fluid. Broken blisters need to be salved with antibiotic cream and well padded before exercise. They must then be allowed to air for the skin to dry out. As the raw skin underneath the blister heals, the dead skin of the outer blister may be cut away. Open blisters can become infected and any infection should be treated promptly. There is now concern about Methicillin-Resistant Staphylococcus Aureus (MRSA) and other kinds of infections to blisters, so they should be watched carefully. Areas are to be kept clean and dry and shower shoes used.
Callus – A callus is a toughened area of skin which has become thick due to rubbing. Calluses are normal on the feet of soccer players. Problems arise if they are allowed to become too thick. Over-thick calluses need to be trimmed back. Otherwise they can shift or crack. Padding around a callus, typically with a hole cut out in the center, can be helpful. Trimming may be accomplished with a pumice stone, a callus shaver, or even a clean and dry nail clipper. Particularly difficult calluses should be pared down by a podiatrist.
Contusion (Bruise) – A contusion, also called a bruise, is caused by blunt force trauma, such as getting kicked, which causes tissue damage, especially the breakage of small blood vessels, allowing blood to seep into the damaged areas. The body reacts by sending in additional blood and fluids, which causes further damage and pain. Small bruises near the top of the skin can appear quickly with a typical “black and blue” characteristic. Others may be deep within the underlying tissue. Deep bruises can even go unrecognized until weeks later when yellow colors appear at the surface. Treatment for light bruises may include the “RICE” (rest, ice, [cold] compression, elevation), and then heat. Any indication of unexpected expansion, swelling, hardening, pain, or loss of sensation with a bruise should be seen by a doctor. These are potential indications of internal bleeding or “compartment syndrome.”
Cyst- A cyst is typically a small, almost round, hard, closed sac which may contain air, fluid, or semi-solid material. Soccer players tend to get cysts containing scar tissue, or another type of cyst called a “ganglion cyst,” often at points where the shoes bend or crease on the foot. A ganglion cyst is a swelling that often appears on or around joints or tendons. The actual cause of a cyst is generally unknown. Trying to pop a cyst usually doesn’t help and is likely to make it worse. Surgery is almost always required and, once performed, the cyst usually does not come back.
Loss of Toenail, Blood Underneath – Soccer players tend to undergo two situations that can jam their toenails, either scrapping them on the turf during the performance of an instep kick or having them stepped on, sometimes resulting in trauma that creates a blood pool underneath the nail and then the loss of the nail itself. If a toe gets smacked hard enough or repeatedly, the painful bleeding under the toenail that results is called a subungual hematoma. If a subungual hematoma appears and padding of the toe is insufficient to allow the player to put on his shoe and continue practicing, the player needs to promptly go to a competent podiatrist. The podiatrist will likely drain the blood from under the nail. If done quickly and correctly, this may help keep the nail from falling off. The podiatrist should also check the toe for broken bones. If the toenail does ultimately fall off, it can take up to one year to grow back. Proper padding is essential during this time. It is also important to guard against any type of fungal infection.
Plantar Fasciitis - The plantar fascia is connective tissue on the sole of the foot, extending from the heel to the toes. Plantar fasciitis is the irritation and/or injury of this tissue. In soccer players, It is often caused by the constant pounding of running on overly hard surfaces. Diagnosis is made by a doctor, who should also rule out any other possible conditions. There are numerous treatments, including cortisone injections. Others include rest, massage therapy, orthotics, stretching, pain medications, and different shoes. Supplemental padding in the soles and/or heels of soccer shoes is recommended.
Plantar Warts – Plantar warts are caused by a virus which, due to the pressure of the sole of the foot or the shoe, causes the wart to grow into the skin of the bottom of the foot or the toes (as compared to a common wart that grows out). The virus can get into the smallest of breaks in the skin, for example, one that could be caused by the tiniest of pebbles not removed quickly from a shoe. The first manifestation is a small dot of irregular skin. Untreated, plantar warts quickly expand and grow deeper into the skin, and can spread to other parts of the foot. A podiatrist should be seen immediately. Prevention includes keeping the feet clean and dry, using shower shoes, and keeping foreign matter out of the shoes. Treatment usually involves a form of acid paste which kills the outer layer of the wart, allowing the dead tissue to be scraped off so that the body can naturally force the wart to the surface.
