Foot Case Study

A 26 year old male golfer, handicap 6, presented with 2 day history of right ball of foot pain.  The golfer, who plays once per week, walks on average twice per week for an hour. The pain started whilst playing golf, after approximately 6 holes. Prior to the game, he had warmed up by hitting approximately 25 golf balls in the practice net. In the week prior to the foot pain, he had noticed that his right hip was feeling tight.

The pain was described as a strong ache that occurred during the follow through of the golf swing as the patient pivoted on the right ball of the foot. Walking produced no pain.

Previous history revealed the patient used to play semi-professional soccer, had retired two years previously due to knee and ankle troubles. This included two serious right lateral ankle ligament injuries, the last one occurring ten years ago, and several mild injuries the last three months prior to retiring. The patient also reported an arthroscope to each knee for meniscal damage, the right when he was 15 years old and the left when he was 18 years old.

On examination, hip range of motion (ROM) revealed a decrease in external rotation with tightness of the gluteals, the adductors and mild psoas tightness. Knee range of motion revealed an increased in ROM in all directions, particularly medially and laterally. Ankle ROM also showed an increase in eversion. Passive ROM of the foot showed an increase in the 1st metatarsal-phalangeal joint. Palpation of the extensor mechanism of the 1st metatarsal produced pain. A working diagnosis of hypermobility of the 1st metatarsal-phalangeal joint causing aggravation of the surrounding connective tissue was made. This, in part, was due to the tightness of the hip joint.

Treatment consisted of soft tissue therapy to the insertion of extensor mechanism of the foot and the gluteals musculature. Mobilisations of the hip in internal and external rotation were also performed, as well as stretching of the gluteals and psoas. The patient was instructed to perform foot strengthening exercises including picking up pencils both between the first and second toes and also with the phalanges across the foot. Also requested was the undertaking of stretching exercises of the gluteals, the piriformis and the psoas muscles.

Discussion


Foot pain occasionally occurs in golfers, but is rarely reported on, particularly its injury mechanism. This case study reports on a foot injury incurred during golf as a result of faulty leg mechanics. The follow through in golf requires the pivoting of the body around the foot. Due to the tightness of the hip, particularly in external rotation, this movement occurred primarily in the contact point of the foot with the ground – the 1st metatarsal-phalangeal joint. This resulted in an increase in mobility and resultant strain to the surrounding tissue.

For more information on Foot Pain and Foot Injuries and Professional Treatment available contact Dr Andrew McHardy PhD today.

Foot Pain Occasionally Occurs in Golfers