SPORTS PODIATRY

Baseball and Podiatrists

It’s a game of inches and a game of feet

BY KEITH LORIA

here’s folklore that has made its way around ball- parks all over the nation Today, every team has a team that every podiatrist of a podiatrist on staff or one it can refer to. major league baseball team Thas heard. The story involves former Rangers Kevin Mench, who missed five of his team’s ey Tettleton once went on the DL that more foot injuries don’t keep first 15 games with a with a severe case of athlete’s players off the field. sprained second toe—other- foot allegedly caused by tying Whether it’s Dr. Larry Oloff, the wise known as “turf toe”— his shoes too tight, while leg- ’ podiatry spe- in his right foot. Thanks to endary Hall of Famer George cialist performing surgery on 2012 the keen eye of his team po- Brett broke his toe on a chair MVP to repair torn liga- diatrist, it was discovered at his home while running ments in his left ankle, or Milwaukee that Mench’s shoes were ac- from the kitchen to the TV to Brewers podiatrist Dr. Kevin Sunshein tually half a size too small watch fellow All-Star Bill creating custom orthotics so All-Star and, once corrected, the out- Buckner . Corey Hart could continue playing fielder went on to his most Dr. Oloff Today, every major league last year, or even Dr. James Ricketti productive season ever. baseball team has a team po- of the Red Sox helping Bizarre foot injuries are no diatrist on staff or one it can refer to, rehab after he broke his navicular stranger to the Great American Pas- and it’s thanks to their experience, bone last October, an MLB team podi- time. Baltimore Orioles catcher Mick- knowhow, and even love of the game Continued on page 84 www.podiatrym.com JUNE/JULY 2013 | PODIATRY MANAGEMENT | 83 SPORTS PODIATRY BASEBALL

atrist is essential for every ball club. best to take a conservative route and lete,” he says. “I have earned the re- The continue to not opt for surgery right away. “As a spect of many of the players who shock the baseball podiatrist, we are not going to deal have come through, and that’s why I world by compet- with the traumatic injury, but what see players from all over the country, ing for a playoff we can do is keep them safe and com- players who used to play for the team spot almost every fortable. If surgery has to be done, come back and see me, which is a re- year, despite hav- we’ll do it, but we need to present all ally nice feeling.” ing one of the low- the options to the athlete Unlike football where he’s est payrolls in the and the trainer,” he says. required to be at every game, league. For the “With Doc, I made a tempo- Weil can usually be found at past decade, Dr. rary orthotic and he was about half of the team’s 81 Dr. Runyon Tim Runyon, a po- able to continue on for the home games. “It’s not unusu- diatrist in St. Pe- season.” al that I will be watching the tersburg, FL., has been the team’s po- Dr. Lowell Weil has game on television and the diatrist and has done what he can to been team podiatrist for trainer will call me and tell keep the players on the field. “I see a the me “Doc, I have someone lot of overuse injuries that a regular since 1983 and has learned Dr. Weil, Sr who needs you’ and I will get weekend athlete might not have,” a lot in his three decades in the car and go to the stadi- Runyon says. “Major league players on the job. Back then, he was one um,” he says. “Otherwise, I’m there want to stay at the peak of perfor- of only two team podiatrists in all the beginning of every home stand so mance and are always working on of baseball. “When I started, I was anyone who had problems on the trying to get an edge. Sometimes that known around town for my work road can be seen. I’m always on call leads to overuse injuries. Common occurrences are tendonitis, heel pain, Achilles tendinitis, stress fractures; a myriad of things that are not so much The most common injury that baseball podiatrists see in indigenous to baseball but for all pro- their players is an ingrown toenail. fessional athletes.” The laundry list of things an MLB podiatrist deals with also includes work on the lower extremities, poste- with the Bulls and Bears, so I had a and I’m at every game of the play- rior tibial tendons, inflammations of lot of experience with sports offs.” the foot, and a variety of sprains and medicine and was able to work strains. with the White Sox because of my Dealing with Injuries Ever since the connections,” he says. “I have done The most common injury that New York Yan- everything from making a diagnosis baseball podiatrists see in their play- kees moved their to performing surgery and, over the ers is an ingrown toenail. Last year years, have encountered just about alone, players such as Chipper Jones, site from Fort every issue with a foot that some- , and David Murphy Lauderdale to one can have.” all missed time on the field because of Tampa, Florida Back at the beginning of his time this. “Ballplayers have a lot of prob- (in 1996), Dr. with the team, future Hall of Famer lems with this because of their Gerald Cosentino Dr. Cosentino came to the Sox and footwear,” Weil says. “Spikes that are has served as the wasn’t too happy with Weil or his ad- worn are very soft with not much team’s spring podiatrist. “Most of vice—at first. “He was a little nasty support to them and a lot of the guys the things I see in ballplayers are and I gave it to him straight. I told like to wear them tight so they can repetitive injuries,” he says. “Some- him, ‘It’s you and me and I will do faster. That’s not good.” With thing like when Joba Chamberlain what’s best for you and not worry , because of the way they dislocated his subtalar joint, that’s about what the coaches are saying,’” throw the ball, with their back foot not the norm, but we are available Weil says. “He liked that assertive- coming forward and hitting the to help with something like that. ness and we became good friends and ground, it causes ingrown toenail is- We’ll see different dermatology is- I was able to help him stay on the sues all the time. sues, sprained ankles, and of course, field.” The second most common need deal with shoe issues.” Years later, Dr. Weil helped out- for a podiatrist comes from a player While working with Dwight fielder Magglio Ordonez find a doctor taking a foul ball off the foot. “This Gooden years ago, the veteran hurler in Austria for a procedure not yet ap- happens all the time. It’s usually off was suffering from some feet issues, proved in America—and at the re- the instep, so we come up with modi- but because it wasn’t affecting his quest of the player, stayed quiet. fications for braces—little Velcro pitching, he and Cosentino decided it “My first obligation is to the ath- Continued on page 86

