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Agony of the Feet
November 21, 2000

Stroll into any suburban town in the U.S. on a Saturday morning and you’re likely to see a replay of the same scene: hundreds of kids taking to the fields to play soccer. The game is not only one of the most popular team sports in the world, it’s also one of the fastest growing in the U.S.

But with more kids playing soccer, more of them are suffering injuries—particularly of the legs and feet. And according to one researcher, growing feet and the way soccer cleats are constructed has a lot to do with many foot injuries.

Painful reality

According to the National Soccer Participation Survey, almost 14 million children between the ages of 6 and 17 played soccer in 1998. More children in this country now play the sport than Little League baseball. With so many players out there, it’s not surprising that injuries abound. More than 200,000 youths under age 15 are treated for soccer related injuries each year, according to the Centers for Disease Control and Prevention (CDC).

Chelsea Metz

Chelsea Metz has been playing soccer since she was five. But a painful injury that affects mostly young soccer players between the ages of nine and 12 almost sidelined this athlete.

"I felt a sharp pain in my Achilles, right in back of the heel," she says. "After about twenty minutes of playing on and continuing through the pain, I couldn’t run, so I had to leave."

Chelsea thought she had hurt herself by not stretching properly. But her doctor says the injury had another cause. "We feel the shoe that the child is wearing is very much responsible for a good portion of the problem," says Dr. John Walter, a podiatrist and professor at Temple University’s School of Podiatric Medicine.

Achilles is the weak spot

This computer-generated 3-D graph/animation shows how much pressure is put on certain parts of the foot for a soccer player wearing soccer cleats (a sensor giving these redadouts was attached to the subject’s foot while he walked and ran on a treadmill and a computer generated the pressure results). Two steps are shown here, one of which has been slowed down to better display the readings. Red shows the most pressure while blue is the least.

Chelsea suffers from a condition known as calcaneal apophysitis, or Sever’s disease, an inflammation of the growth center in the back of the heel bone, says Walter. When the foot grows, bones often grow faster than muscles and tendons, which become tight. This makes the heel less flexible, causing the tendons to put too much pressure at the back of the heel. Because he saw a lot of this type of injury every spring and fall, Walter deduced it was related to soccer.

To find out exactly what it was about the sport that causes heel pain, Walter took 36 boys between the ages of eight and 11 to a soccer field and videotaped them while they were running in both cleated and non-cleated shoes. He also used an in-shoe sensor called an F-scan to study foot positions and pressure points during running. The research was funded by The American College of Foot and Ankle Orthopedics and Medicine, with Nike contributing the shoes.

The results showed that the cleat design puts more pressure at the rear of the foot. Frame by frame analysis of the videotape and the sensors showed that 23 of the boys took longer to lift their heels while running in cleated shoes, while 26 of them had a more dorsiflexed, or "negative heel" foot position, meaning that their heels were lower compared to the rest of the foot.

The heel of a person with Sever’s disease.

"At heel contact, the force and increase of body weight is substantial and what that does is drive the heel cleats into the ground at a much lower depth than the front cleats," Walter explains, "and essentially creates ‘negative heel,’ which means the back of the heel is lower than the front when the entire shoe is on the ground."

This positioning puts stress on the back of the heel, causing inflammation of the heel plate, or growth center, of the heel bone, which doesn’t fully close until age 15 or 16. The problem is exacerbated by the repetitive movements associated with soccer and continued playing despite the inflammation. Experts say that heel pain is the most common problem in soccer players between nine and 12 years old, but Sever’s disease doesn’t cause deformities or long-term problems.

Back on the right foot

Soccer Safety Tips

•Make sure your child wears all recommended safety gear, especially shin guards.

•Insist that your child warms up before playing, especially before shooting goals.

•Don’t encourage your child to play through pain. If he or she gets injured, see your doctor and follow the advice given.

•Make sure your child follows all the rules of the game, which coaches should enforce. Coaches should also be aware of special injury risks that children face.

•Have fun. Don’t put too much emphasis on winning or your child may push too hard and risk injury.

courtesy of the CDC

So what should you do if your child complains of heel pain? A lot of parents don’t know what to make of it, so they just ignore it. Walter says that kids are taught at an early age to endure pain, and that this is the wrong message. But heel pain can be treated fairly easily.

Simply elevating the heel can be helpful if the problem is minor. Children with more serious cases need turf shoes or should be restricted in how much they wear cleats. If the pain is too debilitating, they have to stop playing and stay off their feet.

In Chelsea’s case, adding heel lifts to her soccer shoes solved the problem. But she has another piece of advice for kids who get hurt. "The more you continue just to play through the pain, it’s just building up and in the end it’s just going to hurt you more," she says. "And when you can’t play forever, it’s a lot worse than not having to play one game."

Elsewhere on the Web

The Evaluation of Cleated Shoes with the Adolescent Athlete in Soccer (Walter’s study)

Sports and Your Children’s Feet (American Podiatric Medical Association)

Contact Sports and Your Feet (American Podiatric Medical Association)

Soccer safety info from the CDC

Safety tips from the American Academy of Orthopaedic Surgeons

American Academy of Pediatrics policy statement on safety in soccer

U.S. Consumer Product Safety Commission

The Institute for Preventative Sports Medicine

National Youth Sports Safety Foundation

American Youth Soccer Organization

Soccer Association for Youth USA

US Youth Soccer

by Jill Max

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