There were a lot of reports circulating last month about the rise of injuries in the National Football League (NFL). An Indianapolis Star article noted that after four weeks of play, 34 players had been placed on injured reserve, the highest number in six years. As this issue went to press, 346 players are listed on injury reports in the NFL with the injuries ranging from mild to season-ending injuries. (That is an approximate average of 11 injured players per team.) Sixty-three of these injuries (18 percent) are lower-extremity injuries.

   When asked about the causes behind the recent wave of injuries, many cite the high-impact, high-velocity collisions of the sport. Others cite playing surfaces, particularly artificial turf, as a contributing factor.

   What caught my ear, though, was a recent comment from reporter Peter King on HBO’s Inside The NFL. Discussing the slew of recent injuries in the NFL and the various theories about it, King noted that one of his sources cited the inadequacy of the football shoes, saying they were equivalent to wearing ballet shoes on the football field.

   One DPM believes football shoes have improved in recent years as there are more sizes and more choices for athletes. However, other podiatrists cite potential problems with football shoes. One podiatrist says there has been a trend toward lower profile, lower bulk shoes that are more streamlined and anatomical but the increased torque with these shoes may facilitate too much flexibility. “You can twist these shoes like a piece of licorice,” he says. On the other hand, he says, you have shoes that are too rigid. He says there needs to be more middle ground between the two extremes.

   Another DPM who frequently lectures on sports medicine topics says the last for football shoes may not be wide enough to accommodate players’ feet. He says the plastic outsole that is cupped around the midfoot may cut into the foot sometimes and possibly predispose an athlete to a Jones or proximal-lateral metatarsal fracture.

   Some football cleats — such as those with longer, irregular cleats at the peripheral margin of the sole with small pointed cleats in the middle of the sole — produce more torsional resistance, which may increase the risk of knee injuries, cites another DPM, who is a team podiatrist for high school and college teams, and has been an athletic trainer since 1976. He says flat cleats, screw-in cleats or pivot disk models have decreased torsional resistance and are therefore less likely to cause knee injuries.

   He also cautions that football cleats “typically have little or no arch support” so there needs to be room for an orthotic device. It’s also important to educate athletes on appropriate orthotic use. One podiatrist who treats professional athletes notes that some patients take orthotics from their old shoes and place them in new shoes. He says one pro football player wound up suffering a season-ending injury as a result.

   The consensus among the podiatrists whom I spoke with is there are five key fundamentals for an appropriate football cleat. It should meet the demands of the player’s position, the playing surface, the temperature and address the player’s foot type and any biomechanical problems.

   The nature of the game isn’t going to change and the playing surfaces are largely beyond one’s control. However, if teams place more emphasis on preseason foot and ankle screenings, and seek more input from podiatrists on appropriate footwear for their athletes, it will likely have a favorable impact on reducing the number of football injuries at the high school, college and professional levels.