Active duty military personnel endure some of the most physically demanding routines, often placing tremendous strain on their bodies. Among the various injuries sustained, foot injuries are particularly common due to the rigorous activities involved, running, jumping, and carrying rucksacks or other heavy loads. Understanding these injuries, their prevention, and treatment is crucial for maintaining the health and readiness of our service members.
Common Foot Injuries
1. Plantar Fasciitis
Description: Inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot. Over time, inflammation of the plantar fascia can lead to thickening of the tissue, called plantar fasciosis. Plantar fasciosis can be challenging to treat, especially in our active duty military personnel.
Symptoms: Sharp heel pain, especially in the morning or after prolonged periods of rest. Pain is worsened by prolonged periods of standing or walking in combat boots. Running in combat boots can lead to debilitating pain in the arch or heel when patients are experiencing plantar fasciitis.
Causes: Overuse, improper or worn out footwear, and prolonged standing or running on hard surfaces, to name a few. Another cause is tightness of the Achilles tendon, a condition called ankle equinus, which places greater strain on the plantar fascia.
2. Stress Fractures
Description: Small breaks in the bones of the foot, often occurring in the metatarsals, but can develop in any bone of the foot or lower leg. Tibial stress fractures are especially common.
Symptoms: Localized pain, swelling, and redness that worsens with activity. Pain, redness, and swelling may improve with rest, but is often felt consistently when a stress fracture is present.
Causes: Repetitive impact activities like running, jumping, and marching, especially on hard surfaces. Patients with bunion deformities are especially prone to stress fractures of the metatarsal because of the strain placed on the metatarsals with running.
3. Achilles Tendonitis
Description: Inflammation of the Achilles tendon, which connects the calf muscles to the heel bone. Over time, the Achilles tendon can become thickened or develop micro-tears, a condition called Achilles tendinosis. Patients may also develop spurs on the back of their heels secondary to Achilles tendinitis.
Symptoms: Pain and stiffness along the Achilles tendon or at the back of the heel, particularly in the morning or after physical activity. There is often swelling localized over the back of the heel or along the Achilles. It can be difficult to wear shoes with a back on them because the shoe irritates the site of insertion of the Achilles.
Causes: Sudden increase in activity intensity, improper footwear, core stability weaknesses, and lack of flexibility in the calf muscles.
4. Ankle Sprains & Instability
Description: Occurs after a sudden twisting motion of the ankle in an inward or outward direction. The sudden twisting motion leads to stretching and/or tearing of the ligaments that support the ankle.
Symptoms: After an acute ankle sprain, patients experience swelling, bruising, and pain around the ankle, often coupled with difficulty walking. In the setting of ankle instability, which happens after an ankle sprain has led to a total tear of one or more of the ankle ligaments, patients easily and frequently roll their ankles. This can happen when a patient is simply walking around their house on flat and even surfaces.
Causes: Twisting or rolling the ankle, often during physical activities such as running or jumping, or on uneven surfaces. Foot structure, in patients with a high arch for example, can make a patient more susceptible to ankle injuries and instability.
5. Shin Splints
Description: Also called anterior tibial stress syndrome, pain is felt along the front of the lower leg or the shin bone.
Symptoms: Pain along the front of the shin which worsens with running and activity. The area can become swollen and warm to the touch if left untreated, and can progress to a tibial stress fracture.
Causes: Prolonged marching, running, jumping, or other activities cause a repetitive-load type of injury to the anterior tibialis muscle and/or the anterior tibia, or shin bone. Wearing ill-fitting or worn-out shoes, and having a weak anterior tibialis muscle can make a patient more prone to the development of shin splints. If ignored, the repetitive-load type injury can progress to a tibial stress fracture.
6. Blisters
Description: Fluid-filled sacs caused by friction between the skin and footwear. Blisters can drain clear fluid, and may become infected, showing redness, swelling, and significant pain.
