Whether you’re Serena Williams or just a weekend warrior, foot injuries are common in tennis. This is because the game requires intense footwork and repetitive impact.

The lateral ankle movement and quick directional changes also predispose players to muscle strains. Moreover, the repetitive foot movement may lead to shoe pressure on the toes which can cause pain and discomfort.

Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain and is caused by repeated strain on the plantar fascia ligament that runs from your heel bone to your toes. This repetitive strain causes micro-tears in the ligament which leads to inflammation and heel pain.

Symptoms include pain when you first stand up after sitting or sleeping, and pain when you start walking or running. You may also have a sharp or stabbing pain when you walk on hard surfaces, especially after exercise or long periods of time standing. Other symptoms include difficulty or pain when lifting objects, and the pain getting worse over time.

Tennis players are at high risk for foot and ankle injuries due to the dynamic and high impact nature of the sport. This is also a sport where quick changes in direction are frequent, and the Achilles tendon can be stretched or ruptured as a result of sudden contraction of the tendon while the foot is being extended.

Treatment options for plantar fasciitis include RICE (Rest, Ice, Compression, Elevation) and anti-inflammatory medications. Physical therapy to improve foot strength, flexibility and balance can help. Another option is Extracorporeal shock wave therapy (ESWT) which is a noninvasive procedure that uses high energy waves to promote healing in the plantar fascia tissue. In severe cases, corticosteroid injections may be considered.

Stress Fracture

A stress fracture is a tiny crack in a bone. It develops over time from repetitive force that puts too much pressure on the bone. This pressure can come from repeated activity, sudden increases in training or practice, and wearing inappropriate footwear. It can also be caused by a medical condition that weakens bones, such as osteoporosis. Stress fractures often occur in the weight-bearing bones of the foot and lower leg, such as the metatarsals that connect your ankle and heel to your toes. They’re most common in young and active athletes, particularly women and girls who participate in competitive sports.

Pain from a stress fracture usually feels different than muscle soreness. It’s a dull, persistent pain that gets worse during and after physical activity. It may become swollen or tender, especially when trying to use the affected area.

Treatment for a stress fracture involves resting your feet and gradually increasing the amount of activity you do. Non-surgical treatment options include RICE (rest, ice, compression, elevation) and anti-inflammatory medication. Surgical procedures, such as cutting the plantar fascia to relieve tension or using shoe inserts, can also be helpful. Most stress fractures heal with time, but getting them treated early can help you avoid long periods of downtime from your favorite sport.

Metatarsalgia

Metatarsalgia is pain in the ball of the foot that is aggravated by sports or activity. It usually feels like a pebble in your shoe or a burning sensation under the balls of the feet when you stand or run. It may also feel swollen and tender to the touch. The pain usually develops gradually, but can occur suddenly from increased activity or wearing high-heeled shoes or other footwear.

The five metatarsal bones in the ball of the foot bear the weight of your body when you stand or walk, so they are prone to injury from repeated trauma. Anyone who is active can get this problem, but distance runners and those who engage in other high-impact activities are especially susceptible. Certain foot types, such as a high arch or having a second toe that is longer than the big toe, can also contribute.

To help alleviate this type of pain, rest the affected foot as much as possible. Try to ice it after playing, and shave calluses or add a metatarsal pad to your shoes to relieve pressure. Over-the-counter NSAIDs, such as ibuprofen or naproxen, can help reduce swelling and inflammation. In more severe cases, a podiatrist can administer corticosteroid injections or prescribe physical therapy. Regular foot, ankle and calf exercises can help keep muscles and ligaments that support the metatarsal bones and those that contribute to the way you walk flexible and strong.

Blisters

The running, stopping and pivoting in tennis creates a lot of shear stress on the feet. This can lead to friction blisters. Blisters are fluid-filled bubbles that occur just underneath the surface of the skin. They develop from rubbing or friction on the skin and are often painful. Often, they heal on their own. It is important to resist the temptation to pop or peel blisters. This can open the wound to bacteria and infection. Wash the area gently with soap and cover it with a sterile, dry dressing.

The quick lateral movements, repetitive impact and high-speed changes in direction and intensity of tennis play can also cause ankle sprains. These can be graded from mild to severe. Heel pain (plantar fasciitis and heel spurs) can also be a result of these injuries.

Metatarsalgia is another problem associated with repetitive high-impact activities such as tennis. This condition is characterized by a burning or shooting pain in the ball of the foot where five long bones come together.

These conditions can be prevented by wearing proper shoes, doing appropriate warm-up and stretching exercises before playing, and taking rest days between matches. Players with pre-existing foot maladies or structural abnormalities are at an increased risk of injury and should consult with their podiatrists before participating in the sport. In some cases, surgical intervention may be needed to realign the bones in the foot or ankle.