With the lockdown rules gradually easing, hopefully we are not too far away from being able to play in-door sports like squash again.

Squash is a unique sport that requires multiple dynamic movements such as:

• lunging to retrieve low bouncing balls,
• pushing off rapidly
• changing direction mid flow
• short sharp sprints.

Therefore, your Achilles tendon is put under a lot of strain. Whether you’re a Brackley Squash Club team player, compete in the club’s leagues and ladders, or play socially at the weekends, Achilles tendon problems are one of the most common injuries that can arise in any squash player.

You are even more susceptible to injury when returning to squash having not been on court for many months.

The Achilles tendon is the longest and strongest tendon in the body. It attaches your calf muscle to your heel bone and helps you push your foot off the ground during walking or running.

Essentially there are two main Achilles injuries:

• Achilles tendinopathy
• Achilles ruptures.

Achilles tendinopathy

This is a soft tissue injury due to overuse. Repetitive small tears occur in your Achilles tendon that you might not recognise whilst playing. These small tears do not completely heal after each injury.

You gradually develop pain, stiffness and swelling of your Achilles tendon. Your symptoms are usually most noticeable when you wake up first thing in the morning and can even prevent you from participating in any exercise.

Achilles ruptures

An Achilles tendon rupture is a more sudden and severe injury. The tendon ‘snaps’ and it feels like you have been kicked in the back of the heel by someone. You will experience severe pain and will have difficulty walking. If you suspect you have ruptured your Achilles tendon on court, you must immediately seek medical attention. Preventing an Achilles tendon injury is much easier than managing it.

Here are FIVE Top Tips to help reduce your chance of sustaining an Achilles tendon injury:

1. A good stretching program
   This is the best way to prevent an Achilles tendon injury. Having a tight Achilles tendon is very common. Thorough stretching before and after exercise will help re-lengthen your Achilles tendon, and more importantly, reduce the risk of sustaining an injury.

2. Gradually increase your playing intensity
   When you first get back on court, warm-up with your squash partner longer than usual. Consider focusing on basic drills or playing friendly knock-ups before strenuous competitive matches. Increase your intensity levels as you feel stronger and more aerobically fit.

3. Wear the correct shoes
   A good pair of squash or tennis shoes have a supportive sole to stabilise your foot and provide cushioning on the hard-court floor.

4. Strengthen your calf muscles
   You calf muscles might be weaker than usual if you haven’t been able to participate in other sports. Some simple ways to strengthen your leg muscles include:

1. lunges,
2. calf raises
3. squats.

5. Seek medical help early on and avoid high impact sports
   This is the one that not everyone wants to here, however, if you have ANY Achilles tendon symptoms it is better to be cautious and avoid having an Achilles tendon rupture. Avoid high impact sports until you have spoken to a professional.

There is no perfect preventative measure to avoid an Achilles tendon injury, but I hope these tips will help fellow members of the club safely to return to playing squash post lockdown.

Joel Humphrey

Joel is a member of Brackley Squash Club and is an experienced Consultant Orthopaedic Surgeon with specialist expertise in the foot and ankle.

At Mercury Foot & Ankle Clinic, we help many people who have had injuries either while playing sport or simply during social activities. We are also one of the few clinics that only specialise in injuries to the foot and ankle.

Can running cause foot problems?

Running is a great way to maintain good health and psychological well-being. However, running can also be a source of injury, placing repetitive stress on the foot’s 26 bones and 30 joints, therefore, overuse and traumatic injuries to the foot are common.

Why do we get foot problems related to running?

Most foot problems related to running are caused by many factors. Some of which you are actually able to control yourself, therefore, preventing injury during training or preparation for a race.

For example:

• wearing appropriate running shoes
• not running on hard surfaces regularly
• gradually increasing your training intensity
• avoiding excessive mileage.

Other factors that contribute to overloading the foot are from abnormal lower limb biomechanics.

For example:

• tight calfs
• a leg length discrepancy
• over-pronation (flat foot) or;
• insufficient pronation (high arched foot).

These can be addressed with physiotherapy or medical insoles.

What are the common foot conditions related to running?

Plantar fasciitis

Plantar fasciitis is a common foot condition caused by chronic inflammation to the plantar fascia, caused by repetitive small tears that do not completely heal after each injury.

Runners with a stabbing pain in their heel may have plantar fasciitis. The pain can be worse when going up stairs, standing for long periods of time or even after prolonged rest, such as getting out of bed first thing in the morning. Symptoms can range from minor to debilitating.

The majority of cases are treated successfully with simple measures such as:

• rest
• stretching exercises
• anti-inflammatory medication
• medical insoles.

If the pain continues further specialist treatment may be required, which includes shockwave therapy or even a steroid injection. Surgery is only considered an option as a last resort.

Morton’s neuroma

A Morton’s neuroma is caused when a nerve becomes repetitively trapped in the “ball of the foot” (between the metatarsal heads) during running. Morton’s neuroma generally occurs between the second and third or third and fourth toes.

Symptoms include:

• activity related pain in the “ball of the foot”,
• numbness in the affected toes
• the feeling of a pebble is trapped in your shoe.

The majority of symptoms settle overtime with appropriate training shoes, activity modification and addressing any abnormal lower biomechanics. A steroid injection can sometimes help. In a small number of cases if the problem persists, surgery is an option.

Stress fracture

A stress fracture is a small crack in a bone, that develops gradually when a bone is subjected to repetitive impact. A stress fracture in the foot most frequently occurs in a metatarsal bone, a long bone in the front of the foot connected to the toes.

Symptoms include a deep ache in the foot, which is more noticeable during or after running and can disappear with rest. Symptoms start about a week after an increase in training. Treatment is quite time consuming and involves weeks or even months of rest. You may require a special boot or sandal to off load your foot and a physiotherapy programme. Stress fractures are rarely treated with surgery.

When do I need medical attention with a foot problem related to running?

If a painful foot does not improve with rest within two weeks or if the pain is severe or if you sustained a sudden injury, you should seek medical attention to make a diagnosis and to discuss treatment options.

Joel Humphrey

Joel, a partner at Mercury Foot & Ankle Clinic, is an experienced Consultant and Orthopedic Surgeon with specialist expertise in the foot & ankle.

At Mercury Foot & Ankle Clinic, we help many people who have had injuries either while playing sport or simply during social activities. We are also one of the few clinics that only specialise in injuries to the foot and ankle.

If you would like to know more contact us today.