By Dr. Simon B. Small, DPM, FACFS, FAAPSM

Reprinted from World Tennis

AGONY OF THE FEET

Lots of tennis players suffer from foot problems. But for those of you who don’t have time for the pain, here’s a step in the right direction. "When your feet hurt, you hurt all over." Simon Small, DPM. Most of us have heard this phrase at one time or another, and if you’re serious about tennis, you know just how true that statement is. Foot problems are very common among tennis players today, but the truth is that you don’t have to suffer if you give your feet the care they deserve.

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Pain is a sign that your feet are trying to tell you something. But even if you’re experiencing recurring pain in your foot, ankle, or lower leg—on or off the court—you need not resign yourself to living in discomfort. You may need to go see a sports podiatrist, but it’s a good idea to see if you can solve the problem by yourself first. Here are some scenarios to consider:

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It could be that your tennis shoes don’t fit properly, which can cause corns, calluses, blisters, black toes, or a variety of other injuries. They may not be providing adequate support to prevent ankle twists or sufficient cushioning to offset the pounding during play that can cause soreness in the balls of your feet. If that’s the case, consider both your foot type and special fitting/playing needs, then consult the shoe reviews that follow to help pick the right model. Then again your shoes may not be the culprits at all. Perhaps you’re guilty of foot neglect, particularly when it comes to exercising. What to do? Well, it’s important to realize that your feet are just like any other part of the body—they respond to conditioning. By performing certain foot exercises at least four times a week, you can strengthen your feet and reduce your level of discomfort during strenuous activity. You’ll feel a welcome difference when moving to the ball on the court by doing the following of it:

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• Limber up by walking or jogging easily in place.

• Draw imaginary figure eight’s with your feet to stretch the ligaments in your ankles.

Do the following series of Achilles tendon exercises:

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• Stretch 1: Extend your left foot in front of the right one: stretch the Achilles tendon of the rear leg by bending the front leg with hands on the knee. Force your weight back toward the ground through the back heel.

• Stretch 2: Face a flight of stairs, placing both forefeet parallel to the front edge of the same step, without bouncing, relax and allow gravity to pull your heels downward for about 20 seconds.

• Stretch 3: Face a wall with both heels on the ground; place your hands on the wall at shoulder height and width apart; extend your chest so that it and your nose touch the wall keep your heels on the ground and your body straight, except for bending at the ankle joint.

Pampering your feet is even more crucial during the summer months. Tennis players tend to vacation more frequently in the summer, but their feet never seem to get a rest. So when planning your next trip, keep in mind that your feet may get more of a workout on the road than they do at home.

Here are some helpful hints:

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1. Most people do more walking during a vacation than they realize, when you add tennis to the equation, you may be asking for blisters. If they develop, drain the fluid with a sterilized needle but don’t remove the skin until it's ready to fall off; the skin serves as a natural, biological dressing. Be sure to keep the area clean and cover it with a Band-Aid.

2. Keep your feet covered, inside and out—unless, of course, you happen to be at the beach. Resist the urge to go barefoot after a long match on a hot, humid day. Walking around shoeless predisposes your feet to the contagious athlete’s foot fungus.

3. Watch out for splinters, glass, and needles, which seem to find a way to seek out and lodge inside the soles of the feet (another good reason to keep your shoes on).

How can your feet get relief from the heat? Bring along extra socks. Since feet perspire more heavily in the summer, you should probably change your socks twice a day even if you’re not playing tennis, and more often if you are.

Feet often face another serious challenge during vacations: the lengthy car ride. Sitting for an extended period of time puts pressure on the muscles surrounding the nerve tissue, which can cause those nerves to compress. Feet retain fluid or become numb—especially in the driver’s case—and upon resuming normal movement, pain and stiffness occur. The following exercises can be done in the car and will help stimulate circulation and prevent compression of the nerves:

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• Draw your knees to your chest, resting your heels on the front edge of the seat.

• Gently flex the ankle joints by pulling your feet upward while allowing your heels to press into the edge of the seat.

• Make figure eights with your feet to help reduce the stiffness in the ankle joints.

Try not to sit in the same position for too long. If you decide to take a snooze, avoid crossing your legs to prevent that "pins and needles", feeling when you awaken.

Once out of the car, start moving. Take a short walk or jog, do some stretches, and gradually begin working the muscles until they loosen up.

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Unfortunately, sometimes doing all the right things can get you nowhere. Suppose you’ve been stretching and exercising. You’ve purchased the right tennis shoe. And you’ve tried soaking, resting, and elevating your feet, but the pain persists. What now?

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In all likelihood, your feet have developed structural abnormalities and/or muscular imbalances that may make you prone to sprains, pulls, and other foot infirmities. The bad news: You suffer. The good news: Such problems lend themselves to non-surgical treatments, the most effective being orthotics, custom-designed foot supports with, when placed in shoes, add balance, support, and biomechanical control to feet on the move.

Chris Evert, Michael Chang, Katerina Maleeva, Pete Sampras, and Pam Shriver are but a few of the many touring pros who have turned to orthotics in recent years. (In Evert’s case, a high arch and a tight Achilles tendon had created tension on the back of her legs and the bottom of her feet. A special wedge in her custom orthotic raised the floor up to her foot and reduced the pressure she brought to bear every time she lunged for the ball.)

Orthotics can ameliorate a variety of foot ailments. Bunions—deformities of the joint that attaches the big toe to the rest of the foot—can be created by using an orthotic to redirect the motion of the foot. Individuals who suffer discomfort as a result of flat feet, high arches, hammertoes, and calluses (and who have tried other methods without success) often benefit immeasurably from orthotics. Orthotics can relieve knee and back pain related to abnormal foot function and can be worn as part of post-operative therapy.

Being fitted for orthotic devices is like getting contact lenses. Your podiatrist makes a plaster impression of your foot and generally produces the orthotic within two weeks. It is constructed according to your weight and level of activity. If one area of your foot absorbs more pressure, more supportive materials are placed on that part of the orthotic.

But keep the following in mind. Orthotics should always be a last resort. They are a costly investment ($300-$400 on average) and can’t guarantee relief from what ails you. Always try a new pair of shoes and the aforementioned exercises first.

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Still, the entire body must function optimally to achieve peak performance. Pain has a way of working its way up so stay on top of foot ailments—before they get you down.