What is “normal” pain in student athletes?

As the Fall sports season reaches its conclusion, many adult, adolescent and child athletes are playing with seemingly normal but persistent foot pain that could be a sign of a more serious injury.

Playing with pain is often viewed as a badge of honor among athletes, but they must be aware that the persistent pain they dismiss as normal exercise-related stress could be something far more serious.

Athletes of all ages visit my office with foot pain due to overuse injuries from repetitive loading of the foot and ankle during running and aerobics. When athletes overdo their workouts, it may be normal to experience some temporary discomfort. But if pain continues longer than a few days with continued redness, warmth or swelling, the athlete should see a podiatric foot and ankle surgeon for proper diagnosis and advice on treatment options.

Athletes who ignore persistent foot pain and inflammation, and continue to train, risk potential complications that could sideline them for months. Among possible injuries associated with persistent foot and ankle pain are stress fractures, muscle strains, tendonitis and subtle fractures after inversion ankle sprains.

Stress fractures are sometimes not very debilitating and some athletes might continue their normal training despite the injury. But continual rigorous activity can worsen the problem. An examination and diagnosis by a foot specialist can determine whether the pain is from overuse or subtle trauma, requiring only a few days of rest, or something that may require surgical intervention.

Heel pain in children is often caused by injuries to the growth plate and secondary growth centers. Tendons pull at the top and bottom of the growth plate of the heel and can create pain and inflammation. Boys and girls ages 8 to 14 are susceptible to this problem, and its major symptom is pain on either side of the heel.

Growth-plate trauma is very common in soccer and other sports that involve a lot of running. Parents should make sure that their children stretch before playing and apply ice to the back of the heel after the game or practice. In some cases, anti-inflammatory drugs and shoe inserts or lifts are recommended, but the potential for recurrent injury exists until the growth plate closes.

Foot and ankle surgeons provide many forms of treatment to keep children pain free and participating in sports activities. When treating athletes of any age, they will evaluate several factors that could be the underlying cause of foot pain. They include:

Running or Playing Surfaces: Athletes who train on asphalt or cement are more prone to stress injuries than those who run on cushioned tracks or natural grass fields.

Shoes: Footwear should be appropriate for the sport and match the biomechanics of the individual’s foot. For example, those who engage in one sport more than three times a week should wear athletic shoes designed for the sport, and shoe technology has advanced to allow for variances in foot characteristics that require stability cushioning.

Training: Injuries often result when athletes fail to build up to a desired training goal. Accordingly, a runner shouldn’t set a goal of 20 miles a week without gradually progressing to that goal.

Behavioral Factors: In children, overuse injuries sometimes occur from excessive parental pressure to achieve in sports.

Nutrition: Stress fractures can occur in athletes with poor nutritional habits.

Over-Training: Sleeping problems and resultant irritability and fatigue are common among some athletes who exercise aggressively.

Physical Characteristics: Variations in bone structure and muscle development are evidenced in individuals who are bowlegged or have malalignment problems.

For more information on foot conditions affecting athletes and children, go to FootHealthFacts.org.

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