Most of the time, injuries that occur in the foot and ankle during golf activites are either due to overuse type injuries or traumatic injuries. Overuse injuries are more common and are commonly directly related to the mechanics of the golf swing.
The golf swing can be broken down into the following phases: Set up Takeaway Downswing Impact Follow-through
At set up: The weight should be evenly distributed on both feet with slightly more weight on the inside of the balls of the feet. During the takeaway or back swing phase, the front foot should pronate, placing more pressure on the inside of the foot while the back foot stays stable as it receives more weight. At times the heel of the front foot will come off the ground to promote a full shoulder turn.
During the downswing: Weight will rapidly shift to the front foot until impact, at that point the weight should be evenly distributed between both feet. A lateral shift of the hips and knees will occur during downswing that continues through the impact of the ball and will continue slightly into the follow-through phase.
During the follow-through phase, the front foot supinates and the back heel comes off the ground with the weight of the back foot being placed on the big toe.
The most common golf injuries that occur in the foot and ankle are heel pain, metatarsalgia, Mortons Neuroma and tendinitis. Most of the time these injuries occur due to an increase of the motion in the feet.
Most common complaint in golfers is an intermetatarsal neuroma. Typically these occur in the third interspace and is almost always in the non-dominant foot. In other words if you swing the foot with the right then the neuroma is more likely to develop in the left foot. The nerve becomes irritated and is more noticeable in longer shots. As the forefoot inverts and the rearfoot supinates the interdigital nerve becomes irritated within the interspace. Symptoms include burning, tingling, numbness and shooting pains into the toes. Treatment begins with NSAIDS, Ice, Injection therapy and custom orthotics. One important treatment option is to adjust the mechanics of the swing to decrease the inversion/supination of the foot. Abduction of the front foot will help decrease the inversion at the end of the swing and decrease the irritation of the nerve.
Extensor Tendinitis: another complaint that we commonly see with golfers. This is due to driving the golf cart. It is often caused after driving a hilly course and using the brake to much. The motion of depressing the brake on a golf cart can cause a strain on the extensor digitorum longus tendons and causes irritation of those tendons. Symptoms include top of the foot pain and sometimes swelling. If this sounds like something you may have developed try alternating feet that use the brake. Using the heel to depress the brake may also help.
Lateral Ankle Pain: Occurs due to excessive motion of the rearfoot during the golf swing follow through. The forces that are applied during the follow through phase cause an abduction of the knee on the non-dominant limb and a supination on the foot on that side with eversion of the rearfoot. Symptoms include lateral ankle pain, lateral midfoot pain and swelling to the foot and ankle. Treatment starts with stabilizing the ankle with a compression brace or ankle brace. Trying to abduct the front foot toward the target and away from the midline of the body in the stance position when the golfer is addressing the ball will help take pressure off the lateral ankle.
Hallux and Subungal Hematomas: this occurs when the golfer applies excessive pressure to the big toe during the golf swing. Typically this occurs at the end of follow through and will only happen on the dominant foot. It occurs due to a jamming of the toe into the top of the shoebox. With repetition the subungal tissue will be injured and blood will form under the nail plate. Symptoms include pain in the hallux, pain with pressure on the hallux and a discolored big toenail. Treatment includes draining of the toenail or removal of the toenail.
We talked at the beginning that most golf injuries are caused by an increase motion of the foot. Studies have found that custom orthotics, which are devices that are made specifically for your feet are able to increase balance and allow golfers to drive the ball farther.