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1 Tennis Injuries of the Lower Extremity: “The Tour is Tough” Alex Kor, DPM, MS Froedtert and the Medical College of Wisconsin Milwaukee, WI ---------------------------------------------------
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Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

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Page 1: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

1

Tennis Injuries of the Lower

Extremity: “The Tour is Tough”

Alex Kor, DPM, MSFroedtert and the Medical College of Wisconsin

Milwaukee, WI

---------------------------------------------------

Page 2: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Whether you are a podiatry

resident, a podiatrist in private

practice, a podiatrist in a multi-

specialty clinic, a podiatrist in

an orthopedic group, etc. you

are likely to encounter a tennis player that has

lower extremity pain.

Page 3: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

The United States Tennis Association

sponsors junior, open, and senior tennis

tournaments in addition to year long leagues

for different levels, and ages.

Page 4: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Palm Springs, CA. Baton Rouge, LA. Atlanta,

GA. Austin, TX. Wheeling, WV. Indianapolis,

IN. Portland, OR. Jackson, MS. New Haven,

CT. Tel Aviv, Israel. Philadelphia, PA.

Alexandria, VA. Sarasota, FL. Las Vegas, NV.

Scottsdale, AZ. Pittsburgh, PA. Savannah,

GA. Naples, FL Ft. Lauderdale, FL. , Park

City, UT, La Jolla, CA, Santa Barbara, CA.

Boise, ID, Seattle, WA, El Paso, TX, etc.

Page 5: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

It is estimated that 7,416 unique players

competed in national adult Cat 1 and 2

tournaments in 2016, and 7,241 played in

2017. A unique player is a person who plays one or more of these tournaments. They are only

counted once regardless of how many Cat 1 or 2 tournaments they played.

• Source: Doug Wenger, Manager, Adult/ Senior

Competition, USTA Office, White Plains, NY 10604

Page 6: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

• The USTA League Program had this # of

participants in:

A. 2016 = 915,860 The unique # of

players was 312,447.

B. 2017 = 928,292 The unique # of players

was 313,885.

• Source: Bonnie Vandegrift, Chair, USTA League

Committee

Page 7: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

“Despite a slight decline in key “core” player

category, the latest research shows 1 %

overall growth (i.e. 17.9 million players) with

another 14 million Americans showing an

interest in playing tennis…”

• Source: tennisindustry.org, March 12th, 2018

Page 8: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Whether one plays recreationally,

competitively in USTA Leagues or at National

Senior events, injuries of the lower extremity

will occur.

Page 9: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

“…Tennis players at all competitive levels

sustain overuse injuries. Lower limb injuries in

these tennis players are nearly equal to or

exceed upper limb pains...”

Pluim, B, Staal J, Windler G, Jayanthi N. Tennis Injuries: Occurrence,

aetiology and prevention. British Journal of Sports Medicine. 2006; 40(5):

464-468.

Page 10: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

ATP sports medicine officials conducted a

study of the injuries for which professional

players seek treatment from officials They

found that 35-50% of all injuries were to the

lower extremities,

Source: Bastholt P, ‘Professional tennis (ATP tour) and number of medical

treatments in relation to type of surface , Society for Tennis and Medicine and

Science (www.stms.nl)

Page 11: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

• According to a review article by Bylak J. and

Hutchinson, junior tennis players are two

times more likely to injure the lower

extremity than the upper extremity or spine.

• Source: Bylak J, Hutchinson MR. Common sports injuries in young tennis

players. Sports Medicine. 1998; Aug. 26 (2):119-32.

Page 12: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

The Distance Run Per Game in Various Sports

1. Baseball= 0.0375 miles,

2. Football= 1.25 miles (receivers, DBs),

3. Basketball= 2.55 miles,

4. Tennis= 3 miles (varies with style, level)

5. Field Hockey = 5.6 miles

6. Soccer= 7 milesFrom: Fox, K. Runner’s World, June 29th, 2016, “The Distance Run Per Game in

Various Sports”.

