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Injuries Related to Being Active with Diabetes: Part 5 (Foot and Ankle Injuries)

Oct 20, 2009


By Sheri Colberg, Ph.D., FACSM



Feet and Ankles

Because of the amount of stress placed on your feet and ankles, they are also a common site of overuse injuries, including plantar fasciitis, chronic sprains, Achilles tendon problems, blisters, calluses, and ulcers. For people with diabetes, particularly if they lose some of the feeling in their feet, blisters, calluses and ulcers can lead to larger problems, possibly even gangrene and the need for amputation. In some cases, foot deformities (e.g., Charcot foot) are more likely to develop following a sprain and continued walking when you have neuropathy; at such times, a foot cast may be necessary for appropriate healing to take place. In addition, people with any type of diabetes have greater risk of fractures of the metatarsals (long bones in the feet), likely because of some loss of calcium and other minerals associated with long-term diabetes. In athletes without neuropathy, though, plantar fasciitis is the biggest concern, followed by problems with the Achilles tendon.




Plantar Fasciitis 

An inflammatory overuse injury, plantar fasciitis is the most common cause of heel pain. It is usually recognizable by your first steps in the morning being painful. Your feet are extended when you sleep (in a position called plantar flexion), which allows the fascia that makes up the underside of your foot to shorten. Pain also occurs at the start of activity and generally goes away with use, but it returns after a long rest when you restart being active. Plantar fasciitis is common in runners and in those who gain weight quickly because the plantar fascia runs the length of the inside of your arch, and it is stretched to flatten your arch slightly each time your heel hits the ground. The plantar fascia isn’t very flexible, so repetitive stretching from impact can result in small tears in the fascia, which then become inflamed.

You’re more likely to get this injury if you have very flat feet or high arches, excessive pronation (tipping your ankle inward to flatten your arches), a tight Achilles tendon, obesity, or sudden weight gain. It can also result from a rapid increase in your workout intensity or duration, wearing shoes with poor cushioning, a change in your usual running or walking surface, or having to stand upright for excessively long periods. A Type 2 diabetic athlete from Mesa, Arizona, found out the hard way that you can also develop this problem from not wearing shoes at all. Her fitness routine includes doing "Dance, Dance Revolution" (a video game on Playstation and Wii), which she did in her socks until she developed plantar fasciitis. After taking two months off from it, she now does the game wearing proper athletic shoes.

If you find yourself with plantar fasciitis, taking NSAID’s can help control the inflammation and resulting discomfort. In addition, take some time off from the activities that are most irritating to that area, including walking barefoot on hard surfaces. It may also help to stretch the plantar fascia and massage that area by rolling your foot over a 3- to 4-inch (8- to 10-centimeter) diameter tube like a rolling pin, soup can, or tennis ball. You can also try taping your heel and arch and using medial, longitudinal arch supports and good shoes.

A new stretching technique may reduce pain when performed several times a day. To do it, you need to cross one leg over the other, pull your toes toward your shin for a count of 10, and repeat 10 times. To prevent recurrence, try doing strengthening exercises, such as scrunching up a hand towel with your toes or pulling a towel weighted with a soup can across the floor. After exercising, ice your heel where it is most sore for 15 to 20 minutes to relieve pain.

Achilles Tendinitis

This type of tendinitis is caused by inflammation, irritation, and swelling of the Achilles tendon, which is the one that connects the two calf muscles, the gastrocnemius and the soleus, to your heel bone (the calcaneus). You use these muscles for pushing off your foot or going up on your toes and, of course, for walking and running. As an overuse injury, it occurs most commonly in walkers, runners, and basketball and volleyball players, because of the large amount of stress that jumping puts on this tendon. As you age, you can also experience Achilles problems from arthritis, which can cause extra bony growths on the heel (i.e., spurs) that inflame the tendon. Having an inflammation in this area also increases your risk for experiencing rupturing of your Achilles tendon, correctable only with surgery. 

Usual treatments include rest, ice, NSAID’s, exercises, and occasionally a cast, boot, or brace worn to keep it from moving and becoming more inflamed before the swelling goes down. To prevent Achilles tendinitis, progress slowly when starting an exercise program after being inactive for a while and make sure to stretch your calves and thigh muscles properly. Another point of caution is relevant if you’ve been wearing high-heeled shoes and switch to flats. Your Achilles tendon and lower leg muscles adapt to a shortened position because the high-heeled shoes prevent your heel from stretching down to ground level; putting on flat shoes to exercise causes your tendon to stretch farther than it’s accustomed to, which can cause it to become inflamed. If you wear high heels regularly, stretch every morning and night to keep this tendon a more normal length to prevent problems.

In my next column, you’ll learn more about prevention of muscle cramps and soreness.

This column is excerpted from Diabetic Athlete’s Handbook (2009), which contains essential exercise-related information and examples for Type 1, Type 1.5, and Type 2 diabetic exercisers of all ages. More information is available at www.shericolberg.com.

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