Pronation: Necessary or Evil


shutterstock_228691018.jpgPronation has become a dirty word in the commercial world of shoe sales. Along with “flat feet” pronation has been used to describe a serious issue that is impacting on you in your day-to-day life and the reason you need controlling footwear and orthotics to stop this unnatural action!
Scare tactics aside, have you ever asked why pronation is considered bad? Does everyone who pronates need posted shoes and orthotics? If we stop you from pronating does that reduce your potential for injury?

Well first of all let’s get one thing straight, pronation is a natural movement of the foot. It is the amalgamation of subtalar eversion, dorsiflexion at the ankle joint and forefoot abduction to create a number of important moments for efficient human locomotion.
These include but are not limited to;

  • Shock Attenuation: Shock attenuation is necessary when walking and running to reduce the amount of impact forces on the body and more specifically, the lower limb. The foot “unlocks” as it enters pronation reducing its previously rigid position to absorb the forces and in many cases redistribute them appropriately.
  • Elastic Energy: Elastic energy is created and stored within tendons of the leg and foot. Of note, the plantar fascia and achillies tendon form the primary spring mechanisms which are placed on stretch during pronation and refocus that energy into propulsion as the foot begins to re-supinate.

What the foot intends to do and what it actually does comes down to individual circumstances, past injury history and anatomical make – up. Let me clarify this for those who have been told they have flat feet so it is better understood.
Your arch height is primarily defined by the bone structure of your feet and the soft tissues which are associated with these bones. If you suffer an injury to these areas either by way of direct contact or load intolerance which is then not appropriately rehabilitated the structure of your arch may change.
Additionally, the amount of pronation your foot goes through may or may not be appropriate depending on how well your body tissues can deal with the forces which are being placed upon them as a result. It may come as a surprise but some people’s pain can be identified as being due to a lack of pronation.midfoot strike
As mentioned above, pronation is an action and many soft tissue injuries occur due to an inability to deal with the load associated with this action or an inability to cope with secondary biomechanical changes which may occur due to this action. This may include restriction of the first metatarsal phalangeal joint (big toe joint) or internal rotation of the lower leg these actions can both lead to other pedal and lower limb complications.

This information has been used to sell footwear for the last 40-50 years with many sports footwear companies offering a number of options along the continuum of supportive shoes. Some options are secure and cushioned while others provide a solid density foam to limit pronating forces through the heel and mid-foot. It is a matter of fact that sometimes the shoe being sold to you is not necessary the right one – believe me I used to work at one of the more highly recommended retail groups and when I think about some of the shoes I sent people out in I cringe!

Pronation is NOT Evil,
Pronation is NECESSARY!

 

Until Next Time,

Jackson McCosker
Director/ Chief Editor

 

References

Baan, H., & Hermanns, H. (2012). Foot and Ankle Kinematics in Rheumatoid Arthritis: Influence of Foot and Ankle Joint and Leg Tendon Pathologies.

DeSilva, M., Bonne- Annee, R., Swanson, Z., Gill, C., Sobel, M., Uy, J., & Gill, S. (2015). Midtarsal Break Variation in Modern Humans: Functional Causes, Skeletal Correlates and Paleontological Implications. American Journal of Physical Anthropology, 1 – 10.

Liu, A., Nester, C., Jones, R., Lundgren, P., Lundberg, A., Arndt, A., & Wolf. (2012). Effect of an Anti-Pronation Foot Orthotsis on Ankle and Subtalar Kinematics. Medicine & Science in Sports & Exercise, 2384 – 2391.

 

Corns, Callous and Blisters: The What, Where, When and Why of Common Dermal Lesions


shutterstock_314339363.jpgSkin lesions as a result of friction are a common nuisance for a large percentage of people. Blisters, callus and corns are three of these lesions which present on a regular occasion to podiatry clinics. The questions posed around the pathologies are based on what the actual presentation is and how it came to be. In this article we look to answer those questions in a quick-fire way.

BLISTERS

What: Blisters – are small pockets of fluid under the upper layers of the skin as a result of high friction and heat.

Where: Blisters can occur anywhere. However, common places for blister presentations is at the medial and plantar aspects of the foot.

When: Blisters generally occur as a result of short term repetitive friction or high pressure across a specific spot or region.

Why: Friction associated with blisters commonly occurs as a result of an introduction to a new environment. This may include but is not limited to; socks, shoes, insoles/ orthotics or playing surface.

CALLUS

What: Callus – Callus is a build-up of skin as a result medium to long term friction. Its clinical name is hyperkeratosis or HK and is thus named due to the abnormally high quantity of keratin it establishes as a lesion.

Where: Callus typically forms on both the dorsal and plantar aspect of the foot. It can be associated with bony deformities or biomechanical issues.

When: Callus builds as the skin tries to protect itself from increased pressures at a specific spot or region.

Why: Friction over a medium to longer period or duration can cause the development of callus. High pressure areas created by deformities, ill or inappropriate fitting shoes and individual biomechanics are the primary cause. Much of the time these areas can be addressed and improved.

