The impact of any foot and ankle injury can be wide-ranging. Injuries can affect overall health through the compensation of other body parts due to pain. Changing an anatomic alignment or the way the body is built to move places added stress on other areas in order to accomplish the same goal. This can be both positive and negative. Positive in the way that this compensation can allow the athlete to continue to play through injury or compete at a high level. Negative because the long-term effects are often setting up for further injury in a different location, and once the compensation can no longer be maintained, a wide range of disability may result. A study conducted in 2009 showed that a foot and ankle-specific disability scale was successful in discriminating between different age, gender, and ethnic groups. In this age of performance measures, athletes place great emphasis on any factor that may hinder their play. This includes common everyday pains, to severe disabilities. Disability resulting from a foot and ankle injury can have a significant impact on an athlete’s mental health and well-being. High-level athletes, in particular, may experience negative psychological effects resulting from a loss in training time or competition and the fear of being replaced or forgotten on their team.
Also, athletes often dismiss the early signs of a foot or ankle problem, assuming that related aches and pains are just part of training. However, foot and ankle pain is not normal and should not be ignored. Evaluation by a physician is always recommended if one has been experiencing any pain in their foot or ankle. In some cases, pain resulting from an injury on the lower extremity may gradually subside only to result in the worsening of the problem due to an unnoticed and compensated change in gait. Development of a bony growth or chronic pulling of the tendons or ligaments around a certain joint may lead to a set of stress-related injuries, including stress fractures and tendonitis. Early diagnosis and intervention are the keys to successful treatment. Minor problems are easier to treat and respond better to treatment.
Foot and ankle injuries can affect athletes at all levels and in any sport, impacting not only the athlete’s ability to train and compete, but also his or her long-term health and quality of life. The structure of the foot and ankle is complex, consisting of 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments. All of these components work together to provide the body with support, balance, and mobility. Injuries to the foot and ankle can be debilitating and are often associated with prolonged pain and risk of re-injury. A thorough understanding of how to prevent and manage foot and ankle injuries is crucial for all athletes and should be considered a priority at all levels of competition.
Importance of Foot and Ankle Health in Athletes
However, despite the foot and ankle’s importance, athletes have largely neglected to design and purchase appropriate footwear for their respective sports. Limited supportive and correctly fitting shoes are the leading cause for foot and ankle injuries in athletes. The range of foot and ankle injuries due to lack of supportive shoes can vary from stress fractures, tendonitis, and ligament sprains, just to name a few. An athlete with no foot and ankle symptoms can still suffer from remote injury due to poorly supportive shoes. The foot and ankle have a significant impact on lower extremity biomechanics and the overall structural foundation for basically all forms of physical activity. Maintaining foot health and preventing pain is paramount in preserving mobility and the ability to remain active throughout every stage of life.
Competitive athletes of all levels are respected for their dedication and commitment to training and performance. In hindrance to success and performance, an alarming number of athletic competitors, including world class, Olympic, professional, varsity, and junior level athletes, are sent to physical therapy and take time off from their competitive sports due to foot and ankle injuries. Foot and ankle pain can be disabling as the pain and dysfunction can limit simple ambulation. The importance of a healthy functioning foot and ankle complex is paramount to the performance for most, if not all, sports. The function and performance of the foot and ankle directly affect the runner to the pole-vaulter, rendering an injury to the foot a debilitating affliction. Even minor pain in the foot or ankle can lead to altered biomechanics and can impair athletic performance. An understanding of the foot and ankle anatomy is paramount in treating and preventing further injury on this critical structure.
Common Causes of Foot and Ankle Pain
Dynamic foot and ankle function is important in absorbing shock, providing stability, and producing propulsion during physical activity. There are many potential causes of pain in the foot and ankle, with the most common being mechanical, degenerative, or traumatic in nature. The clinical presentation of the symptoms is dependent on which tissue is affected, i.e., bone, ligament, tendon, or muscle. The location of the pain can often be directly related to the structure involved and the stage of injury. For example, anterior (front of) ankle pain might suggest a bony pathology involving the joint or a musculo-tendinous problem with the tibialis anterior, peroneals, or extensor digitorum longus muscles. Posterior ankle pain commonly derives from a problem within the ankle joint or an irritation of the Achilles tendon. Medial pain may involve a tendinopathy of the tibialis post or dysfunction of the posterior tibialis, while lateral pain might suggest an ankle sprain or a problem with the peroneal tendon. The following list of common foot and ankle problems is far from exhaustive but attempts to encapsulate the majority of clinical conditions encountered in an athletic population.
