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Pertinent Insights On Preventing Injuries On Tennis Court Surfaces

This author provides a guide to preventing unnecessary tennis injuries caused by inappropriate shoe selection on the sport’s three most common surfaces.

The tennis player presents a unique challenge to the podiatric physician and surgeon. For each different playing surface, there are unique shoe gear considerations that one needs to take into account in order to avoid common injuries.

The most common surface in the United States is the hard court, which is a mixture of rubber acrylics, silica, asphalt or concrete and sand.1,2 This mixture induces tremendous amounts of shock to the lower extremities with each limb supporting up to six times the player’s body weight. This produces common complaints such as patellar tendonitis, Achilles tendonitis, plantar fasciitis and plantar heel bruising.3-4

A rule of thumb on tennis courts is that the harder the surface, the heavier the shoe should be. Most hard court shoes are manufactured at around 14 to 15+ ounces for a size 10.5 shoe. This bulk gives the shoe’s outsole durability and cushioning for hours on unforgiving asphalt or concrete. Those who predominantly play on hard courts should avoid lighter, clay-specific shoes.

What You Should Know About Clay Courts

Clay courts are the second most common court surface for tennis in the United States. They are made of crushed brick (red clay) or a proprietary mixture of natural materials with a chemical binding agent (green clay).1,2 While this surface is much softer and more forgiving on the lower extremity than hard courts, the delicate moisture balance needed to keep clay tennis courts safe can come with its own set of challenges. If the court is too dry, it can induce slipping and sliding, which can cause frequent hamstring and Achilles strains. If the surface is too moist, the tennis shoe can “catch” on the clumps of clay causing ankle sprains.

In regard to these surfaces, I routinely recommend shoes with a herringbone pattern. These shoes are on the lighter end of the spectrum (10 to 13 ounces for a size 10.5 shoe). They are forgiving on wet surfaces but are also able to grip slightly dry surfaces. For patients who slide into their shots, a commonly taught technique on clay surfaces, I place a layer of adhesive felt on the underside of the shoe’s vamp to prevent the forefoot from jamming in the toe box. Such a sliding motion can cause blisters, onychodystrophy, onycholysis, subungual hematoma, turf toe and hallux limitus.

Considerations For Play On Grass Tennis Courts

Grass tennis courts are uncommon surfaces for the routine tennis player. Grass is the softest surface on which tennis players play.1,2 Dry grass courts pose the same risks as clay courts. Players should avoid a moist grass court as the most common injuries on grass are ankle sprains and hyperextension injuries due to poor traction.

Shoes designed for grass court play are outfitted with rubber “nubs” on the plantar and distal outsole to grip the soil underneath the grass. If the player does not have access to these shoes, a deep herringbone pattern is acceptable. The shoe should be heavy enough to grip the dirt under the blades of grass. If a patient is going to be playing on a grass court for the first time, he or she should do an extended warm up to get a sense of the proprioceptive challenges that grass presents.

I routinely educate on proprioceptive exercises for grass court tennis players or tournament participants in infrequent grass court events. Some examples include drawing the alphabet with the ankle, toe curling using a towel, balance boards and single limb balancing exercises. Many players elect for a basket weave prophylactic taping prior to grass court play.5

When Athletes Play Tennis On Carpet Courts

Carpet tennis courts are uncommon for routine play given their high propensity for injury. Carpet tennis courts are sanded to allow for the softness of grass and the traction of clay. However, if the sanding is not uniform, unsanded spots will snag the plantar outsole of the shoe and spots with too much sand can cause slippage. For carpet court play, I recommend a hybrid shoe and for the participant to pay close attention to the condition of the court.

In Conclusion

The ailing tennis player can benefit from a podiatrist who is knowledgeable in the intricacies of play on multiple surfaces. Those athletes who have experienced significant fatigue due to years of play on hard courts can benefit from switching to a well-maintained clay court with the appropriate shoe.

For clay court players having issues with recurrent injuries, I first ask about the quality of the surface they are using and then I assess their shoe design. Most hard-court shoes have limited traction for natural surfaces although there are hybrid designs available. A clay tennis shoe will break down faster on hard courts than a hybrid or hard-court shoe because of the heat produced by a hard court on the less bulky outsole and the smaller surface area created by the herringbone pattern of the clay shoe. Advise grass court tennis players on proprioceptive exercises, bracing and strapping for prophylaxis.

Ultimately, the physician must meet the demands of the surface under the players’ feet to improve their performance and avoid recurrent injuries.

Dr. Thomas is a United States Professional Tennis Registry-certified tennis professional, a former NCAA Division II tennis player/coach and a former NCAA Academic All American. He is in private practice in Pittsburgh. 

References

1. USTA Facilities. Available at www.usta.com/facilities .

2. ITF Facilities Surface Descriptions. Available at www.itftennis.com/technical/facilities/facilities-guide/surface-descriptions.aspx .

3. Bouche RT. Racquet sports: tennis, badminton, squash, racquetball, and handball. In: MB Werd, LE Knight (eds): Athletic Footwear and Orthoses in Sports Medicine, Springer, New York, 2010.

4. Valiant GA, Cavanagh PR. A study of landing from a jump: implications for the design of a basketball shoe. In: Winter DA (ed): Biomechanics IX, Human Kinetic Publishers, Champaign, IL, 1983, pp. 117-122.   

5. Werd MB, Knight EL. Athletic Footwear and Orthoses in Sports Medicine (Kindle edition). Springer, New York, 2010, p. 223.

6. Macdonald R. Taping Techniques: Principles and Practice. Butterworth-Heinemann, Oxford, U.K., 1994.

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Zach Thomas, DPM, AACFAS
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