Rugby

How playing rugby impacts on the foot

Rugby is a multidirectional, multi-speed impact sport played on various types and quality of surfaces, and in every kind of weather. Research has demonstrated that the lower limb is the most frequently injured part of the body, with excessive loads being focussed specifically about the joints of the ankle and foot, either through poor technique (using the ‘wrong foot’ position to tackle a player) or more commonly, through unexpected contact with the ground or another player (being tackled or going into a ruck or maul). As a result, rugby injuries are more traumatic when compared with other sports and specifically relate to the player’s position.

Front row players in particular are subject to greater absorption and transmission of forces through the foot in scrummaging and experience a high degree of knee and cartilage injury, calf muscle and Achilles tendon problems, lateral ankle ligament damage, inflammation or rupture of the tissue in the arch of the foot (plantar fascia) and stress fractures of sesamoids (small bones under the big toe joint) and the metatarsals. The incidence of injury in centre and back row players is greatly increased by tackling and usually occurs as a result of direct force. Interestingly, during training sessions, running is the predominant cause of injury for both forwards and backs.

Potential problems and when best to seek
the help of a podiatrist

• Injuries incurred during training or playing can be attributed to two main factors: single traumatic events resulting in direct injury or multiple, repetitive, traumatic events that impact on joints and soft tissues and ultimately lead to chronic injury and disability.
• Common injury as a result of direct trauma includes damage to the nails, ligamentous damage in particular of the big toe joint (known as ‘Turf Toe’) and skin lesions such as blisters or haemorrhage. Repetitive injury may lead to heel or arch pain, shin splints or medial tibial stress syndrome and knee problems such as swelling/locking of the joint. Due to biomechanical mechanisms involved, such types of injury may be more difficult to manage and rarely respond to standard methods of sporting medicine such as rest, cold and heat treatments, physiotherapy, strengthening, proprioception retraining and rehabilitation. Where these methods are effective, the results may be short lived unless the underlying faulty mechanics are also addressed.
• The key role of the podiatrist is to identify any underlying issues and address them by means of insole or orthotic therapy whilst incorporating methods of rehabilitative management, such as improving lower leg muscle function as part of the treatment regime. Such therapy may also benefit the short term management of the player with direct contact injury.

Equipment required

Protective equipment available includes gum shields, padded headgear and clothing, fingerless gloves, strapping, grease, support sleaves, shin guards and ankle braces. However, with the exception of mouth protection, there is no solid scientific evidence in support of or against the use of protective equipment. Despite the lack of research into protective clothing, such equipment is generally advocated as a preventative measure against injury and applies to male and female players alike.