Impact of Foot and Ankle Pain on Athletic Performance
entucky Wildcats basketball team doctor describes the negative effects of a change in the aforementioned gait pattern on a basketball player suffering from an ankle sprain. He states, “A player with a sprained ankle may not be able to carry his weight to the balls of his feet, so even though he is trying to go full speed, his heel will hit the ground first. When he does this, he is trying to transfer his weight to the healthy foot.” This will result in poor push off and decreased speed. With an injured foot or ankle, an athlete will have to work harder just to achieve the same levels of performance. It has been demonstrated that the energy cost of transport at comfortable walking speed is directly related to the mechanical work necessary to support body weight. Additional energy will be used to compensate for altered movement patterns and distribution of weight, thus decreasing the efficiency of the athlete. Any athlete would testify that a decrease in speed and athletic output is very frustrating. This only adds to the frustration of being injured and can decrease the morale of the athlete.
Explain and expand on this less coherent overview stating that the impact of foot and ankle pain on athletic performance is vast. Being very painful and greatly hindering movement, any pain in the foot or ankle will hinder various aspects of athletic performance. It is often said that 90% of what we do originates in the feet. Despite the source of this claim, it is hard to deny its logical merit. Our ability to jump, run, skip, or engage in any other form of movement, whether it be in everyday activity or athletic participation, relies greatly upon the proper function of our feet and ankles. Pain or dysfunction of the foot and ankle will greatly impair any of these forms of movement and cause a redistribution of weight to try and avoid pain in the affected area. For example, a study found that during level walking, ankle injury patients showed decreased ankle and knee flexion immediately prior to the injury side limb contacting the ground compared with controls. This was indicative of movement strategies designed to avoid or lessen the loading of the injured limb, which would have load-bearing consequences. A simple change in the gait pattern implies a significant shift in the distribution of weight on the lower extremities.
Injury Prevention Strategies
Lace-up shoes should not be too tight or too loose, and any foot movement within the shoe can cause friction and irritation on the foot. Shoelaces are often overlooked and will often require retying during activity, so a lace lock can be used to prevent loosening. Lastly, the ankle collar should not be too high and back since this can irritate the Achilles tendon or cause blisters on the heel.
A simple way to determine foot type is by doing a wet test, leaving a footprint on a brown piece of paper. This static measure of the footprint can give some indication of foot type. Width sizing is also important, and various brands fit differently, so it is important to try many different shoes.
Sports specific shoes should be selected relative to the activity and surface (i.e. running vs. basketball on a hardwood surface) and the individual’s foot type. There are three different foot types: low arched (pronated), normal arched (neutral), high arched (supinated). Pronated feet need a motion control shoe to reduce over-pronation, a neutral foot needs a stability shoe, and a supinated foot needs a well-cushioned flexible shoe to encourage pronation.
Proper footwear selection and fit is the most important aspect in injury prevention. Shoes should be in good condition without excessive wear on the outer sole or heel. Old shoes, notably running shoes, lose their shock absorption after three to five hundred miles of use. Athletic shoes need to be replaced every 300-500 miles since damage occurs gradually.
Proper Footwear Selection and Fit
Athletes are sometimes clueless when it comes to picking proper footwear for their sport. Many are influenced by fancy advertisements and buy the most expensive brand names, not realizing that the shoe may not be the best quality for the specific activity. What many fail to understand is that a particular sport shoe greatly affects the athletes’ performance and chance for injury. A good and appropriate pair of athletic shoes can enhance an athlete’s performance as well as prevent injuries. The explanation behind this lies in the concept of anatomic motion. Certain shoes are designed to allow the foot to move in specific directions and to accomplish specific tasks (i.e. A basketball shoe will allow more vertical motion while a running shoe will allow forward motion). When the foot is restricted due to an improper shoe, there is stress placed on the joints of the foot and also on the surrounding muscles. Over time, this can lead to acute and chronic injuries. Another consideration is that specific foot types require specific shoes in order to prevent biomechanical problems. These problems are common sources of acute and chronic injuries in athletes. The three basic foot type categories are pronated, neutral, and supinated. A quick and easy way to determine foot type is by doing a wet foot analysis. This requires the athlete to wet his/her feet and then stand on a piece of brown paper. If the imprint shows a wide band along the outside of the foot, the foot is supinated. If there is a wide band along the inside of the foot, the foot is pronated. A neutral foot will display even width bands all the way around the foot.
