A Guide To Common Foot And Ankle Golf Injuries
Foot and ankle injuries that happen during golf activities can occur from traumatic events but are more likely to occur from overuse type injuries. Having practiced in a golf resort and retirement community for over 20 years, I have seen many different overuse injuries that could be directly related to the mechanics of the golf swing.
In personal discussions I have had with Ken Crow, the Director of Golf Instruction at the Pinehurst Resort and Country Club in Pinehurst, N.C., the golf swing can be broken down into the following phases: set up, takeaway, downswing, impact and follow-through.
At set up, the weight should be evenly distributed on both feet with slightly more weight on the inside of the balls of the feet. During the takeaway or backswing phase, the front foot should pronate, placing more pressure on the inside of that foot while the back foot stays stable as it receives more weight. The front foot heel may come off the ground and place more pressure on the ball of that foot. This is necessary to promote a full shoulder turn.
During the downswing, weight rapidly shifts to the front foot until impact when the weight should be evenly distributed between the feet again. There is a lateral shift of the hips and knees during downswing that continues through impact and will continue slightly into the follow-through phase. During the follow-through phase, the front foot supinates and the back heel comes off the ground with the weight of the back foot being placed on the big toe.
What The Literature Reveals
There is little published on lower extremity golf injuries. Campbell describes multiple golf injuries with the back and the elbow being the most common areas injured.1 He does not mention any foot or ankle injuries. Foster cites back and upper extremity injuries, but does not include any lower extremity complaints in his list of top 10 golf injuries.2
In their review of golf injuries and treatment, Herring and Pearson state that injury rates per golfer per year range from 1.19 to 1.31 with 37 percent of those injuries occurring in the low back or lower extremity.3 They presented a case study of one patient with heel pain who was treated with a combination of podiatric and chiropractic care. Daniels states that the most common golf-related foot injuries he sees are heel pain, metatarsalgia, Morton’s neuroma and tendonitis.4 He says these injuries are caused by increased motion of the foot. A study by Stude and Gullickson found that orthotics can increase balance and allow golfers to drive the ball farther.5
How To Recognize And Address Intermetatarsal Neuromas
The most common golf-related complaint I see is an intermetatarsal neuroma. It typically occurs in the third interspace and is almost always in the non-dominant foot. In other words, if the golfer swings the club right-handed, the neuroma occurs in the left foot and vice versa. This occurs due to the repetitive force placed on the nerve between the metatarsals as the momentum of the golf swing causes the forefoot to invert at the end of the golf swing.
The irritation of the nerve is more noticeable on longer shots such as a drive and is imperceptible on shorter shots like putts. As the forefoot inverts and the rearfoot supinates, the common interdigital nerve gets irritated within the third innerspace. This nerve unit then enlarges due to the irritation and the classical neuroma symptoms develop. These symptoms include burning, numbness and shooting pain into the toes.
The treatment options for this problem are the same as for any neuroma. They consist of NSAIDs, corticosteroid or alcohol sclerosing injections, orthotics and surgical intervention. One important treatment goal is to adjust the mechanics of the swing to decrease the inversion and supination of the foot. A 45-degree abduction of the front foot during ball address will decrease the inversion at the end of the swing and decrease the mechanical irritation of the nerve. Most of these golf-related neuroma cases resolve with a simple change in stance and minimal other treatment.