Watch your footwear when you train

SINGAPORE- The pain in his ankles when he was training for a marathon last year was intense.

Army regular Izaac Koh, 33, decided to change his running style and bought a pair of super-light shoes which cost him $110.

He ran fewer than 10 times in those shoes before hanging them up.

"My ankles were hurting badly," he said.

So he bought another with conventional cushioning for $120.

It alleviated the pain, but not for long.

He said: "Over a distance of 42km (for the marathon), the pain was eight or nine out of 10. I walked the last 12km, I could hardly feel my ankles - it was that painful."

What Mr Koh did not realise was that his right leg was shorter than his left by 1cm and that he had a high arch - these two factors contributed to the pain in his ankles which lasted six months. He required customised insoles, not new shoes or a different running style.

Changi General Hospital podiatrist Hu Wenyan, 26, said that people with high arches are prone to "stress fractures" along the metatarsals, or mid-foot bones, because they are unable to absorb the impact on the knees while walking or moving.

Mr Koh's experience is not unique.

As more people here take up running and other sports, doctors and podiatrists are seeing more foot and other leg injuries.

Changi Sports Medicine Centre consultant Roger Tian, 42, told The New Paper that several ankle and knee problems are due to "poor footwear selection".

'Too much too soon'

'Too much too soon'

The sports physician said runners are also trying to do "too much too soon".

Explained Dr Tian: "They fail to condition their bodies, or they wear the wrong footwear or shoes with worn-out soles. These can cause injuries."

The injuries are not just confined to the feet and lower legs, but also the hips, pointed out Ms Hu.

Podiatrist Tye Lee Tze of The Podiatry Centre wasn't surprised by Mr Koh's painful experience.

"When you're running, the impact on the heel is three times your body weight (on the joints).

"So if a 50kg woman runs 5km, that's 50 times three, and over a distance of 5km, that's some 2,000 to 2,500 footsteps."

He added that this is roughly equivalent to lifting a 150kg weight 2,000 to 2,500 times; therefore, wearing the correct shoes is important.

Dr Tian said the impact on the feet can even go up to five times the body weight.

"A lot of people don't realise this, but you have to build up muscles to take the load," he said.

Mr Koh found out about his high arch and about his right leg being shorter when he consulted a physiotherapist and a podiatrist, whom he saw for three months at Changi General Hospital.

A podiatrist made a mould of Mr Koh's feet and sent it to a lab for customised insoles.

Mr Koh spent $166 on one such pair and is looking forward to receiving them this week. So does the pain go away completely?

More ankle, knee injuries due to sports

More ankle, knee injuries due to sports

Said Mr Tye: "In any weight-bearing activity, especially running, rarely are you going to be 100 per cent pain-free.

"The goal of treatment is to enable the patient to continue their activities in a functional (and) manageable way."

About 30 per cent more people have sought treatment from him for sports-related ankle injuries over the last two years.

For sports-related knee injuries, it is about 15 to 20 per cent more, said consultant orthopaedic sports surgeon Tan Jee Lim, who runs the JL Sports Medicine and Surgery clinic at Gleneagles Medical Centre.

Mr Tye Lee Tze of The Podiatry Centre, who has been practising in Singapore for 19 years, has also seen more patients with similar foot problems in the last few years, although he does not keep track of the numbers.

Both Dr Tan and Mr Tye attribute this trend to more people taking up running or extreme sports.

These injuries can be caused by wearing the wrong footwear for the wrong surface, or for the wrong sport.

For instance, some footballers wear the wrong type of boots for the pitch they are playing on.

Said Dr Tan: "There is an increase in astro-turf (artificial grass) usage for football pitches here, and these surfaces have very different characteristics from the normal grass surfaces."

Better grip

Better grip

He said: "Astro-turf grips much better than the traditional natural grass, and players wearing the standard football boots for grass pitches and play on astro-turf run a higher risk of knee ligament injuries because of excessive stress focused at the knee."

These players should switch to "rubber-studded boots which are specially designed for astro-turf", like how hockey players have all switched from traditional football boots to rubber-studded ones, DrTan said.

Foot injuries can also result from wearing the wrong footwear for the wrongsport.

This includes wearing cross-trainers for running. These shoes do not have adequate cushioning and flexibility for running, said Changi Sports Medicine Centre's consultant, Dr Roger Tian.

Dr Tan agreed and said that another common mistake is to wear running shoes to play court games like tennis or badminton.

"Jogging shoes tend to have higher hind soles for cushioning effect, which raises the centre of gravity of the ankle, which is (not) for court games, where you need to change direction quickly.

"This leads to ankle injuries, ranging from sprains to fractures," he said. Changi Sports Medicine Centre will be holding a public forum on preventing and managing foot and ankle injuries on Oct 13. Call 6850-2987 for details.

estherng@sph.com.sg