Strengthening and Conditioning Exercises for the Foot and Ankle
For those who have suffered from an ankle sprain before, the chances of a re-sprain reoccurring is very high. It takes about a year for a sprained ankle to regain functional stability, which is the ability for your ankle to maintain balance on an uneven surface. It is essential to do some of these exercises to facilitate the process of stabilizing the ankle, for it will lessen any chance of a re-sprain. One of the most effective ways to help stabilize a weakened ankle is to do balance and proprioception – there are various ways to do this, but a few simple exercises can be done by standing on one leg with your eyes closed for 30 seconds. This may seem easy, but it is much harder than you think and should be done on both legs. Another good exercise is to practice catching a small ball while standing on one leg. Time on the balance board is also a great way to work on ankle stability. Other exercises such as tendon strengthening may also help to prevent future ankle sprains, so it is a good idea to do them as well. This could involve using a resistance band to do 20 repetitions of inverting and everting the foot, preparing the ankle for the application of stress which so often causes an ankle sprain.
Warm-up and Cool-down Techniques
Proper foot and ankle warm-up and cool-down techniques are important for injury prevention and performance optimization. A good warm-up should last at least 5-10 minutes and should work up a light sweat. The warm-up should start with 5 minutes of low-impact exercise, increasing to moderate impact activity. Low-impact exercise can be achieved by stationary biking, and moderate impact activity can be achieved by running. By using stationary biking and light jogging as warm-up activities, this will take some of the stress off of the foot and ankle. After warming up the body, post-activity static stretching is beneficial to increase overall flexibility. During the stretching exercises, specific focus should be placed on the foot and ankle. Each stretch should be held for 15-20 seconds and repeated 3 times for maximum effectiveness. After an event or strenuous activity, cool-down exercises are essential to aid in the recovery of the body and to reduce muscle soreness. Similar to the warm-up exercises, 5-10 minutes of low-impact exercise followed by post-activity stretching is an effective cool-down regimen. Static stretching is recommended over dynamic stretching during the cool-down, as static stretching has been shown to increase flexibility while not hindering muscle strength. Static stretching after the cool-down low-impact exercise will be very beneficial to increase overall flexibility of the foot and ankle with a smaller chance of injury.
Cross-training and Rest Days
Cross-training is an exercise regimen which utilizes different modes of training to develop a specific component of fitness. It is used to improve performance and avoid overuse injuries for a specific sport or activity. Cross-training for runners utilizes non-impact aerobic activities such as swimming, water running, cycling, or using an elliptical trainer. Athletes with foot and ankle injuries have found that deep water running 3-4 times per week for 15-45 minutes, using a flotation vest and running form, simulates regular running and decreases pain. This allows maintenance of running aerobic fitness while the injured foot or ankle is unloaded or partially loaded. Swimming is also an excellent cross-training activity for runners. It provides a great aerobic workout and strengthens the upper body and core. Upright swimming strokes and dolphin kick are good choices to avoid foot strain. Stationary cycling and elliptical training simulate running and provide a good aerobic workout but may aggravate certain foot and ankle injuries. Symptoms during and after these activities should be monitored. A good alternative to cross-training is a temporary activity modification, a period of decreased activity or rest with an expected improvement in symptoms and gradual progression back to full activity. This can be a refreshing break from regular training and is often beneficial for overuse injuries with minimal fitness loss.
Treatment and Rehabilitation Approaches
Those with severe ankle sprains involving a complete tear of the ligaments or those who have repeated ankle sprains may be more likely to require adjunctive therapies such as low-level laser therapy or ultrasound to stimulate the soft tissue healing process. There is ongoing research in the area of the use of magnetic field therapy and its effectiveness in soft tissue healing and resolution of pain for musculoskeletal soft tissue injuries. Medications and pain management play a role in the treatment of athletes with foot and ankle pain, particularly those with osteoarthritis of the foot and ankle. Those who wish to return back to the activities or sport may require nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce swelling in order to start a rehabilitation program. Corticosteroid injections may be indicated for those with inflammatory joint conditions, tendonitis, or may be used in the management of soft tissue pain.
