THE ATHLETE'S FOOT IS OFTEN an Achilles heel.
It's the body part that hits the ground in all activities except cycling and water sports.
Hop, skip, jump or jog, and it's your feet that take the shock, absorbing two to seven times your body weight with every step. Walk the wrong way off a curb or down a step, and it's your foot that twists. Stop short on a tennis court, and your toes slam into the end of your shoes. Go out on a playing field: Guess what smacks into the ball and the equipment, and gets stepped on by the other players?
"You're likely to see everything from trauma to overuse injuries," says Dr. Vito Giardina, a podiatrist with a sports and general practice. He gives examples: Athletes fall, they twist their ankles, they kick the post instead of the soccer ball, they get whacked by someone else's lacrosse stick.
Or they do too much, too soon, without sufficient stretching or without enough toe room, support or cushioning in their shoes. And they end up on the disabled list, with aching arches, sore soles and hurting heels, with blood clots under the toenails, stress fractures in the metatarsal bones and inflammation of the fibrous "plantar fascia" that connects the heel to the ball of the foot.
And because the foot bone is connected to the leg bone, and the leg bone to the hip, disordered feet can make their presence felt in other places, too. "A lot of problems at the knee and hip can originate from problems in the foot," says Dr. John Senatore, a podiatrist with a general practice who spends one day a week at the Union Memorial Hospital Sports Medicine Center.
Anatomically akin to the hand, but specialized for weight-bearing movement rather than fine motor coordination, the foot is a complicated structure of bones and muscles, joints, tendons and arches.
"There are a lot of moving parts," Dr. Senatore says, "and if one of those parts isn't working properly, there are going to be problems with everything."
Non-athletes with an imperfect part often can get away with it: Uneven leg lengths, a peculiar foot-strike pattern, an abnormally high arch that makes you supinate (walk on the outside edge of your foot) or a flat foot that has you pronating (walking on the inner edge) may not make much difference if you're sedentary, except in the way you wear down your shoes.
With athletes, such abnormalities are more of a problem. "If you ++ don't have a normal arch, you are more subjected to foot pathology when you take up sports," says Dr. Peter Hoffman, a Pikesville podiatrist. "Some people with high-arched feet run, and run well. Others have knee pain or low back pain, or develop painful calluses. With a high-arched foot you have a lot of pressure under the metatarsals and heel," causing inflammation, overgrowth of bone and pain.
Flat feet, on the other hand, can lead to muscle fatigue, he says: "Those people complain of tired feet because their muscles are out of alignment."
Distance also makes a difference. "A patient who runs 2 miles, three times a week, frequently won't have problems. Runners who do 30 to 35 miles a week may develop symptoms," according to Dr. Hoffman.
Stoic about their symptoms, athletes usually are hurting a lot before they seek foot-aid, Dr. Giardina has found. "If they're a little sore, they try to run through it," he says. "At the second level of pain, they take aspirin or Advil; at the third level, they come for help."
Finding the source of the pain can be a fairly sophisticated process. "You have to determine why there's a problem, not just treat it," says Dr. Senatore. "You can't just look at the patient as he sits on the table. In this center, we put them on the treadmill, videotape them running, and analyze the tape to see where the mechanical fault may be. We do the same thing with dancers."
What Dr. Senatore finds most often is that the difficulty results from behavior rather than biology.
"In 80 percent of patients, the problem is in the way they train or in their shoes," he says. The prescription is likely to be longer warm-ups, more stretching, new shoes or orthotics -- custom-made, foot-supporting innersoles that correct abnormal footstrike, relieve abnormal pressure or compensate for uneven leg length. In fact, he says, good athletic shoes are now being made with innersoles that can be removed easily and replaced with made-to-order orthotics.
Generally, that's the sort of thing the athlete wants -- a remedy that gets him or her back to full activity very quickly. But sometimes that can't happen: Some biomechanical faults are not amenable to orthotic correction, and some injuries won't heal without rest.
That's where sports psychology comes into play, Dr. Giardina says.
"If you tell runners not to run, they'll go to someone else," he says. "So you have to help them get it into their heads that taking days off, or not running so fast is a part of training.