Page 13: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Before we look at some of the

more common lower extremity

tennis injuries (aka horses), let’s

discuss a few unusual injuries

(aka zebras).

Page 14: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Not all injuries encountered are the typical

injuries that you and I would expect. That is,

unusual lower extremity can sideline even the

top players in the game.

Serena Williams – 1. In July of 2010, after

winning Wimbledon, she lacerated her EHL

Tendon while celebrating her victory in

Munich.

Page 15: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

2. On July 15th, 2010, she

had surgery to repair the

EHL Tendon.

3. Returned to practice in

Sept. 2010.

4. Had a second surgery

on foot in October.

Page 16: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

5. In March of 2011, she was diagnosed with a

PE .

6. She returned to competition in June 2011.

7. She advanced to the Finals of the 2011 US

Open Finals before losing to Stosur.

Page 17: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Kim Clijsters, a three time US Open winner,

hurt her right ankle in April 2011 while dancing

in high heels at her cousin’s wedding.

She sustained a soft

tissue injury that

Included a partial tear

of ankle jnt. capsule/

tendon sheath.

Page 18: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Page 19: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Jo-Wilfried Tsonga, in August of 2012 required

10 stitches (in Toronto) to close a laceration

near his knee when he walked into a fire

hydrant on a street.

Page 20: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH

IN JULY 2012, AT THE QUEEN’s CLUB (IN

ENGLAND) , DAVID NALBANDIAN KICKED A

CHAIR & LINE JUDGE WAS INJURED.

Page 21: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

As a podiatrist, we should tell our tennis

players:

1. Avoid dancing

2. Avoid fire hydrants

3. No kicking

Page 22: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Common tennis injuries of the lower extremity:

1. Achilles Tendinitis,

2. Tennis Leg

3. Achilles Tendon Rupture

4. Plantar Fasciitis/ Tear

5. Ankle Sprain

6. Peroneal Tendinitis/ Tear

7. Jones Fracture

Page 23: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Case #1 (S.B.): The current #4 (55 and over)

men’s singles player in Florida (and # 17

nationally) has recurrent achilles tendinitis and

hamstring issues.

Page 24: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

And he wears these shoes :

Page 25: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

Rigid Shank

25

AVOID ANY TENNIS

OR GYM SHOES

THAT BEND HERE

BAD FLEXION IN MIDFOOT

SHOE FLEXION STABILITY

Page 26: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

“THE EFFECTS OF A

RIGID SHANK SHOE

ON PLANTAR

FASCIITIS IN

RUNNERS”

Susan E. D’Andrea1, Kasey R. Parker1, 3,

Jason Novick2, Michael Kahelin1, Patrick

McKee2 and Alex Kor2

Departments of

1 Biomedical Engineering and

2 Orthopaedic Surgery, The Cleveland

Clinic Foundation, Cleveland, OH

3 School of Human Kinetics, University of

Ottawa, Ottawa, Ontario, CANADA

Page 27: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

X-rays of an athlete with Achilles Tendinitis

– 30-40 % of the

general population

has a heel spur on

X-ray and yet has

no pain.

Page 28: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Treatment for Achilles Tendinitis:

1. NO HEAT

2. Ice Applications (use a towel between heel

& ice) x 20 – 30 MIN. , once per day x 4

weeks

3. Heel lift(s)

4. Modification of shoes.

Page 29: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

5. Modification of activity level.

6. Anti-inflammatory med. X 3 weeks

7. Never a cortisone shot.

8. Boot/ Night Splint

9. Physical Therapy (Home Stretching

Program)

10.Shock Wave/ PRP

Page 30: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

Stretching Exercises

30

NON-WEIGHT BEARING (A.M.)

(Do this exercise in the morning prior to getting out of bed)

Sit with one leg bent, the other leg straight. Use a towel

around the ball of your foot to pull your foot toward the

knee. Hold for 30 seconds. Repeat 5 times.

