Key Insights On Treating Tennis Injuries

Author(s): 
By Eric Feit, DPM

   One of the fastest growing sports in the United States, tennis is also one of the few sports that people can play throughout their lives. More and more seniors are active tennis players and they have their share of foot and ankle injuries. Other tennis players are very similar to most weekend warriors in other sports such as running, aerobics and volleyball. It is very difficult to slow them down even if they become injured.

   This is the challenge for the foot and ankle specialist. How can we treat injured players and keep them on their feet? What alternative forms of exercise can we offer them that may not aggravate their current injury? If they compete in local tournaments, how can we keep them playing and still improve their symptoms?

   There have been many new advances in equipment over the past decade and they have dramatically changed the nature of the sport. The racquets are lighter with more shock resistance and they generate much more power. As a result, the ball moves more quickly and may result in more sudden reactions and sudden movements by an opposing player. This may cause a variety of injuries but the lower extremities are particularly vulnerable.

   A prior study on the prevalence of lower extremity tennis injuries surveyed nearly 400 recreational players about their types of injuries.1 The most common injuries were subungual hematomas, muscle cramps (particularly calf and foot), muscle strains (particularly groin and calf), knee injuries, ankle sprains, plantar fasciitis, Achilles tendonitis and a heel bruise (see “Prevalence Of Lower Extremity Injuries In Tennis” below).

Pertinent Pointers On Treating Subungual Hematomas

   The sudden movements of starting and stopping that occur while playing tennis often cause the foot to slide forward within the player’s shoe, resulting in trauma to the toenails. The force of impact from the end of the toenail transmits proximally along the nail, resulting in disruption of the nail plate from the underlying vascularized nail bed. The painful symptoms that ensue are related to the increased pressure on the nerve endings produced by the pooling of blood within the nail bed.2

   Several factors may contribute to this injury. These include improperly sized shoes, loose fitting shoelaces, long toenails or digits, movement of the foot if wearing two pairs of socks and the hardness of the playing surface. When an injury occurs during a match, it is a very difficult problem to treat immediately. It will often prevent the player from being able to play at that time.

   Ideally, one would treat this injury by using a sterile 18- to 22-gauge needle to drain the fluid in the center of the nail. Once the fluid drains, the patient often has enough pain relief to keep playing. If the patient presents to the office, one should tape the toe circumferentially after drainage in order to keep the nail in place unless it is very loose. Performing a total nail avulsion will alleviate the pain but the player may not be able to play tennis for a few days after the procedure. It is important to advise the patient that if he or she leaves the nail intact and simply tapes it, it may come off on its own or develop underlying fungus.

Stressing The Prevention Of Muscle Cramps

   Muscle cramps can often prevent a player from completing a match or result in limited movement for the remainder of the match. A cramp results from decreased blood volume due to an excessive loss of body water from sweating.3 Factors that influence the degree of sweating include increased heat, electrolyte loss, poor conditioning, inappropriate clothing and the duration of the match.

   Calf and foot cramping are particularly prevalent due to the physiologic demand athletes place on these muscle groups in tennis. This is most common when a player propels forward into the court when serving, when rushing the net, when moving laterally to retrieve a wide shot or when changing direction.

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