Rest, ice, compression, and elevation (RICE) method is an effective initial treatment to relieve pain, reduce swelling, and speed the healing process. Studies have shown that immediate cooling of an injury can help to reduce the pain and swelling and may help improve the strength in the injured limb, leading to a faster recovery. Caution must be taken in order to avoid the use of heat on a new injury as this can exacerbate the swelling. Joint mobilization and gentle massage have also been shown to have an effect in the management of ankle sprains, improving the range of motion and reducing pain in the acute and sub-acute stages. Functional rehabilitation, which involves specific exercises, aims to return the individual to normal activities or sport as soon as possible. This involves a progression through functional exercises, i.e. exercises that will directly translate to the individual’s activities or to the sport they are involved in, to improve strength, flexibility, and proprioception. High-quality studies have shown that those who partake in a supervised rehabilitation program, as opposed to those who did not, were much more likely to have returned to their normal activities in a shorter period of time and were less likely to have recurrent or residual problems with their ankle.
Rest, Ice, Compression, and Elevation (RICE) Method
The R.I.C.E. method is described by the name. It includes rest, ice, compression, and elevation. This method is mainly used for the treatment of an acute injury (24-48 hours after its occurrence). In this regard, the first intervention would be to stop the activity which caused the injury and then to rest the affected joint area. This prevents any further damage caused by stressing the area. The next step involves applying ice to the affected area. Ice should be applied within the first 48 hours of an injury to prevent excess swelling in the affected area. This should be done for 15-20 minutes with at least 3 intervals per day. The ice should not be applied directly to the skin but through a wet cloth to prevent frostbite. The application of ice to the affected area will be used in conjunction with the next step, which is compression. Compression, through the use of bandages, will restrict the flow of fluids to the affected area and also provide support for the affected joint. This will reduce swelling and also provide some stability, reducing the pain caused by movement of the affected joint. The final step of the R.I.C.E. method involves elevation of the affected area. Elevation reduces swelling by increasing fluid drainage from the affected area to the circulatory system. This is achieved by placing the affected joint below heart level and then using gravity to move the fluid away from the joint. Both the application of ice and the use of compression bandages aid this process by making sure the fluid leaves the affected area and then preventing it from returning. Any fluid left in the joint may cause a pocket of dead tissue, which will inhibit full motion and may cause chronic weakness in the affected area. Reducing swelling will ensure a faster recovery and typically lessen the amount of physiotherapy needed to return the affected joint to full function.
Physical Therapy and Rehabilitation Exercises
A progression to proprioceptive and balance exercise is important in order to prevent re-injury of the foot and ankle. This is especially important when returning to sport. Lastly, a regime of specific agility and plyometric drills can be used to simulate the demands of the athlete’s sport. With the specific goal of the return to full athletic activity, therapy should be as specific as the patient’s condition will allow.
The type of physical therapy will depend on which tissue is injured and to what degree. In acute injuries, the RICE method is the initial therapy. However, in some chronic foot conditions such as anterior tibialis tendonitis, peroneal tendonitis, and plantar fasciitis, use of the RICE method may only be used for pain control on a short-term basis. This will be accompanied by various flexibility exercises for the involved lower extremity muscle groups. For the posterior tibialis tendonitis and dysfunction, the main goal of therapy will be to improve strength of the muscle and its ability to dynamically support the medial longitudinal arch of the foot. This can usually be accomplished with a myriad of global strengthening exercises for the lower extremities as well as specific strengthening exercises for the foot intrinsic muscles. Sports massage and soft tissue mobilization can also be used to help increase flexibility and strength of the involved muscle groups.
The goal of physical therapy is to return the individual to their previous level of functioning. It is an important step following an injury to the foot and ankle and should be initiated as soon as possible in order to prevent chronic changes or further injury. Therapy will involve decreasing pain and swelling, improving motion, strength, and finally a return to activity or sport.
Medications and Pain Management
Patients experiencing acute injuries or exacerbation of chronic conditions often seek pain relief as the primary goal of early treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) in prescription or over-the-counter strength can provide pain relief, decrease inflammation, and facilitate participation in physical therapy exercises for many patients. Topical NSAIDs may provide a benefit for localized pain relief without an increased risk of gastrointestinal complications. Short-term use of opioids may be considered after surgical procedures for pain relief; however, risks and benefits of usage should be carefully considered. Muscle relaxants and gabapentin are medications that can be utilized to treat conditions with a neuropathic component and/or muscle spasm. Ultimately, the choice of whether or not to utilize medication to manage pain is one that should be made between the patient and physician, taking into consideration the risks and benefits specific to each individual and type of medication.
