Overuse Foot and Ankle Injuries in Gymnasts

Foot and ankle injuries can occur during various sports, but a shoe or cleat may protect the foot from more severe injuries. However, some sports are performed barefoot, such as gymnastics. Gymnasts have high demands on their feet and ankle, especially when landing their skills on vault, bars, floor, and beam. Gymnastics places high impact forces and high repetitions on growing young athletes. Gymnasts train all year and are therefore susceptible to overuse injuries.

Causes of Overuse Injuries of Foot and Ankle

• Poor landing mechanics
• A high number of repetitions
• Training surface
• Muscle weakness
• Decreased muscle flexibility

Types of Overuse Injuries for Gymnasts

Achilles Tendinitis

Achilles tendinitis is a strain at or near the insertion of the Achilles tendon into the heel bone. Achilles tendinitis often is due to multiple repetitions, sudden starts and stops, and repetitive jumping activities. Achilles tendinitis presents as swelling and tenderness over the area, pain and decreased ability to pull toes up toward the nose, painful push-off when walking or going up or down stairs, pain first thing in the morning, and pain during exercise.

Treatment of Achilles tendinitis may include rest, immobilization, ice, or medication for inflammation. Physical therapy can improve flexibility and range of motion of the ankle and help strengthen the area to return to normal activities and gymnastics.

Peroneal Tendinitis

The peroneal muscles are located on the outer part of the lower leg and ankle. These muscles help provide ankle stability and balance. The symptoms of peroneal tendinitis include pain on the lateral side of the ankle, pain that is worse with activity, and possible swelling. This injury is usually due to overuse but may be exacerbated by an acute injury such as an ankle sprain.

Treatment for peroneal tendinitis is initially similar to Achilles tendinitis – rest, ice, and immobilization. Physical therapy is also recommended to improve strength and balance to return to gymnastics.

Posterior Tibialis Tendinitis

The posterior tibialis muscle runs from the lower leg to the inner side of the ankle and into the bottom of the foot, helping support the arch of the foot. Repetition in high-impact sports can lead to injury of this tendon. Symptoms of posterior tibialis tendinitis include pain in the inside portion of the ankle and foot, pain that worsens with high-impact activities, difficulty rising onto toes on 1 foot, and decreased flexibility to pull toes up toward the nose. Gymnasts with a more flat foot or a lower arch may be more susceptible to these symptoms.

Treatment for posterior tibialis tendinitis includes rest, ice, possible immobilization, and physical therapy. It is important to note that gymnasts who perform their sport barefoot, which means no arch support, wear good supportive shoes outside of the gym. They may benefit from an arch support brace during gymnastics or an orthotic device in regular shoes.

Stress Fractures

Stress fractures in the foot and ankle can occur in gymnasts due to frequent hard landings. A stress fracture can occur at any age and is usually due to repetitive pounding without periods of rest or a rapid increase in training. Pain is usually pinpoint and can happen over the shin bone, ankle, or foot. Diagnosis of a stress fracture is usually done with an x-ray or MRI.

Treatment of stress fractures includes rest from impact activities. Often the athlete is placed in a walking boot, possibly with crutches. Recovery should also include physical therapy to assess flexibility, strength, and proper mechanics upon returning to sports. Prevention of stress fractures includes coach, parent, and athlete monitoring overall training volume, a gradual increase in training, especially of new skills, use of mats to reduce the impact of landings, and proper landing mechanics.

Sever’s Disease

Sever’s disease is inflammation of the growth plate on the back of the heel and is seen more often in adolescent athletes who have recently had a growth spurt in addition to overuse. Symptoms include:

• Pain in the heel
• Pain with pressure on the heel (try to stand on heels)
• Possible limp and stiffness pulling toes up toward nose.

Treatment of Sever’s disease is usually focused on rest and stretching. See this blog for more information on Sever’s disease in gymnasts.

How to Improve Your Landing Mechanics

• Practice landing properly
  • Try to land with feet shoulder width-apart
  • Keep your kneecap in line over the 2nd toe – do not let knees or feet fall into the middle
  • Land with a slight bend in knees- avoid landing with knees locked straight
  • Land on your toes and roll through the foot to a flat foot position- this should help you absorb the impact of landing
  • Your heel should touch the ground
  • Keep the stomach tight and pelvis level to avoid arching low back
  • Keep your chest upright
  • Breathe- do not hold your breath
• Practice landings from a low height first, progressing to higher as you are able to demonstrate good mechanics
• Progress to practicing single leg hopping skills paying attention to how you land
• Try landing backwards or with half turns with good mechanics
• Make sure you are using the proper mats to practice landings and perform landings in front of a mirror for feedback on your positioning

If you or your athlete are experiencing pain, do not wait. Schedule a free assessment at an Athletico near you.

Athletico provides rehabilitation to gymnasts of all levels and abilities. We have physical therapists involved with our Gymnastics and Cheerleading Program who understand the sport’s demands to address the athlete’s physical needs.

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*Per federal guidelines, beneficiaries of plans such as Medicare, Medicaid, Tricare, VHA and other federally funded plans are not eligible for free assessments.

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