Rugby foot and ankle injuries

The ankle is in many ways a mechanical miracle. It is flexible and resilient, is a good shock absorber, serves as a foundation and propels you forward. It carries the weight of the entire body. It can sustain huge pressure, while providing the body with mobility, balance and support.

The ankle is made up of two joints, namely the subtular joint and the true ankle joint. The latter is composed of three bones, the tibia (the inside portion of the ankle), the fibula (which forms the outside portion of the ankle), and the talus underneath. The true ankle joint makes it possible for you to move your foot up and down and the subtular joint makes sideways movement possible. The ends of these bones are covered in cartilage and there are nine different ligaments in the ankle.

Together with the muscles and tendons of the lower leg, these different parts of the ankle make jumping, walking and running possible.

There are numerous injuries that can be sustained by the foot and ankle. Sprains and strains commonly occur. Backs are vulnerable to ankle injuries as a result of running, swerving and side-stepping at speed. So are hookers, locks and loose forwards.

Ankle sprains can be prevented with the use of sports insoles and propioception exercises on a wobble board. The ankle becomes more stable through increased awareness and response by the person.  

Achilles tendonitis can be a bastard to treat and is triggered by a number of things, including:

• Rapidly increasing running distance or speed. It is therefore common amongst backs
• Adding hill running to training routine
• Starting too quickly after a break from exercise (This occurs frequently at the beginning of the rugby season when there is a sudden increase in activity)
• Sudden contraction of the calf muscles such as during a final sprint
• Overuse resulting from a lack of flexibility in the calf muscles

Symptoms include pain and stiffness in the morning, pain at the beginning of exercise until warmed up and some swelling.

Rugby puts a toll on the Achilles tendon. Therefore, a sudden rupture of the tendon during a sprint or when jumping in a lineout is not uncommon. An audible pop sound can often be heard and it feels like being hit in the calf. It is impossible to stand on the toes.  

Stretching important

Proper stretching of the tendon (the good ol’ calf stretches) is important before a game to prevent Achilles tendon injuries. 

Plantar fasciitis is a tell-tale sign of overtraining. It can also occur due to an overpronated foot and due to improper footware. This leads to increased stress to the Achilles tendon which in turn causes more strain on the plantar fascia.

The plantar fascia is an essential structure involved in running. Once you “toe-off”, the plantar fascia contracts and serves as a lever to exert force on the ground. The heavier the player, the more pressure is put on the plantar fascia. Therefore, rugby forwards are particularly prone to this injury.  

The main symptom is pain along the arch of the foot. It is often felt in conjunction with a spasm in a small muscle inside the arch of the foot. The pain is often worse on rising, like when getting out of bed, or standing or walking after resting, sitting or driving. It is painful to pull up the toes.

Ankle fractures result when a direct blow or stress forces the ankle inward or outward past its normal range of motion. This can occur when a jumping or running athlete lands on an uneven surface. It may also occur when the foot is on the ground and the body gets twisted.

Metatarsal fractures is one of the most common rugby injuries. Several high-profiled players have had this misfortune. Fractures occur due to direct trauma, overuse (stress fracture) and excessive rotation with sudden twisting. The fifth metatarsal (on the outside of the foot) is most commonly affected as this is the metatarsal most involved in twisting. Because there is little soft tissue to protect the metatarsals on the top of the foot, players being stamped on in a ruck end up with this injury. A stress fracture of the fifth metatarsal is notoriously difficult to heal.   

(Health24, September 2011)