CORNS

What: Corns – are a pathological build-up of tissue which may lead to pain normally as a result of unattended Callus development.

Where: Corns have the potential to form anywhere friction occurs. Typically, they occur on the plantar aspect of the metatarsal phalangeal joints (MTPJs) and dorsal aspect of the interphalangeal joints (IPJs).

When: Corn will occur when callus builds at a specific point in a cone shape lesion which causes pain during weight bearing.

Why: Corns are more likely to result from specific pressure areas such as bony deformities and shoes which may increase the area of pressure.

In conclusion, skin lesions as a result of friction can be a nuisance but worse than that, they can be painful. In some circumstances all 3 can lead into each other and create a cycle of skin build-up which will continue to cause issues more than a couple of times.

Until Next Time

Jackson McCosker
Director/ Chief Editor

Sixteen-Year-Old Female with MTSS and ITB Syndrome: A Case Study


A sixteen-year-old female attends the clinic presenting with pain at her medial tibia and lateral thigh bilaterally with the right being worse than the left side. Pain has been present for just over four years with both herself and parents previously agreeing that it was most likely growing pains as the issues began at approximately twelve years of age. However now that the pain has increased recently and has been continuous for an extended period of time they thought it best to have the problem investigated professionally.
Previously to combat the aching at the medial tibia and lateral thigh the patient received weekly sports massage that would help for 2-3 days. Additionally, a physiotherapist has been seen who also had done very little to alleviate the patients pain.

The patient states the pain can be as high as 8/10 on the Visual Analog Scale but as low as 0/10 at times, with her most noted aggravated pain being extended time standing associated with school and work. Non-weight bearing rest was seen as the only really successful management thus far to the patient. The patient states that she has no allergies, regular medications or medical conditions and overall is considered quite fit.

The patient footwear at this time is deemed to be appropriate as she regularly wears;
1. Clarkes Daytonas – School and Work (80% of her week)

  1. Asics Nimbus – Gym and Activity (15% of her week)
  2. Barefoot mostly around the house (5% of her week)

The patient is a student in high school and works at a supermarket checkout that requires long periods of standing. Additionally, she attends the gym three times a week for a mixed cardio and resistance workout, attends taekwondo once a week and jazz dance once a week.

In the initial assessment the following significant findings were observed:
– Pain on palpation of the medial and anterior tibia as well as the insertion and mid portion of the iliotibial band bilaterally.

– The left foot showed a very restricted 1st ray range of motion in weight bearing and the right foot appeared to have an active windlass mechanism available.

– Both feet, left more so then the right, pronated through mid-stance to an end point range of motion further locking up the 1st MTPJ

– Due to restricted range of motion the left foot was shown to be Apropulsive and both feet displayed an early heel lift.

– Non weight bearing range of motion was found to be within normal limits.

– Proximally, there was visualized femoral rotation and poor glute activation/ control.

Given the patient’s presenting complaint and assessment finding a number of steps were taken in the initial appointment to reduce the patient’s biomechanical risk factors, the forces through the effected tissues and improve the tissues ability to cope with the stressors which are placed upon them.
The patient’s feet were supported through a low dye moccasin taping technique used to shorten the distance between the origin and insertion of the plantar fascia and reduce the speed and force of pronation occurring at the feet. This in part would have more proximal influence as we look to reduce the amount of medial tibial rotation occurring which has been producing some of the patient’s pain. Additionally, a group of glute activation exercises were prescribed so that deficits both distally and proximally were addressed.

First Follow-up
In her first follow up appointment the patient exclaimed how good she had felt with the taping on her feet and would like to invest in orthotics as a mid to long term option for her condition. On this statement the patient was talked through her orthotic therapy options and a decision was made regarding her prescription.

ORTHOTIC CASTING & PRESCRIPTION
The patient was cast using the Vertical Foot Alignment System, a weight-bearing process using cushions and cranks to create a negative cast of a patient’s foot, with the primary theory of casting associated with the tissue stress model.

The device created was a 3mm polypropylene device with a 400 durometer EVA heel post and 220 durometer EVA arch fill reinforcement. The top cover was full length with a cambrelle base, 1.5 mm poron and a 2mm EVA top for comfort purposes.
EXAMPLE:

 

Second Follow- up

The second follow up with the patient took place one week later and the primary focus of the consult was to release the deep and superficial muscles of the lower leg through dry needling techniques and soft tissue massage. A total of eight 40mm x .28mm acupuncture needles were used in various trigger points and adhesions of both lower legs. The patient reported feeling as though her muscles has “reset” post-treatment.

Third Follow -up
The third follow appointment was for dispense of her custom function orthotic device. The orthotic top cover was resized and shaped to mimic that of the patient’s most commonly worn shoes, the patient felt the orthotics were comfortable and supplying adequate support at this time. Additionally, the patient was taped with the same moccasin taping technique which had previously provided benefit and advised to remove it in approximately 48 hours.
It should be noted that since her initial appointment the patient has not experienced any notable pain or irritation.

