It is that time of year again when we take our games indoors to avoid the cold. With the pounding and movements that feet, ankles and the Achilles and other tendons around the ankle endure, court sports such as basketball, racquetball and tennis present unique problems for athletes, whether they're a professional athleteor weekend warriors. But preparation and common sense go a long way toward prevention.

Hard surfaces and sports calling for fast, lateral movements are two characteristics of indoor sports that can contribute to injuries. One of the most frequently encountered court injuries is the common ankle sprain, due to the lateral aspect of those sports and, especially in basketball, the potential for stepping on a competitor's foot.

Other court injuries are more shock-related, such as stress fractures in the foot or tibia. Stress fractures can be hard to detect and many times people with stress fractures will continue to play and delay the correct diagnosis.

If the stress fracture is in the metatarsal bone, the most frequent site for stress fractures, there can be swelling in the forefoot. But stress fractures can occur in any of the 26 bones of the foot without many symptoms. Some are more common than others, but all of them can happen in court sports. In the stronger, more dense area of the mid-foot, stress fractures can take a long time to diagnose, and if not properly diagnosed, can lead to devastating consequences. Whether competing in court sports on an organized level or in everyday use, the foot should not hurt. If pain persists, consult a foot and ankle surgeon.

Another common injury site is the heel. Heel pain can indicate a plantar fascia injury or bone spur. The plantar fascia is a thin, very strong tissue band that supports the arch of the foot, stretching from the heel to the ball of the foot. As the arch falls, the band of tissue is under increasing tension and the weakest link is where the tissue attaches to the bottom of the heel. Over time and with repeated shocks, micro-events can occur and cause the fascia to tear from the heel, resulting in bone spurs.

Ninety-nine percent of the time, conservative care is effective in relieving painful heels. For the few who don't respond, surgery may be considered. Foot and ankle surgeons frequently see injuries to the Achilles tendon and other tendons about the ankle that often could be prevented. Appropriate stretching for Achilles and calf muscles go a long way toward prevention. A ruptured Achilles tendon requires surgery and is very common in older athletes who aren't flexible and don't warm-up.

For a gentle stretching of the lower extremities and the Achilles tendon, lean against a table or wall, placing one foot behind the other. Point the toes slightly inward and roll the ankle toward the outside. Gently lean forward and feel the stretch high up into the calf muscle. Always roll the weight to the outside border of the foot and never stretch to the point of producing pain.

Additional tips include:

  1. Buy new, quality athletic shoes and replace them frequently (at least every 6 months).
  2. Have the proper footgear for the sport; running shoes are not proper for sports such as basketball due to their lack of lateral support.
  3. Seek appropriate arch support; flat and high arches often call for custom-made orthotics in shoes.
  4. Avoid too much, too hard, and too soon syndrome; start slowly to transition between activities or the stress will take you out of the game quickly.
  5. In children, be aware of the potential for injuries of the growth plate in the heel. Persistent heel pain is more than simple overuse; kids should stop participation immediately and a diagnosis should be sought. Boys and girls often go from soccer season right into basketball and the collective shock from running and the pull of the Achilles can cause growth plate damage.

Start your winter sports season off on the right foot! Follow these tips and try to avoid the common pitfalls associated with indoor sports.