How much sport is enough for a child? When does too much sport become abuse? Is an over-use injury at a young age, in the pursuit of excellence worth the possible long-term consequences? Consider this:
Last week, an 8 year old boy, barely able to walk, was brought to see me by his mother. He had a severe limp, walking with his foot out and his ankle stiff, to reduce the pain. Three days previously he had spent nearly 5 hours doing athletics at school. His mother told me that the initial pain began more than 6 months ago, after he had played a lot of rugby.
The school under 8 team had been very successful, winning their area age group, so had a long season. Then he moved up an age group to under 9 which extended the season further. Nevertheless he continued with all sports, despite the pain and the fact that he was not running as fast as before. A compounding factor is that athletics and rugby are both done barefoot.
The timetable of sports reads like that of a professional adult, with daily practice depending on the sport and season, with inevitable overlap; plus the fact that the school plays some sports out of season as well.
- Athletics: 1 hour a day, x 5 days, plus meetings
- Cricket: 1 & half hours a day x 5 days, plus club games on Saturdays for a university club junior side
- Rugby: 1 hour a day x 5 days, plus matches
The boy is obviously very good at his sports and according to his mother is always active at home whilst playing. However, this timetable with an injury would cripple most adults.
So what's the point? How far must we/should we push or allow our children in pursuit of sporting excellence? We try to teach balance in most aspects of life, sleep, study, money etc., but when it comes to sport we seem to make up the rules as we go along.
After requesting X-rays of both feet and discussing them and my diagnosis with two different medical colleagues, it was agreed that the cause of the pain is damage to the growing part of the back of the heel bone, where the Achilles tendon inserts. Clinically called a Traction Apophysitis.
The initial treatment is rest and avoiding any vigorous activity that causes the Achilles tendon to pull on the heel bone. Raising the heel or possibly orthotics may help.
So ask yourself the question – is this youngster suffering an over-use injury or child abuse or both?
A full Case History will be posted during this week.
Best wishes for 2009. The first holiday injury came this week. Another sesamoid fracture . A 38 year old male patient returned to the practice for follow up to a visit in December, due to have impressions made for new orthotics.
He told me that on Christmas Eve he had slipped and fallen into a swimming pool with his leg fully extended – 'straight out in front and under me'. The leg had hit the bottom of the pool with the ball of his foot, jarring it severely.
Over the next few days he experienced varying degrees of severe pain, best relieved with wearing thicker soled shoes. However, with the weight off the foot there was a constant throbbing.
Remembering the young lady I wrote about about towards the end of last year, I sent for X-rays. Result a fracture shows clearly in one of the sesamoids.
Treatment? Take it easy. No excessive activity – but cycling in the gym is OK. Thick and soft soled shoes – probably sneakers. Be patient!
Sesamoid fractures should always be suspected with a history of sudden stamping under the foot. They usually heal well, but may take time.
In just under 7 hours time South Africa will welcome 2009. Will you make a resolution to become a podiatrist? Maybe one of your family or friends will?
Are you sitting with your 'Matric' results and not sure what to do next? South Africa has a serious shortage of podiatrists and as I wrote the other day even our new graduates are emigrating. There are fewer than 200 registered podiatrists for our population of about 48 million people.
However, with increasing access to health care and awareness of the benefits of a healthy lifestyle, there is a growing demand for foot care, especially for children and people with foot problems associated with diabetes and arthritis. Nevertheless, many sectors of the South African population still don't know what a podiatrist is or what we do. As our population changes more people will need foot care.
A podiatrist is really a 'doctor of the feet'. We diagnose and treat foot disorders and abnormalities. This is done in many ways. Biomechanical examination involves assessing the whole lower limb and its function and then prescribing the appropriate treatment to maintain or restore normal mobility or function.
Many systemic diseases affect the feet and may even be diagnosed from foot symptoms. As a podiatrist you may need to refer your patient to a specialist for further management. A large part of podiatry treatment involves the skilled use of sharp instruments to treat corns or callus or possibly perform detailed corrective surgical procedures on toe nails.
Some of the conditions that Podiatrists treat are fungal infections of the feet and toenails; corns and calluses; ingrown toenails; foot ulcers in diabetes; causes of foot pain in arthritis. Most podiatrists incorporate orthotics and insoles into their treatment when necessary.
The assessment and management of childrens' foot problems forms an important part of a podiatrists work, whilst some podaitrists are skilled in the managemment of foot problems arising from sports. Nowadays, prevention of foot problems has become very important, so foot health education is also part of podiatry practice.
Although there is no official specialist register for podiatrists, many of us have developed 'special interests' in sports injuries, chronic disease, children or the elderly.
The day to day work of a podiatrist is interesting and varied. Giving relief from pain or diagnosing the cause of a foot problem is both challenging and stimulating. You do need to be able to work alone but also need to be a 'people person' to relate to the different patients you meet every day. Most podiatrists are in private practice, but we hope there will be an increasing deployment of podiatrists in the State Health services in future. For example Limpopo Province appointed their first graduate podiatrist.
To practice in South Africa you have to register with the Health Professions Council of South Africa.(HPCSA). This means that you become part of the Team of health care professionals providing care to South Africans and that you adhere to ethical standards.(By the way, it is illegal to practice as a podiatrist in South Africa if you are not registered with the HPCSA. So always check the credentials of a podiatrist).
To become a podiatrist in South Africa requires four years of full-time study at the University of Johannesburg. You will obtain a Bachelors degree and be able to go into practice immediately. Although bursaries are limited I believe this is changing as Provincial Health Departments begin to realise the value of foot care. Your entrance is dependent on your Admission Points Score (APS) or your M-score.
There are still vacancies for 2009 enrolment. So why not contact the University of Johannesburg – they reopen on 5th January 2009 - at 011 559 6167 or www.uj.ac.za
However you welcome in the New Year, dancing the night away, taking it easy at home with friends, walking on the beach on an exotic island or if you are unlucky, at work! Enjoy yourself and I wish you all good foot health and happiness in 2009.
TAKE CARE OF YOUR PAIR! SEE A PODIATRIST
Merry Christmas! Happy Holidays! We closed the practice today. Tomorrow I start a short break in Hout Bay with my family. Including my son who is visiting from the UK.
I know that some of you reading this site do not actually celebrate Christmas and so I wish you and your families well over the long weekend. If you are celebrating Christmas, I hope that you too can spend some time with those you love.
Travel safely and tread lightly. You never know when you will need a podiatrist!
Best wishes
Andrew
