As the official podiatrists for Queensland Cricket and Cricket Australia, as well as developing Custom Cricket Shoes for over 12,000 cricketers, we know a lot about cricketer’s feet. Cricket is a tough game, especially on your feet and lower limbs caused by the huge forces being transmitted through the feet in fast bowling and the long hours spent standing in the field. Many of these athletes have foot and lower limb overuse injuries, arch strains and even acute nail and foot trauma.
Common Foot & Lower Limb Injuries
Some of the most common injuries our Podiatrists see in cricketers include plantar fasciitis, Sever’s disease, heel bursitis (bruised heel), Achilles tendonitis, metatarsal and toe fractures, stress fractures of the foot, shin splints and turf toe (overstretched plantar metatarsal head ligaments). Cricket players can also suffer from metatarsalgia, ankle sprains, ankle joint impingement (bone spurs), anterior knee pain, traumatic nail injuries, midfoot sprains and os trigonum (posterior process) injuries.
Plantar Fasciitis in Cricketers
Heel and arch strain is very common in cricket in all player types. It can be caused when bowlers land heavily on the front foot or in batters that stand and run between wickets on hard pitches and fielders that often stand for hours at a time can all have problems. Players that have both lower or higher than normal arch heights, or have feet that pronate (roll in) excessively are at greater risk of developing plantar fasciitis. Plantar fasciitis can be a very debilitation condition and if not manageed soon enough or appropriately can lead to significant time off the field. Care Management with custom foot orthotics, plantar fascial splints, footwear modifications including spiked up cross trainers, and stretches and strengthening exercises are often very successful care management and many of our players are back on the field in just a matter of days.
Sever’s Disease or calcaneal apophysitis is a self-limiting, growth related but extremely debilitating condition affecting the secondary growth centre (apophysis) of the heel bone. It results in acute posterior heel pain during and after sport in younger players aged between 10 and 14 years old. It is often so severe that players miss an entire season. If your child has heel pain after or during sport, it might be comforting to know that soft custom foot orthotics designed with heel raises specifically for this condition worn in appropriate cricket shoes coupled with stretches is a very effective care management. Make an appointment with a podiatrist, experienced in managing cricket injuries as soon as possible as this can become a chronic condition.
Strain from overstretching, partial and even full thickness rupture of the Achilles tendon is a common cricket injury. Although the Achilles is the thickest and strongest tendon in the body, it can be strained by chronic overuse, particularly in players with low arches and pronation of the foot. Appropriate footwear and Custom Cricket Shoes and foot orthotics coupled with physiotherapy and eccentric strengthening and stretching exercises are paramount in the care management of this condition. This is because these conditions are chronic in nature and likely to recur if the underlying biomechanical problems are not addressed.
Acute strain is also common in fast bowlers who sprint for several kilometres per day. GPS data showed that Mitchell Johnson sprinted over 23 kilometers in distance reaching speeds in excess of and this included 144 sprints on the first day of the Boxing Day Test in 2013. (Cricket.com.au 29th December 2013). Older batters with tight calf muscles are most at risk of developing Achilles injuries and we have manageed some of the best international top order batsmen who said they could have prolonged their careers a few more years if they had been manageed sooner.
Stress Fractures of the Foot & Leg
Stress fractures are overuse injuries and can be complex conditions to manage. Load management, footwear modifications including sole stiffening, and a forefoot rocker, foot orthotics and biomechanical assessment in consultation with the team’s bowling coach, physiotherapist, and sports medicine doctor are all important in the care management rationale. Repetitive microtrauma with the foot landing in an awkward position over many overs increases forces through the bones in the foot, particularly the navicular and metatarsals.
Bone constantly attempts to remodel and repair itself, especially when extraordinary stress is applied and sometimes fast bowlers who land heavily on their front foot during the delivery stride are predisposed. Too many overs, insufficient recovery, and bowling technique can all play a part in the development of stress fractures of the foot and lower limb.
Stress fractures of the spine are also common in fast bowling due to poor technique with “mixed” bowling actions and counter-rotational stresses and loads transmitted for long spells, especially in the lumbar vertebrae on the non-bowling side of skeletally immature bowlers (under the age of 25). In older bowlers, however, lumbar intervertebral disc compression and osteoarthritis are more common.
Shin Splints are caused by overstraining the muscles in your leg that attach to the tibia (shin bone) due to overtraining, insufficient rest and running on hard surfaces with faulty lower limb biomechanics. Well researched causative factors include overpronation (rolling in) of the foot, oversupination (rolling out) of the foot, non-supportive and appropriately cushioned cricket shoes, increasing your training too rapidly at the start of the season, lack of ankle joint range of motion, tight calf and hamstring muscles.
Shin splints are grouped by their anatomical location and are described as anterior, posterior and lateral. Posterior shin splints are common in cricket and caused by overuse of the tibialis posterior muscle and also its tendon. As the main muscle that dynamically supports the arches of the foot, flat feet and pronated feet are the main biomechanical cause. Foot orthotics are often required to improve foot posture and biomechanics and work very effectively.
Poor knee flexion or gluteal (buttock) control and core stability, along with weakness in the quadriceps and intrinsic foot muscles that decelerate forces are also implicated, therefore podiatry combined with physiotherapy can be very useful in managing shin splints.
Anterior Knee Pain
This condition affects the anterior knee joint which consists of the knee cap (patella) and the lower end of the thigh bone (femur bone). Patellofemoral Syndrome occurs when the patella does not glide properly on the lower end of the femur due to anatomical anomalies, or quadriceps weakness and can cause acute to chronic pain in cricketers of all age groups.
If the patella does not glide up and down in the groove it can cause bone on bone rubbing and/or degeneration of the cartilage. Poor biomechanics can be remedied with foot orthotics, cricket shoe modifications and muscle strengthening programs.
Another common cause of pain in the front of the knee in fast bowlers, is patella tendinopathy, or jumper’s knee, as the greatest amount of force translates through the patellar tendon whilst jumping and landing. The patella tendon connects the knee cap to the tibia or shin bone. At first, the pain and stiffness in the front of the knee may only be minor but as the tendon is repeatedly strained, the lesions occurring in the tendon can exceed the rate of repair. Tendon cells can repair early on but the damage will progressively become worse, causing pain and dysfunction. Eventually, chronic damage leading to tendon cell death and even catastrophic rupture can occur.
If you have pain in the front of your knee just below the knee cap, you should contact your podiatrist as soon as possible. Care Management involves biomechanical assessment, rest, ice, a patella tendon support, foot orthotics if poor foot posture is implicated, shock wave therapy and most importantly an eccentric strengthening program.
Sometimes just a change in footwear and some quad strengthening can make a big difference.
Trauma to the toenails, especially the big (hallux) toenail, is a common problem in cricketers. We have kept some of the world’s best fast bowlers in the game by addressing something as simple as toenail care management. (Picture of injured toenail and big toe cut out on CCS) Periodic nail debridement and alteration to the cricket shoes by cutting out a section of the upper adjacent to the hallux toenail, and reinforcing this with kangaroo leather, can make a vital difference to a cricketer’s foot health.
How can we help?
At my FootDr, we love cricket so much that we have been the naming rights sponsors of the legendary Queensland Bulls for the past 3 seasons. We are the official podiatrists for the Queensland Bulls, Queensland Fire, Brisbane Heat men’s and women’s teams and our founders Greg Dower and Darren Stewart are podiatrists for the Australian Cricket Team.
Our podiatrists have a deep knowledge of cricket injuries and we have a special offer for junior cricketers in association with Queensland Cricket. We are here to help!