Surgical Intervention and Post-operative Care
Surgical interventions are typically the last resort for foot and ankle pain, to be used after all conservative treatment has failed. There are several different types of foot surgery, geared toward repair of specific injuries or disorders and to help restore or maintain function of the foot and/or ankle. One of the most common is arthroscopic surgery of the foot and ankle. This is a minimally invasive surgery done to treat many foot and ankle conditions. The surgeon will make a very small incision and insert a pencil-sized instrument with a small lens and lighting system on one end and a video screen on the other. From this, the surgeon is able to investigate and repair the issue within the joint. This surgery is beneficial due to its low recovery time and low complication rates with most patients being allowed to partially weight bear immediately after surgery. Another type is joint fusion (or arthrodesis) at the ankle joint often used to treat arthritis, also it is one of the few surgeries where some level of arthritis pain can be relieved. It involves removing the cartilage surfaces at the ankle joint and then placing the bones in the best possible alignment and fixating them using screws or a plate and screws. This is done to allow the bones to grow and eventually fuse into one, it is this fusion of the bones which stops the pain as it stops the movement of the joint. Finally, ankle replacement surgery is another option for arthritis sufferers. This is a more complex surgery involving replacing the diseased joint with an artificial implant. Some patients prefer this option as it allows for more movement in the joint and is expected to be repeatable if the implant wears off.
Performance Optimization Strategies
Nutritional factors have been identified as both risk and protective factors in the development of various musculoskeletal injuries in athletes. Nutritional intervention studies with the aim of enhancing soft tissue healing, increasing bone density and preventing joint injury are largely absent from literature, and adequately powered studies investigating the role of nutrition in preventing specific types of sports-related joint injuries are required. These areas of research are beyond the scope of this article, however, it is clear that having an understanding of the nutritional requirements for soft tissue and joint health would be beneficial when dealing with injured athletes, and when developing injury prevention programs for teams and athletes.
Biomechanical analysis is an important process in the programs of all levels of athletes with the objective of performance improvement, increased efficiency, and reduced risk of injury. The goal of the analysis is to identify biomechanical deviations and inefficiencies that are predisposing the individual to or causing injury or that are impairing performance. The findings from the initial assessment will then guide the health and performance professionals in the development of an intervention program, as well as providing a baseline for subsequent assessment of the effectiveness of the intervention. Various assessment tools are used ranging from the simple and low tech (such as video analysis) to the more complex and high tech (such as force plate analysis of dynamic kinetics). The level of analysis required will depend on the nature of the individual, their injury, and the demands of their sport. Once the assessment is complete, and the nature of the movement impairment is understood, a rehabilitation program can be developed to specifically target the underlying cause of the problem.
4.1. Biomechanical Analysis and Corrective Techniques
Corrective techniques can involve a variety of methods effective for the prevention of overuse injuries, reduction of pain, offloading irritated tissues, and improving foot and lower limb dysfunction. One of the main methods for reducing pain and preventing overuse injuries is through activity and footwear modification. The basic aim is to intelligently phase in the activity that is causing pain to gradually increase tissue capacity, whilst minimizing pain, rather than a total cessation of the aggravating activity. Using pain as a guide, it is then slowly and progressively increase load on the lower limb tissues towards the point of pre-injury levels. This method has been supported by a recent systematic review by Silbernagel, which investigated the mid-portion Achilles tendinopathy, and the first step involved identification of lax midfoot control.
Bio-mechanical assessments evaluate optimal and suboptimal movement patterns. By assessing movement patterns that occur during functional activities, it can be determined where the potential for injury lies. This, in turn, allows for more focused and specific exercise prescription to readdress these faulty movement patterns. Evidence supports the theory that strength or flexibility alone are not indicators of potential lower limb injury. It has been suggested that faulty movement patterns are more likely to predispose an individual to an acute injury. These faulty movement patterns often occur over several joints, and a good example of this is dynamic knee valgus. This is where the knee moves in towards the opposite knee during activities such as squatting, running, or jumping and has been associated with several lower limb overuse injuries. By understanding which movement patterns are faulty and which biomechanical factors are related to specific injuries, it is then possible to improve strength, flexibility, and coordination over the relevant areas to reduce the risk of injury occurring. Randomly prescribing strength and flexibility exercises without taking into consideration the specific requirements of each activity and the relevant underlying biomechanics is less likely to have a positive impact on injury prevention. Finally, formulating the above findings into a structured and progressive exercise program is the final step in being able to prevent the occurrence of specific lower limb injuries.