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straps or foam rubber—so they are tendonitis is another issue with run- ble to arch pain, commonly traced to more comfortable,” Weil says. “Guys ning around the bases. The quick an inflammation on the bottom of the who have had it happen in the past stop-and-start motion of baseball foot. It’s not uncommon for a team don’t wait until it happens again, they often creates pain and tightness in the podiatrist to prescribe orthoses to will start the season with these be- calf, and aggravation of the Achilles help alleviate the pain. cause they don’t want to get hit tendon.” A related condition for catchers again.” When a player does hit a foul is heel spur syndrome, which oc- off his foot, Dr. Runyon says it can The Battery curs when the plantar tendon pulls lead to bleeding under the toenails They say pitching and defense at its attachment to the heel bone and it “hurts like heck,” but once he wins baseball championships, so if and can later calcify to form a can release the fluid, it feels 1,000 one of a team’s pitchers is suffering spur. “Many times the ligament times better. from a foot injury, it could be the dif- pulling on the heel creates the Another injury that the podiatrists ference between a ring symptoms, and not the spur itself, especially after getting up from resting,” Dr. Runyon says. “With proper warm-up and the use of sup- Catchers are particularly susceptible to portive shoes, strain to the ligament arch pain, commonly traced to an inflammation can be reduced.” It is always best for injured base- on the bottom of the foot. ball players to allow themselves time to heal. Some athletes need hours of re-training, exercise, check-ups, and deal with often comes out of a runner or watching the game on TV. “Pitch- other remedies, but with the right at- trying to beat out an hit. “They ers will particularly have a few more titude and motivation, it is not hard are trying to run out a hit and stretch lower extremity issues,” Dr. Runyon to get back onto the field after foot out to the bag in an abnormal stride says. “Not only tendonitis and toenail and ankle injuries. and have an extra lunge, and the problems, but toe issues where the front foot hits the bag instead of the toes will curl up inside their shoe and An Early Jump on Things heel, and that puts a strain on their create blistering. That has probably When Dr. Oloff was worried foot and may cause a strained liga- more to do with repetitive motion about the way ment or tendon,” Cosentino says. than anything since they are twisting some of his play- “One of our important players tore his their bodies.” ers had responded plantar fascia ligament; he ruptured Because of a ’s motion and to treatment over the whole thing, and I gave him the the way they land on their foot, it’s the winter, he de- whole works of radio-frequency and not uncommon to see situations of cided to hire Dr. stem cells, and he was back in six corns and callouses developing, caus- David Jenkins to weeks.” ing a lot of pain. “The problem is that serve as the Gi- Sprained ankles are also common pitchers normally don’t like change ants’ podiatrist at among baseball players. Weil says but if we can get a pad or cushion in Dr. Jenkins their spring train- it’s important to make sure players there, we can help,” Dr. Weil says. ing site in Phoenix don’t get on the field too soon. “Sometimes we need to be frontline back in 2004. “They won’t tell you the truth, espe- medics with situations like that dur- “He was based in San Francisco cially the veterans,” he says. “If they ing a game.” and needed someone to be his eyes have a strained ankle or ligament, I J.P. Howell, one of the Rays’ top over here, so I started off doing real- make them hop in a figure of eight relief pitchers, was complaining about ly basic stuff, mostly biomechanical with the foot, and if they can’t, I not getting his foot comfortable last stuff,” Dr. Jenkins says. “I really don’t allow them back. I have never year, and his stats reflected his dis- loved being involved and the next had a manager or coach question my comfort. “He had this pain on the bot- year, an opportunity with the decision.” tom and back of his heel and seem- Dodgers came up and their head Dr. Runyon adds that stretched or ingly nothing the trainer did was trainer brought me in to work with torn ligaments can occur from run- helping,” Dr. Runyon says. “I them.” ning the bases, or pivoting to make a checked his uric acid level, and sure Dr. Jenkins evaluates the cleats of play. “Sprains may cause extensive enough, he had gout. I treated him all the players and will often work up swelling around the ankle just like a with medication, support, and a di- orthotics so they can function proper- fracture and often require casting,” he etary change, and he was completely ly in the cleats. “With elite athletes, says. “With base stealers, they are asymptomatic. He went from not you have the ‘princess and the pea’ going as fast as they can and I see a being able to pitch to being one of our syndrome, where they feel every little lot of tears in the plantar fascia, and most effective relievers.” sensitivity so you need to make sure that can be really painful. Achilles Catchers are particularly suscepti- Continued on page 88

