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Are you slowly killing your feet? Whether you're suffering from bruising, an ankle sprain or fracture, learn how to protect your primary asset.
Contusions / Bruises
A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin. The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body’s response to the injury. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis.
Contusions, which are usually less severe than fractures, are a common result of sparring. Advancing opponents often cut short well-intentioned kicks, which land in an unintended area such as the elbow or shin.
Contusion injuries may have symptoms for up to six weeks although one can usually recommend an early return to martial arts activities. No objective criteria are available for deciding which fighters should be removed from the field of play and which may return to competition. In general, individuals with injuries involving the larger muscle groups, such as the quadriceps or calf, have to stop for immediate attention and evaluation. Each case must be assessed on an individual basis. The first step is to ice the affected area and reassess function and swelling within a short period. You must always consider the potential for re-injury when deciding when to return to competition. Re-injury of an injured muscle is a major factor in developing further damage and also significantly increases the healing time.
Ankle Sprains
Most ankle sprains involve the foot suddenly rolling under the ankle as you bring your weight to bear on the foot. This excessive movement past the ankles normal range of motion can tear the ligaments on the outside of the ankle — the ‘straps’ that hold the joint together.
Acute swelling on one or both sides of the ankle bones accompanied by pain or difficulty putting weight on the foot, often requires immediate rest and injury assessment. Icing, compression and elevation will limit the pain, reduce the amount of tissue damage and result in a faster recovery. The high forces that can sprain ankles can also break bones and chip cartilage within the ankle joint, foot, and the lower leg, so careful medical examination is important with potential X-Rays providing clarification as to the condition of the local bony structures. Even a diagnosis of a simple ankle sprain requires full recovery — one of the most common causes of recurrent ankle sprain is the previous sprain that was never properly treated or rehabilitated. Ligament repair usually does not require surgery and will heal sufficiently to resume full impact training within two to three weeks.
Disability from an ankle sprain can last four months or more. It is essential that all ankle injuries be totally healed before returning to competitive sparring. If you’ve recently sprained an ankle, the best prevention for future re-sprains is retraining your ankle muscles and proprioception — the sense of how your foot and ankle are positioned relative to the ground. Sound medical advice and thorough rehab is often the fastest way of returning to full, uninterrupted training and sparring after a major sprain. The ankle should be pain-free, with full ankle joint range of motion available and ability to walk and run without a limp. There should be equal and symmetrical ankle proprioception for both limbs.
Fractures
A broken bone or bone fracture occurs when a force exerted against a bone is stronger than it can structurally withstand. Bones are a form of connective tissue, reinforced with calcium and bone cells. Bones have a softer centre, called marrow, where blood cells are made.
There are different types of bone fractures that vary in severity. Factors that influence severity include the degree and direction of the force and the particular bone involved. Fractures require early diagnosis and immobilization to ensure healing. The most common foot fractures occur as spiral oblique injuries of either the digits or the metatarsals. They are usually the result of the torsion generated by the impact of the moving foot hitting a fixed object such as an opponent.
If you suspect a fracture, do not continue the training or competition. Further trauma from competition can convert a simple non-displaced fracture into a displaced, comminuted fracture or even a compound fracture. Like the ankle, broken toe/foot bones can look like bad sprains, so any persistent swelling and pain, particularly around where the toes meet the foot, should be medically evaluated ASAP. The worse the fracture, the longer the healing time (with possible surgery required to reduce and stabilize the break). Immobilize the injured area. Apply ice and elevate the limb after achieving initial immobilization.
Do not resume any activity that may subject them to blunt force trauma until the fracture is completely healed, which is usually eight weeks. You will be required to engage in appropriate exercises to maintain strength and flexibility during the bone healing process. Buddy taping toes in groups of two can make fractures less common, at the sacrifice of a little traction; learning techniques properly to avoid unintended impacts during training or sparring may actually do the most good.
Tendon sheath trauma
Tendon sheath trauma on the top of the foot can be incredibly painful — the aforementioned kicking of an elbow is a common mechanism. The tendon straps running atop the foot bones are easily pinched, and can rapidly swell and make even walking difficult. ‘Conditioning’ this area (skin over tendons and tendon sheaths) is considered possible in some styles, but is more difficult to accomplish than conditioning the shin surfaces (skin over bone). Protective gear and carefully practicing kick placement may be a more valuable in the long run: preventing the mechanism of injury can mean the avoidance of weeks of recuperation time.
Toenail avulsions
Toenail avulsions (ripping off) and subungual hematomas (blood bruises under the nails) happen almost exclusively from direct or glancing nail hits. Like fractures, they are at risk without protective footwear, and are otherwise difficult to prevent directly. The nail may need to be re-attached as a healing splint, or to relieve the exquisite tenderness of a blood bruise by removing the blood while it’s still fluid.
No doubt you have experienced these types of injuries during your career. Careful consideration of the importance of your feet and the many strategies you can employ to protect and preserve them, will keep you training and fighting for many years to come.
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