Secrets To Treating Lower Extremity Volleyball Injuries

By Mark A. Caselli, DPM

What About Achilles Tendinitis, Peroneal Tendinitis And Plantar Fasciitis?

   Achilles tendinitis is another common overuse injury among volleyball athletes and occurs more frequently with indoor players. The repetitive eccentric loads of jumping, particularly on hard surfaces, can cause microtears within the tendon. Tight hamstrings, tibial varus, pes cavus and a tight gastrocnemius-soleus complex also predispose these athletes to tendinitis. Athletes will complain of pain while jumping or running that increases over time. Clinicians may detect tenderness, localized swelling, thickening, and crepitus upon palpation. Strength testing may reveal weakness in plantarflexion.    When it comes to treating these injuries, one should ask athletes to reduce their jumping activities, properly stretch the gastrocnemius-soleus complex and use taping to reduce dorsiflexion. Clinicians can add a 1/4- inch to 1/2-inch heel lift to each shoe to reduce stress on the tendon. As symptoms subside and flexibility increases, one can allow a slow progression back to jumping activities. Leave the heel lifts in the shoes for the first seven to 14 days of practice to offer some shock absorption and protection to the Achilles tendon.    The practitioner should always be aware of the possibility of a ruptured Achilles tendon. One would make this diagnosis with a positive Thompson test and/or a palpable tendon defect, and should confirm this with a MRI.    Peroneal tendinitis is often present in volleyball athletes with pes cavus feet. Frequent dorsiflexion and eversion movements while setting and playing defense are the usual causes. Tenderness, inflammation and crepitus may be palpable along the peroneal tendons and range-of-motion testing will reproduce symptoms of pain. Treatment includes ice, compression, elevation and antiinflammatory drugs for pain management. Initiate exercises to strengthen the peroneal musculature. One can use arch taping, foot orthoses and foot wedges to aid in correcting biomechanical abnormalities.    Plantar fasciitis is common in volleyball athletes because of the repetitive jumping required for the sport. The surface and type of shoe can also contribute to this condition. Athletes who practice on hard surfaces without adequate arch support are predisposed to plantar fasciitis. Other contributing factors include a tight gastrocnemius-soleus complex, a tight longitudinal arch and excessive subtalar joint pronation. With indoor athletes, one can treat this with an appropriate pad, heel wedge and/or foot orthoses. The only way to treat these injuries in beach volleyball, which is played barefoot, is to employ an appropriate supportive taping on the foot. Prevention begins with a stretching regimen, offseason conditioning, correct jumping technique and pronation control.

Addressing Hyperextension And Hyperflexion Injuries

   Hyperextension injuries of the great toe (turf toe) and lesser toes occur in both indoor and outdoor volleyball athletes. Employing taping techniques to prevent hyperextension can ameliorate this problem. Avoid ongoing hyperextension trauma since it can lead to hallux rigidus. When treating the indoor player, conservative treatment of hyperextension injuries includes the use of a stable, stiff-soled shoe and appropriate foot orthoses. Taping is the mainstay for beach volleyball players.    Hyperflexion injuries to the toes are rare indoors. It is common to have the toes fold plantarly when landing following a jump on uneven terrain (sand). Taping can prevent reexacerbation of this problem. Capsulitis and synovitis of the metatarsophalangeal joints may become chronic in addition to joint laxity. In chronic symptomatic cases that do not respond to conservative treatment, performing a synovectomy or surgical ligament or capsular repair may be indicated. Dr. Caselli is a Staff Podiatrist at the VA Hudson Valley Health Care System in Montrose, N.Y. He is also an Adjunct Professor at the New York College of Podiatric Medicine and is a Fellow of the American College of Sports Medicine.


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