Kickin' It with Podiatry

PODIATRY AND SPORTS MEDICINE Kickin’ It with Podiatry This sport is particularly hard on the feet. BY KEITH LORIA 117 ccording to editors at field who specialize in dealing with in the ‘90s and fought in many com- Black Belt Magazine, martial arts athletes. petitions and tournaments,” he says. nearly five out of every Alan Ng, DPM, surgical skills “I still train to this day. It’s my stress 100 Americans engage chairman for the American College relief and way of staying in shape. in some sort of martial of Foot and Ankle Surgeons, doesn’t I still train but I don’t compete any- Aarts, meaning approximately 16 mil- lion people are taking classes at the more than 40,000 martial arts schools around the country. I think it definitely helps me understand There are many disciplines of what my patients are going through martial arts and it can refer to any- thing from karate to Bok Fu to Judo and knowing what to look for when they come to Jiu Jitsu to Kung Fu to Tae Kwon Do to countless others. While each in complaining of pain.—Ng has its own distinguishing factors, the one thing they all have in common is that people just treat martial arts athletes, he com- more. I think it definitely helps me training in them petes at a high level in several disci- understand what my patients are often get injured. plines. Currently, he holds a second going through and knowing what to Many of these in- degree black belt in Shotokan karate, look for when they come in com- juries and prob- a second degree black belt in Enshin plaining of pain.” lems can be re- karate, and was the 1994 KyukToo Ng says that martial arts gives lieved by visiting Ki bare knuckle full contact heavy- way to a variety of injuries that ar- a podiatrist, and weight champion. He has also trained en’t often seen with other athletes. there are several in Muay Thai for the past 15 years. They can range from very minor Dr. Ng foot experts in the “I started training in college and © Neil Lockhart | Dreamstime.com Continued on page 118 www.podiatrym.com JUNE/JULY 2014 | PODIATRY MANAGEMENT PODIATRY AND SPORTS MEDICINE Kickin’ It (from page 117) the ground, resulting in tightening though most do not complain and of the fascia. seek out treatment (they are usually things (contusions, toenail trauma Ng sometimes deals with pa- seeing me for different reasons), cuts and uncomplicated fractures) to se- tients with sesamoiditis, another and bruises are readily treatable, and vere debilitating ones. type of repetitive motion-related simple wound care or cold compress- For those involved in more aero- injury that happens due to kick- es are usually prescribed. Other inju- bic-type martial arts, common podi- ing exercises. Someone kicking a ries can be specific per the sport. An atric-related injuries include plantar heavy bag while one foot is elevat- example would be Brazilian jiu jitsu, fasciitis, Achilles tendonitis, sesa- ed onto the metatarsal heads pivots where broken toes are a hazard due moiditis, and ankle sprains. Martial arts participants more involved in traditional methods—such as striking pads, a heavy bag, and/or another The most common foot fractures student—have more extensive inju- occur as spiral oblique injuries of either the digits ries that include fractures, hemato- mas, and dislocation of joints and or the metatarsals.—Sung tendons. “Most of the time what I am seeing in patients are small contu- the supporting leg. The long bone to the ground grappling.” sion-type injuries, little sprains, ankle behind the big toe has two small For ankle sprains, which can sprains and twists, mostly from im- round shaped bones underneath occur in martial arts but more pact,” Ng says. “Then there are lig- the head of the bone, and they can likely during sparring than during ament injuries from direct impact, become irritated and inflamed and training, Sung recommends rest, 118 such as kicking or hitting the bag cause pain just behind and under icing, compression and elevation wrong or someone catching impact the big toe. (RICE). Ankle sprains, especially the in the wrong spot. I see a lot of front Since the Achilles tendon is in- very common lateral ankle sprain, joint contusions and sprains from volved in bringing the foot into posi- occur most often during sparring that.” tion for many of the kicks necessary when an athlete is changing posi- One common thing he sees from in martial arts, Achilles tendonitis tions quickly, as quick changes in martial arts athletes is improper form comes into play. Someone practic- direction during sparring can result when kicking the bag, perhaps from ing karate may engage in as many