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that they are comfortable with what deduced that it was hurting so and bruises can occur. Baseball teams they are wearing or there can be much that the hurler was favoring sign contracts with cleats vendors and problems,” he says. “It’s a small part, his other foot slightly, changing his sometimes that necessitates the whole but it’s up to me to make sure an in- motion, and causing the shoulder roster changing up from one company jury doesn’t happen because of their pain. “I fixed the toenail and the to another. footwear.” shoulder pain went away,” he says. “Nike is different than Adidas Routine care is also necessary “The one thing you learn on this so a player may be used to one and the fact that it’s spring train- ing, if a player finds he has a prob- lem, he’s most likely not going to get it fixed then and risk missing Achilles tendonitis and bursitis with fasciitis are often . “If they have a prob- associated with the cleats that ballplayers use. lem that would normally require a procedure, maybe minor surgery or a nasty corn, most will tolerate it until the season is over,” he says. job, everything is connected and manufacturer and then have to get “I keep them on the field the best I you can’t just look at an individual used to another,” Dr. Cosentino can.” spot.” says. “I might play with the insole Something as simple as an in- or have it removed if I see the play- grown toenail can also lead to big- Shoe Business er isn’t adapting well. I will build a ger issues. A pitcher with the The cleats one uses can also lead custom designed pair and send it to Dodgers was experiencing shoulder to injuries if the spikes get caught in the lab to get the design right into soreness and no one could figure the grass. Problems such as twisted it.” out why. Jenkins noticed the player ankles, fractured ankles, turf toe, and Achilles tendonitis and bursitis picking at the ingrown toenail and foot fractures, not to mention cuts Continued on page 90

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with fasciitis are often associated with and other problems.” Jenkins says. “You want to get your the cleats that ballplayers use. name out there.” Jenkins says that hallux limitus, hal- Getting in the Biz Another good tip Weil adds is not lux valgus, and hammertoes with Dr. Cosentino got his start in to be too aggressive with the ath- second metatarsophalangeal joint sports podiatry by helping out at high letes. “If there is a team doctor, capsulitis are quite common due to school sporting events and the local trainer, or orthopedic surgeon, wait the playing surface, prolonged sea- runner’s club. He eventually parlayed until you are asked for help. Don’t son, genetic predisposition to injury, that into a job with the NFL’s Tampa do anything until then,” he says. footgear, and the nature of the Bay Buccaneers. “The best way to de- “Being aggressive doesn’t work well game. velop a strong sports medicine prac- in professional sports. That’s a mis- Sometimes, Dr. Cosentino says, tice is to associate with physicians take younger people have. Be cool in players just need to use common and get to know trainers,” he says. “If what you do.” PM sense to avoid foot discomfort. you want to have this type of job, you “When Wade Boggs was my pa- need to concentrate and develop a tient, he purchased a brand new reputation with everyone in your Keith Loria is a free- pair of cleats and just took them area.” lance writer who has out of the box and started playing According to working major written about every- with them, and he got abrasion in- league baseball podiatrists, for young thing from baseball to juries,” he says. “I tell all my play- doctors one day hoping of cracking corporate mergers to healthcare, with a little ers to start slowly with new cleats one of the 30 jobs available, nothing entertainment thrown in and break them in. Use them for will help more than experience. “I the mix. Recent notable batting practice and make sure they recommend that young practitioners interviews include leg- are comfortable. Shoe sizing is a should volunteer services with a high endary actor William big issue and if they don’t fit prop- school team, do research and educate Shatner, heart surgeon pioneer Dr. Marc De- erly, it can cause stress fractures themselves as much as possible,” domenico and Pez Candy CEO Joe Vitttoria.

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