Page 31: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

Stretching Exercises

31

WEIGHT-BEARING (P.M.)

Face a wall. Bend one knee and

bring it toward the wall with foot flat

pointed straight. The back leg

should be straight. Slowly move

your hips forward, keeping the back

leg straight and feet flat until

you first feel a stretch. Hold for 30

seconds. Repeat 5 times.

Page 32: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Case #2 – G.W. , a 43 year old airport

engineer was playing a 4.0 USTA match in

northern VA. With a previous history of a

achilles tear that required surgery, he was

unsure what had happened to his calf muscle

when he felt a “pop” in his left calf (medial

head of the left gastrocnemius). He was

unable to finish the match.

Page 33: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

• Case #2 continued – So, he called the

volunteer podiatrist of “The Tour”. I

explained the injury to him.

Page 34: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Case #2 continued – The treatments offered

GW included:

a. No impact activities x 3 – 6 weeks

b. Heel lift (in one or both shoes)

c. Ice / No heat

d. Boot x 2 – 4 weeks

e. Compression of calf

f. Physical Therapy

Page 35: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE # 3 – K.B., a 51 year old business

owner from LaPlata, MD and a national ranked

player was hitting a service return and then

took a step forward.

“… My leg felt like it exploded !

It was like someone hit me on

the back of my ankle...”

Page 36: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Case #3 continued – When a patient has a

suspected achilles tendon rupture,

Thompson’s test is usually performed.

Page 37: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

• Thompson’s Test

*In a patient with a ruptured

Achilles tendon, the foot will

not move. That is called a

positive Thompson test.

Page 38: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE #3 continued – Less than 2 days (Aug.

2003) after having the rupture, Ken underwent

successful surgical repair. He returned to

playing in June 2004 and continues to play

competitive tennis !

“THE TOUR IS TOUGH”

Page 39: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE #4 – G.S., a 50 y/o teaching

professional and nationally ranked player from

Ellicott City, MD was playing in a USTA match

on Aug. 14th, 2009 when he felt a “snap,

crackle, & pop” in his arch.

Page 40: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE #4 continued – He could not continue

his match and was unsure if he could

compete in the upcoming national grass courts

in Philadelphia (singles and doubles).

Page 41: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

• CASE #4 continued – So, he called me a

few days prior to the tourney (that I was

playing in, as well).

• He and his partner had won a national

doubles tourney in 2008.

• Because, he was still having pain, I

suggested that he not play singles and only

play doubles (which started on 8/26)

Page 42: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE #4 continued – Beginning on Aug. 26th,

G.S.’s treatment included:

1. Cross Friction massage

2. NSAIDs

3. In – shoe orthotics

4. Taping of the foot

Page 43: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE #4 Continued – Fifteen days after

partially tearing his plantar fascia, G.S. and

his partner won the 2009 45 and over Grass

Court Doubles Championships.

Page 44: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

• # This compares favorably to a study by

Saxena and Fullem who followed 18

athletes who suffered same injury and

returned to competition in 9.1 weeks (+/- 6.0

weeks).

Source : Saxena, A. and Fullem, B. “Plantar Fascia Ruptures in Athletes.” .

American Journal of Sports Medicine, 2004; April – May , 32(3): 662-5.

Page 45: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE #5 – Ankle Sprain

According to a paper in the British Journal of

Sports Medicine (from 2006) ankle sprains

accounted for 20–25% of all acute injuries

on a tennis court.

• Source :Van Zoest WJ, Janssen RP, Tseng CM. An uncommon ankle sprain.

British Journal of Sports Medicine. 2007; Nov. 41(1): 849-50.

Page 46: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE #5 – Alex Kor and John Isner

Page 47: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

• By definition, an ankle sprain is an

acute soft tissue injury that results in damage

to the ligaments, tendons, and associated

soft tissues of the ankle.