Symptoms: Painful, raised areas on the skin that can sometimes burst, leading to raw skin exposure. Clear or bloody fluid can be expelled from the blister. If a blister becomes infected, it may show pus drainage, redness, swelling, and severe pain.
Causes: Prolonged marching, running, or wearing ill-fitting boots can cause blisters. Going without socks can lead to greater friction and the development of blisters. Wearing wet socks and shoes for prolonged periods will make blisters more likely to develop.
Prevention Strategies
1. Proper Footwear
Ensure boots and shoes provide adequate support and fit correctly. Replace worn-out footwear regularly. We recommend our active duty military patients replace their boots annually. Running or exercise shoes need to be replaced at more frequent intervals, every 3-6 months, depending on the average weekly mileage a patient walks or runs.
Use insoles or orthotic inserts if necessary to provide additional support and cushioning. These are a great tool for combating conditions such as plantar fasciitis and Achilles tendinitis, and can be worn in combat boots or exercise sneakers.
2. Gradual Increase in Activity
Avoid sudden increases in exercise intensity. We often see patients who have not been running or training present to the office with overuse injuries because of a rapid and sudden increase in their training. Gradually build up the duration and intensity of physical activities. This is especially important to prevent injuries and pain that can arise, such as stress fractures.
3. Foot Care Hygiene
Keep your feet clean and dry to prevent blisters and fungal infections. Change socks regularly and ensure they are moisture-wicking.
Disinfect the shoes weekly with Lysol spray. Shoes that are over a year old should be donated or tossed as these shoes will be much more difficult to disinfect.
4. Stretching and Strengthening Exercises
Incorporate regular stretching and strengthening exercises for the feet and lower legs to enhance flexibility and resilience.
Placing an emphasis on posterior chain stretching and strengthening is vital to prevention of conditions such as Achilles tendinitis and plantar fasciitis.
We recommend core stabilization exercises as well.
5. Rest and Recovery
Allow adequate rest periods to prevent overuse injuries. Listen to your body and avoid pushing through pain. It can often be difficult given the demands placed on our active duty military personnel, but rest is an important part of injury prevention.
Treatment Options
1. R.I.C.E. Method
Rest, Ice, Compression, and Elevation are first-line treatments for many acute foot injuries. This can be initiated before setting foot in our office for evaluation, and can aid in kick-starting the healing process.
2. Physical Therapy
After a thorough evaluation, we may recommend a patient engage in physical therapy to strengthen the foot and ankle muscles, improve flexibility, and promote healing. Our physical therapist colleagues play a vital role in ensuring our military patients are healthy.
3. Anti-Inflammatory Modalities
Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation and may be recommended temporarily.
Our office offers other treatments to reduce inflammation and therefore reduce pain, such as shockwave therapy and MLS laser therapy. If you are a candidate for this based on your evaluation, our physicians will discuss the benefits of these treatments at your appointment.
4. Custom Orthotics
Custom orthotics are a powerful tool in treating and preventing foot and ankle pain. These will be fabricated based off your unique foot type, and your gait analysis. Use of custom orthotic inserts can alleviate pain and prevent further injury.
5. Surgical Intervention (as the last resort)
In cases of severe or persistent pain, our podiatrists may recommend further testing, such as MRIs or CTs to evaluate the injury. Depending on the results of testing, treatment recommendations may include immobilization, injections, or, in rare cases, surgery. We reserve surgery as the last resort when all other treatments have failed.
Conclusion
Foot injuries are a significant concern for active duty military personnel, but with proper prevention and timely treatment, the impact of these injuries can be minimized. Prioritizing foot health ensures that our service members remain strong, resilient, and ready to meet the demands of their duties. For those experiencing persistent foot pain or injury, consulting with one of our podiatrists is essential to receive specialized care and support.
At Bayshore Podiatry Center, we are dedicated to providing comprehensive foot care tailored to the unique needs of military personnel. Contact us today to schedule an appointment and take the first step towards healthier feet.