Sports-specific Training and Technique Refinement
A large prevention of overuse and traumatic foot and ankle injuries will ultimately lead to fewer athlete encounters with foot and ankle specialists, and this, save for the time an article was published in 2007, was ignorant, an important function of medical interventions. Any report on surgical interventions, return to play decisions, or encounters in a medical setting could be viewed as an attempt to optimize foot and ankle health and performance. Measures that are taken to refine techniques in these sports and carry them out specifically in game situations will ultimately lead to healthier feet and ankles, with less encounters with foot and ankle specialists and a longer active lifestyle in athletic activities.
The high rate of lower extremity injuries in soccer makes it a good target for injury prevention research, and thus one such investigation was recently conducted in Denmark. This cluster randomized controlled trial (c-RCT) involved 2,119 players from 58 teams in 10 clubs. A total of 24 clubs with 1,413 teams were invited to participate in the trial, from these, 10 clubs with teams in the active age groups for the trial agreed to participate. They were randomized into an intervention group who received an injury prevention program and a control group who continued playing as they always had. The program was based on a neuromuscular warm-up which has been shown to be effective at reducing lower extremity injuries in female adolescent soccer. Playing and training time lost to injuries as well as exposure to traumatic and overuse injuries was recorded, and it was found that the intervention group had a 20% reduction in playing and training time lost to lower extremity injuries. This study had a high level of compliance with only 13% of teams failing to complete more than 2/3rds of the intervention and had a moderate net program cost. With a large amount of players able to perform the warm-up without guidance, this is a program that has potential for high dissemination and implementation.
The high rate of ankle syndesmosis and fibula fractures, as well as chronic lateral ankle pain, has made the sport of alpine skiing a good target for injury prevention research. A technique that reduces the amount of anterior ankle force, which is thought to be a mechanism of syndesmosis and fibula fracture, was tried, and it was found to decrease the rate of these fractures by 41%. This reduction involved more flexing and less leaning forward at the ankle in a snowplow position, and it is possible that recent changes in ski equipment where the boot does not extend as far forward is also reducing the force on the front of the ankle. This study is a good example of an injury prevention.
Basketball has a high rate of ankle sprains, and the injury is often a result of trying to change direction too quickly. One prospective study examined an on-court comprehensive warm-up program consisting of strength training, stretching, agility drills, and landing and cutting techniques. Only a 10% reduction in lower extremity injuries was found, and it was not clear as to which of the program components had the greatest impact. A speculation would be that the agility and cutting drills would be most effective, and some of these drills could be altered to find the most ankle-friendly cutting technique for changing direction. This is an area where further research is warranted.
The low number of prospective studies that address either injury prevention or performance optimization makes conclusions on most interventions impossible. However, many approaches have face validity and are based on expert opinion. One such strategy is sport-specific training. It is intuitive that simulating movements and conditions that occur in one’s sport would have positive effects. Another approach with face validity is altering technique to a more “foot-friendly” one. These interventions have been investigated in a variety of sports.
Nutrition and Hydration for Foot and Ankle Health
Maintaining a healthy body weight is essential for foot and ankle health. Greater body weight exerts higher forces on the weightbearing joints, which can lead to degenerative changes in the tendons and joint surfaces. Weight loss can be a confusing issue for athletes involved in sports that require high levels of strength and power. While there is evidence that decreased body weight can enhance athletic performance, weight loss can also lead to loss of muscle mass and a decrease in the power-to-weight ratio. At the present time, the ideal body composition for any given sport is speculative and quite individualistic. Nutritionists/dietitians who specialize in sport can be very helpful in determining the best body composition for an athlete, with health and performance both being primary concerns.
Diet has immense potential to influence foot and ankle health both positively and negatively, yet it goes vastly under-recognized in the sports medicine realm. In an era of intense marketing and widespread availability of supplements and ergogenic aids, athletes need to be educated about the best means of enhancing their health and performance through good nutrition. Nutrition for health can be very complex and quite individualistic. The following evidence-influenced guidelines are meant to assist athletes in making good choices that can positively affect their foot and ankle health and general health.
