Chiropractic and children’s foot care: injury prevention for young athletes

Young athletic patients and avoiding injuries from the ground up with children’s foot care

Every day, young athletes put on their uniforms, lace up their shoes and run onto the court or field. In most cases, there is very little time spent thinking about injury prevention. Why should they? In their minds, they are young and invincible, without awareness of or concern for the potential risks involved in their sport, and children’s foot care is rarely on the minds of parents.

Unfortunately, in every sport, injuries are inevitable. However, providing an optimal environment and promoting effective training practices can significantly reduce the occurrence and severity of athletic injuries, especially to the lower extremities and spine.

Children’s foot care: identifying the source of ongoing injuries

The most common musculoskeletal injuries in the athlete involve the lower extremity. Most prevalent is an ankle sprain, followed by knee sprain, and then hip sprain or strain.

Athletic injuries can be acute and occur immediately during practice or game play, or chronic and occur over time. Chronic injuries are caused by excessive and abnormal repetitive stress due to mechanical or technical issues. Acute injuries are going to happen, but the severity of acute and chronic injuries can be curtailed with proper analysis and treatment.

In order to prevent the severity of, or occurrence of, lower extremity and compression injuries to the spine, evaluation of the feet is paramount. Our feet are our foundation. Every step we take, the foot either absorbs and disperses energy or transfers impact up the kinetic chain based on the architectural support in the foot.

One of the most common technical issues involving the foot is pronation. There is a cascade of events that occur when the foot strikes the ground. If pronation exists, the foot strikes the ground and immediately the tibia rotates medially, the knee collapses into valgus, which in turn causes the pelvis to drop on the affected side. These reactions can cause excessive strain in the leg resulting in shin splints, medial knee strain, hip strain, as well as excessive compressive forces in the spine. There is a direct connection to the feet and these potential injuries.

The role of stabilization in preventing injury

Common conditions seen in the young athlete associated with excessive pronation include plantar fasciitis, Achilles tendonosis, shin splints, knee pain, hip pain and back pain. These injuries can be nagging and reoccur year after year. Therefore, addressing pronation in children’s foot care can set the young athlete on a great path by preventing excessive stress and strain on the lower extremity and spine.

Custom orthotics that support all three arches of the foot are the product of choice for combatting the effects of pronation. A custom orthotic will support the natural architecture of the foot. The three arches of the foot form the foot’s plantar vault, a dome-shaped structure designed to allow the foot to absorb and disperse energy when the foot impacts the ground. State-of-the-art laser weight-bearing scanning technology provides the clinician with data and 3D graphics of the athlete’s feet. This information not only provides data points for construction of the physical orthotic but also provides the clinician with valuable tools to educate the athlete on simple lower extremity biomechanics and its influence on the kinetic chain.

Along with supporting the foundation with custom orthotics, putting in place good fitness habits when young will provide the developing athlete with an environment conducive to maximizing performance and injury prevention. Creating a foundation of good fitness habits in the young athlete increases their potential for maximizing performance, reducing risk of injury and allowing them to enjoy longevity within their sport. Therefore, evaluating the feet in the young athlete is vitally important and should happen routinely.

Posture and biomechanics

Fitness is defined as a balance between strength, conditioning and flexibility. I am going to suggest two more components to this definition: posture and biomechanics. Our bodies are mobile machines and work most efficiently when they are in motion. While in motion, proper posture and good biomechanics encourage appropriate distribution of weight-bearing stressors, thus reducing mechanical stresses on the musculoskeletal structures.

Incorporating lower extremity dynamic stabilization exercises is another tool for maximizing performance through injury prevention. Again, the most common musculoskeletal injuries at all levels of sports involve the ankle, knee and hip. Many of these injuries occur without a direct blow but are non-contact in nature.

Developing dynamic stabilization through proprioceptive challenge exercises will increase the athlete’s strength, coordination, balance and most importantly, reaction time. This will allow the athlete a better chance of preventing injuries during a misstep or mis-landing. The exercise of choice for increasing proprioceptive awareness and strength is a single leg stance. This is accomplished by balancing on one foot while standing on a stability trainer for one minute and repeating that 3-5 times on each side. Because of the prevalence of lower extremity injuries, these exercises should be prescribed to every athlete, young or old, and should be performed at least three days per week, preferably daily.

Evaluation and education

Just as important as children’s foot care evaluation is educating the athlete and parent on the connection between the foot and the ankle, knee, hip and spine. Understanding this vital link empowers the athlete to act on the clinician’s recommendations, resulting in increased compliance.

It’s important to understand that any injury, whether acute or repetitive, results in stiffness. Stiffness or lack of flexibility compromises function which in turn eventually leads to failure or injury. Therefore, injury prevention should be a primary focus when evaluating the young athlete.

In order to reduce the risk of injury in these athletes, the clinician should evaluate the feet for technical errors and incorporate proprioceptive exercises to improve strength, balance, coordination and reaction time. If technical issues such as pronation are identified, custom orthotics can be a game changer by providing a solid and secure foundation, giving the athlete the best possible chances for maximizing performance and reducing the risk of the most common musculoskeletal injuries.

KURT A. JUERGENS, DC, CCSP, is a graduate of Brigham Young University and Texas Chiropractic College. He is the owner of Juergens Chiropractic & Sports Rehab Center in Houston, Texas, where he continues to treat student and professional athletes in all fields from around the world. He has been a member of the sports medicine team for the United States Olympic Track and Field Trials, the NCAA Track & Field Championships, and the ATP World Tour’s Tennis Masters Cup and U.S. Clay Court Championships. As a member of Foot Levelers Speakers Bureau, he travels the country speaking on chiropractic topics with a focus on sports medicine. See upcoming continuing education seminars at footlevelers.com/seminars.