Skin Fissure (Base of, or between Toes); Cracked Skin - A skin fissure is a break or crack in the skin not caused by injury. It is usually the result of wet skin, often occurring between the toes. Bacterial or fungal infections can get into the cracks. Toes and the spaces between the toes must be kept clean and dry. Topical treatments appropriate for athletes foot should be applied until the cracks heal. The base of the heel and other callused areas are also subject to cracks and large fissures. A similar treatment applies. Proper maintenance of calluses needs to be observed (see section on calluses).
It is strongly recommended that parents or players search out and identify an excellent podiatrist in advance of needing one.
The following are less common, but potentially more serious, conditions associated with soccer players’ feet:
Broken Bone – A broken bone is a fracture or loss of continuity in a bone. It can have any number of causes, but, in soccer, a broken bone in the foot is usually caused by getting kicked or being stepped on. A broken bone of this type can sometimes be heard when it happens, but most often is felt and usually brings on pain and lack of mobility. Activity should immediately cease and the player be taken for X-rays and treatment. Treatment usually consists of some form of immobilization.
Bone Bruise – A bone bruise is an injury which breaks apart the tissue around the bone. It usually results from a strong blunt force, such as being kicked, which is insufficient to break the bone itself. A bone bruise can also occur on the heel due to the pounding of running on hard surfaces. Like a skin or muscle bruise, the tissues continue to break apart when the body sends blood and fluids to the injury, causing further damage and pain. The pain can be significant and long-lasting. A doctor should be seen for X-rays to confirm that the bone is not broken. An MRI will usually confirm the bone bruise.
Bone Spur – Bone spurs are generally small, extra calcium deposits that form on a bone. Many people have them without knowing it. When they interfere with tendon movement, however, they can become painful and debilitating. For soccer players, bone spurs can imitate tendonitis and plantar fasciitis. Some success in local treatment may be found with ice and heat therapy, ibuprofen, and stretching. Otherwise, a doctor should be seen.
Sprain – The feet and ankle have an extremely high concentration of ligaments, which, when they get inappropriately stretched, torn, or severed, result in mild to severe sprains. These injuries occur as a result of unintentionally rolling the foot inward or outward, hyper-extension, hyper-flexion, and compression. They are generally characterized by severity level, from Grade 1 to Grade 3. A Grade 1 sprain consists of mild damage to a ligament or ligaments without affecting the overall stability of joints. A Grade 2 sprain consists of a partial tear to a ligament or ligaments, which were stretched to the point that joints become loose. A Grade 3 sprain represents complete tears of a ligament or ligaments, causing instability and lack of function in the joints. Bruising and swelling will almost always occur around the ankle as a result of the injury. Treatment usually consists of some form of immobilization.
It is strongly recommended that parents or players search out and identify an excellent orthopedist, and/or sports medicine practice, in advance of needing one.
Prevention goes a long way toward reducing foot problems. The feet should be kept clean and dry as much as possible. They should be washed as soon as possible after exercise. Shower shoes should be used in locker rooms and community showers. Cleats must always fit properly. Growing feet require purchasing new, properly-fitted, cleats, sometimes as often as each season. Cleats cannot be too small, too large, or too narrow. Padding can be added, especially for the heels. The insides of cleats should be occasionally sprayed with an anti-fungal or dusted with powder. Socks and all exercise clothing must be washed after each use. Shin Guards should be cleaned on a regular basis. Toenails must be trimmed properly and on a regular basis. Stretching and strengthening of the tendons and muscles that support the foot and ankle must be done properly and consistently.
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