Page 48: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE # 5 – On August 18th, 2010, John Isner

sustained a severe ankle sprain at the

Cincinnati tour event. He was forced to default

his match after this injury. His playing status at

the 2010 U.S. Open was questionable, at

best. But on Sept. 2nd, 2010, he miraculously

won his first match at the U.S. Open. An MRI

found no fracture but there was significant

ligament damage.

Page 49: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Case #5 – On July 14th, 2008, while playing a

tourney in Bethesda, MD , I suffered a similar

injury. A lob was hit over my head & as I

reached the ball in the corner; my left ankle

inverted and I fell to the ground.

a. I continued the match with a

compression dressing,

b. X rays were normal,

c. Returned to playing in early August.

Page 50: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Initial treatment for an ankle sprain should

include:

P PROTECTION

R REST

I ICE

C COMPRESSION

E ELEVATION

Page 51: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Ankle sprain/ fracture:

After an ankle sprain, initial x-rays can be

normal and yet a subsequent x-ray or another

imaging option may disclose a fracture.

----------------------------------------------------

Thus, a conservative approach to treatment is

highly suggested.

Page 52: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

• TESTS THAT YOU SHOULD PERFORM:

Page 53: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Case # 6 – A 4.5 USTA 49 year old male

(“J.D.”) with a history of plantar fasciitis

presented to my office 2 days after sustaining

a right foot injury (on court) that resulting in

pain (that caused him to faint).

His exam found mild to moderate swelling of

the lateral aspect of the calcaneus with (2 +)

pain to the peroneal tuberacle .

Page 54: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE # 6 -

Page 55: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE # 6 -

Page 56: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE STUDY # 6 –

1. X rays were normal.

2. MRI Found a partial tear of the Peroneus

Brevis tendon at level of Peroneal tubercle

(with small avulsion)

3. Treatment – Immobilization

4. Physical therapy

5. Shoe Change/ Orthotics

Page 57: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE STUDY # 7 – 67 y/o

male (former college player) tennis player

recalls approaching the net

and feeling sudden pain to

the lateral 5th MT Base. He

continued to play and x rays

were obtained ~ 2 weeks

later.

Page 58: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE STUDY # 7 – Additional X-rays

Page 59: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

CASE STUDY # 7 (at “press time”)- The

patient has pursued conservative care:

1. Immobilization

2. Bone Stimulator,

3. Partial weight bearing

Page 60: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Changes in the game of tennis:

1. Tennis players are bigger,

stronger and more athletic

(from WSA, 2006, 12 4:12-14.)

Page 61: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Changes in the game of tennis:

2. Grass courts are slower and hard courts

tend to be faster (from The Queensland Times,

2015, “Tennis biz: great change at

Wimbledon.)

Page 62: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Changes in the game of tennis:

3. “..The strategy of the game has changed.

Less serve and volley play and longer rallies

involving more side-side movement of

players..”

from personal communication with Allan

Grossman, DPM , USTA Sports Science

Committee.

Page 63: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Changes in the game of tennis:

4. According to Grossman, 70 – 80 % of the

baseline strokes are forehands and fewer

than 30 % are backhands.

Page 64: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

“THE TOUR IS TOUGH”

Changes in the game of tennis:

5. Perhaps, the biggest change in the last 5-10

years is the use of sliding on a hard court.

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Traditionally, sliding on clay courts has been

commonplace. But as the game has become

more athletic, faster, quicker, the tennis player

has less reaction time to get to the ball and hit

the shot. Thus, the use of sliding on hard

courts is now a necessary skill at the elite

level.

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So, what is sliding needed and does it affect

injury rates of the lower extremity?

With the increased power of the game, sliding

allows elite players to recover quickly for an

upcoming shot while maintaining foot position

and momentum.

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In a 2014 paper in Procedia Eng. , Pavailler S.

and Horvais N. found that sliding does indeed

allow faster repositioning during tennis specific

movements on hard courts.

1. Backhand time for repositioning was

reduced by 21 %,

2. Forehand time for repositioning was

reduced by 42 %.

