Golf is considered a low impact sport, but the repetitive movements and weight transfer required to perform the game can place strain on the ankles and feet. Heel pain, metatarsalgia and a condition called hallux rigidus can be common golf injuries.
Uneven fairways and sand traps can lead to rolled ankles, especially without proper footwear. Wearing shoes with arch support and cushioning can help.
Plantar Fasciitis
Plantar fasciitis is one of the most common causes of heel pain. It occurs when the plantar fascia (thick tissue on the bottom of your foot) becomes irritated and inflamed. The most common symptom of this condition is pain that starts when you stand up or walk after sitting or sleeping for long periods of time. The pain may be sharp and stabbing, especially when you step down on a hard surface or exercise. It is often worst in the morning or after you have been on your feet for a while, like when getting out of bed or walking up stairs.
The golf swing requires a lot of repetitive stress on the feet and legs. This can lead to foot injuries, such as stress fractures or metatarsalgia (pain and inflammation in the ball of the foot). It is important to warm up and stretch before playing golf. Wearing proper footwear with good arch support and cushioning can also help.
If you are experiencing pain and swelling in your feet, it is best to contact your podiatrist for an evaluation and treatment plan. Nonsurgical treatments are usually effective and can include rest, ice, stretching, shoe inserts, shock wave therapy, and physical therapy to improve foot mechanics and strengthen supporting muscles. In severe cases, steroid injections or surgery may be needed to relieve pain.
Metatarsalgia
Golfing for hours strains the feet and can create overuse problems such as metatarsalgia and Morton’s neuroma. These conditions develop in the ball of the foot, most likely the front foot, as the weight shifts forward and twists in during follow through. The rapid pressure changes and repetitive motion over time can pinch the nerves in between your toes causing pain and swelling. Eventually the pain may affect other parts of the body causing referred pain in the ankle or knee.
The pain is usually in the ball of the foot (metatarsalgia) or around your big toe. It can feel like a pebble is stuck under the end of your foot or it might feel burning or sharp. A callus or a corn (thickened skin) on the affected area of the foot may also be present.
These conditions are not usually severe and can often be managed with conservative modalities such as rest, shoe modifications, using an over-the-counter pad for the foot, or applying ice to the affected area 15-20 minutes every hour. If self-care modalities don’t relieve the pain, your healthcare provider can evaluate your condition and recommend a more extensive treatment regimen. This may include the use of orthotics to improve stability in the golfing stance and redistribute the excessive forces away from the sensitive areas of your feet.
Stress Fractures
Stress fractures occur when a bone is subjected to repetitive, submaximal loads that exceed its capacity for biologic repair and remodelling. They are typically characterised by pain that worsens with activity and localised tenderness. They may be difficult to diagnose as the initial X-rays may appear normal.
While golf-related stress fractures are rare, they can occur in the foot and ankle complex. They often present amongst highly active individuals with vague midfoot pain that worsens on activity and is accompanied by tenderness over the affected metatarsals. The injury is typically diagnosed by a physician with the help of MRI scans which show a stress reaction or a cortical lucency indicating a fracture is present.
Stress injuries such as this can be prevented by gradually increasing the intensity of training or activity and by allowing enough time for the body to adapt to the increased load. Yale Medicine sports medicine specialist Peter Jokl says that these types of injuries usually develop in athletes who are enthusiastic about taking on a challenge, such as a weekend runner who decides to train for a marathon too quickly.
Wearing shoes that provide sufficient support and stability, avoiding excessive force on the big toe joint and practicing proper swing mechanics can also help reduce the risk of turf toe. Treatment includes rest, ice, compression and elevation (RICE), along with physical therapy.
Neuroma
The repeated weight transfer to the front foot that occurs in a golf swing applies pressure that over time can cause a nerve in your foot to become pinched. This is called a neuroma. It most often develops in the space between the bones that connect your second and third toes. It can also affect the nerves in other spaces in the forefoot. The pain, tingling and numbness associated with neuroma may be felt in any activity that increases pressure on the forefoot area. This includes walking, running, wearing high heels and any other activities that place excessive pressure on the ball of your foot.
To confirm a diagnosis of neuroma, we’ll ask you about the location, nature and severity of your symptoms. We’ll then do a physical exam of your feet, including assessing the width and length of your toes. We’ll also check your shoes for narrow toe boxes, which can exacerbate the condition. We may do what’s called Tinel’s test, which involves tapping over known pathways for peripheral nerves to see if you feel pain and tingling. If you do, that’s a good indication that you have a neuroma.
Treatment for neuroma involves removing any pressure on the affected nerve, which can include wearing shoes with wide toe boxes, shoe inserts, and massaging the area. It can also help to reduce your activities that put pressure on the forefoot, including temporarily avoiding high-impact sports and exercise. If you’re taking medications, we can talk to you about tricyclic antidepressants or antiseizure drugs that change how your nerves process pain signals and can relieve the burning and tingling associated with neuroma.