in being caught off balance. a roundhouse kick, causing metatar- as 400-500 kicks during a training “Depending on the severity, sal injuries. Impact into the bag with session so an overuse injury to the bracing may be required for three improper force causes partial strains, Achilles tendon can result in Achilles or four weeks, and swelling can last swelling and discomfort in ligaments. tendonitis as well. over one to two months,” he says. These can take any athlete out of “Ankle sprains are very common “Most times, an x-ray is taken to rule training for a while. “Due to the con- in martial arts training,” Ng says. out other pathologies, but there are stant pivoting and elevation of the “The abundance of side-to-side mo- generally very little to no long-term foot while performing kicks, plantar tion and one limb support while kick- sequelae after the ankle sprain has fasciitis and plantar fascial injuries ing makes this injury a common one healed.” often occur in martial arts training when training.” Contact is obviously a large part for more serious athletes,” Ng says. Jay Sung, fac- of some martial arts mediums—hit- “The pain will be located at the in- ulty and attend- ting a punching bag, an opponent side of the heel and at the bottom ing physician for or sometimes a block of wood—and of the heel when this type of injury White Memorial that results in many fractures to the occurs.” Medical Center, foot and ankle, especially digital and He explains that the mechan- Los Angeles, Cal- metatarsal fractures. These can result ics of performing a front or round- ifornia is a board in an inability to put weight on the house-type kick involves the sup- certified, fellow- foot, and swelling and bruising will porting leg pivoting on the ball of ship-trained foot most likely appear. the foot, while the other leg is in the Jay Sung and ankle sur- Sung says, “The most com- air striking the target. The fascial geon. He says the mon foot fractures occur as spiral injury can occur on the support- variety of injuries in martial arts is oblique injuries of either the digits ing leg due to the strain on the fas- great but the most common injuries or the metatarsals. They are usu- cia, or a fascial injury can occur to for these sports have to be cuts and ally the result of the torsion gener- the striking leg due to the repetitive bruises. ated by the impact of the moving pushing off and tightening of the He says, “For my practice, I have foot hitting a fixed object, such as fascia when beginning the kick, or encountered patients training in mar- an opponent.” when the kick is concluding, which tial arts to have a high number of Another very common injury causes the kicking foot to return to bruises to the legs and ankles. Al- Continued on page 119 JUNE/JULY 2014 | PODIATRY MANAGEMENT www.podiatrym.com PODIATRY AND SPORTS MEDICINE Kickin’ It (from page 118) and see results in their art. Conditioning also helps prevent sloppy technique which can lead to injury due to with those practicing martial arts is hematoma formation, fatigue.” which occurs when the foot or leg strikes a target im- Dr. Ceasar Irby, a podiatrist with the Northeast Med- properly or strikes a target that is not padded well. Sung ical Group in Stratford, Connecticut adds that most nag- explains that by striking an object incorrectly, multiple ging strains and sprains can be avoided with a proper vascular structures are disrupted, causing bleeding inside post-workout routine as well, stretching one’s feet and the foot or leg and swelling of the foot. The primary treat- ankles after training. Other tips Irby gives for proper ment for hematoma is rest, ice, compression, and eleva- foot care are to clean feet with warm soapy water and tion. dry thoroughly to prevent foot fungus, moisturize feet to Dislocation of the toes is a common occurrence in prevent skin fissuring that can lead to athlete’s foot, and martial arts since many of its disciplines are done without apply lotions/creams after showering, avoiding the areas the use of footgear. Tendon dislocation is another prob- between the toes. lem that many podiatrists see. The age of participants should also be considered Ng says, “The characteristic of this injury is that when warming up. Ng says that knowing one’s body the tendon which is usually behind the fibula will limits is important, claiming he can’t do the same pop around the outside of the bone when the foot is thing now that he could in his twenties and thirties. pushed up. The injury will feel much like an ankle He says, “Most of the population are not professional sprain.

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