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Injury rates: Nigg and Denoth (in 1980)

questioned over 1000 tennis players regarding

court surface and incidence of tennis injury.

They found that tennis players playing on

surfaces that allow sliding (clay courts) had

less pain and injury than their counterparts

playing on surfaces that did not allow sliding

(asphalt, synthetic surface).

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Cushioning/ Stiffness of court surface:

Nigg and Yeadon (1987) – The stiffness of the

court surface seems less significant than the

frictional properties for preventing tennis

injuries. The more the surface allows for

sliding, the less lower extremity injuries occur.

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According to a March 2016 paper in the

Journal of Medicine and Science in Tennis,

two other factors play a role:

1. Interaction between court construction (load

experienced by the body) and the shoe

construction.

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Therefore, one can assume that injuries in

tennis players may be dependent on the

advances of shoe gear technology (which has

not been as innovative as the running shoe

gear technology).

Sterzing et. al. ,in a 2014 paper in Footwear

Science, surveyed 1,524 tennis players from

China, Germany and the USA.

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The tennis players in this paper reported:

1. Forefoot outsole durability issues,

2. Excessive sweating,

3. Blisters,

4. Increased ankle sprains,

5. Pain of the MT Heads

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Sterzing concluded that: “ The creation of

innovative tennis footwear, providing forefoot

shoe comfort marks a strong request of tennis

players”

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I would agree with these recommendations:

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The latest tennis shoe trends suggest that the

emphasis is on making the shoes lighter and lower to

the ground. The hope is that this will allow for better

performance without sacrificing durability and

cushion.

Personal communication with David Sharnoff, DPM

and Arthur Gudeon, DPM

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Allan Grossman, DPM, using sensor tennis

technology in tennis and running shoes, wear tested

elite tennis players in 2011. Surprisingly, he found

that running shoes tested better than tennis shoes in

the same group of players. No one is suggesting to

play tennis in running shoes, but the tennis shoe

companies need to utilize more running shoe

technology in tennis shoes.

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IN SUMMARY, AS I CONTINUE TO PLAY ON

“THE TOUR”, THERE IS NO DOUBT THAT I

WILL CONTINUE TO BE EXPOSED TO

UNUSUAL LOWER EXTREMITY INJURIES.

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BUT, BEYOND OFFERING ADVICE AND

OCCASIONAL INTERVENTION, I WOULD

HOPE THAT I COULD OFFER “THE TOUR”

SOME PRO-ACTIVE & PREVENTIVE

MEASURES.

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A FEW YEARS AGO,

MY RT. SHOE HAD WORN

OUT. I CALLED MY TENNIS

SHOP AND WAS SHOCKED

TO FIND OUT THAT THEY

NO LONGER CARRIED MY

MID-TOP SHOE .

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I CONTACTED ALL OF THE TOP SHOE

COMPANIES, REPRESENTATIVES, ETC., &

DISCOVERED THAT THERE EXISTS NO

MID-TOP SHOES.

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THEREFORE, I AM PROUD TO ANNOUNCE

THAT AS OF ,TODAY (JULY 13th, 2018), I

WOULD LIKE TO MAKE MYSELF (AND MY

LIKENESS) AVAILABLE TO ANY SHOE

COMPANY THAT IS READY TO LAUNCH

THE:

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THE KOR-SWISS MID-TOP SHOE

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“THE TOUR IS TOUGH- Got

Tennis?”

Thank you for inviting

us !

• REFERENCE: Kor, Alex. “DOUBLES PLAYERS: COMMON LOWER

EXTREMITY TENNIS INJURIES”, PODIATRY MANAGEMENT, April- May

2011, pp. 91-98.

Page 85: Froedtert and the Medical College of Wisconsin Milwaukee ... NATIONAL 2018- Tennis.pdf · resident, a podiatrist in private practice, a podiatrist in a multi-specialty clinic, a podiatrist

Any questions ?

• Alex Kor, DPM,MS

[email protected]