Fourth Follow – up
The Fourth follow up appointment was due to be a review of the orthotic device and how the patients pain had changed in relation to the new device. The appointment was cancelled within 24 hours of the consultation time due to the patient believing they did not require the appointment stating: “I have not had any pain in a number of weeks now and I am back at the gym running on the treadmills…Everything is going well.”
Although not an ideal situation the patient had shown compliance in her activities and prescribed exercises, therefore the podiatrist suggested the patient book ahead in 6 months for another follow-up and make contact should anything change.

Conclusion:
The patient contacted the clinic after 2 months to inform the practitioner that everything was going quite well. There had been family circumstances which had limited her ability to attend but had had no pain since her last appointment and was attending the gym and running regularly.

The patient was discharged, with a recall put in place for 12 months’ time.

Quick Fire Questions With Trent Croad : An Interview By Sam Davies Part II


This Article was first published on behalf of Frankston Foot Clinic

 

Croad3SD: Hardest player to play on and why?

TC: Alistair Lynch. Just sheer power. When he was playing for Brisbane, you’d look up the ground and see Lappin, Power, Black and Voss and I was standing by myself, aged 19 in the goal square about to be thrown by someone that can bench-press 300kg. It made me want to pretty good on the last line

Best career moment?

Winning the premiership but also seeing my mate Luke Hodge win the Norm Smith medal and for Crawf (Shane Crawford) to finally get one in the end.

Any pre-game superstitions?

Yeah quite a few. I’m a clean freak so I would vacuum the house and clean the night before. Always wore black jocks. Also be well manicured and look good. The thing we always used to say was to play well was, Look Good; Feel Good; Play Good. Get it all done.And the last one. There is a rumour that you have misplaced your premiership medal. Any truth to that?

There is. If someone out there has got it, could you please let me know and get it to me. Or if the AFL could get me another one as I don’t have it

SD: Thanks a lot Trent for meeting with us today, really appreciate it. Good luck with the new business.

TC: Too easy. Thank-you

profile pic (1)Sam Davies
Podiatrist
FootNotes Publishing Contributor

Orthotics and Rehabilitative Exercise in the Prevention of Lower Limb Injury


This article was originally published in Current Pedorthics Magazine

In the allied health profession research is important and should always be the cornerstone of any implemented management or treatment plan. Additionally, what we as practitioners find in a clinical setting can be different to what the evidence may suggest, for better or worse. The following article uses a combination of the literature and what I have found clinically works in the prevention and rehabilitation of lower limb injuries.
The prevalence of lower limb injury amongst athletes has been reported to be anywhere between 19-79%. Those numbers alone are astounding and it is no wonder that when researching this topic, I found no fewer than fourteen systematic reviews based on the prevention of lower limb injury. Many of the studies focus on the non-contact based pathologies: metatarsal stress fractures, medial tibial stress syndrome, patella-femoral knee pain, achillies injury and plantar fasciitis – surprisingly lateral ankle sprains, which have been noted as the most common sporting injury outside of non-specific bruising was not highlighted within the systemic reviews, however, this may be due to it being an umbrella term as opposed to a specific pathology.

Treating the whole person and not just the presenting pathology is becoming a necessity of the services we provide. Although in the podiatry profession we specialise in the foot and ankle there is a need to understand the biomechanics of the more proximal anatomy to help identify movements which may contribute or cause a presenting complaint in the patients we see. As such, the way we treat complaints has moved from a seemingly narrow scope of practice to a multi-faceted management strategy, to get the best result for our clients in the shortest amount of time and attempt to prevent any re-injury or secondary injury as a result of detraining.
When trying to prevent injury a practitioner should aim to offload structures identified as being under high loads of stress, satisfactory rehabilitate previous injury, educate the patient on appropriate footwear choices and refer for a strength and conditioning program tailored to their chosen activity.

shutterstock_89043757Footwear
Athletic attire has transformed the sporting world over the last seventy years or so – especially in the footwear category. From waffle-iron pressed rubber to 3D printed one piece uppers the athletic footwear enterprise encompasses scientific evidence, fashion trends and at times bizarre additions that look like they’re out of a back to the future movie.
The evidence available for footwear’s impact of injury prevention is very limited, most circulates around debate of high top vs low cut basketball shoes and lateral ankle sprains – spoiler alert – low cut wins. Using footwear as an injury prevention strategy primarily comes down to taking an accurate patient history and analysis of the movement patterns and demands of their chosen sport. Football boots have a variety of sports they are useful for whether it be Football, Rugby, Soccer or Aussie Rules each of which also has a variety of surface types they may be played on. Tennis and other racquet sports provide similar issue to the practitioner and patient, as do running shoes!
Your safest option when prescribing shoes for the purpose of injury prevention is to make sure the shoe is designed for the activity in mind, that the shoe is of adequate length and width for the individual and that the outsole is designed for the surface it is to be used on. Other than that it’s all about comfort comfort comfort!
shutterstock_195284591Orthotics/Offloading
The use of orthotic therapy as a way of preventing injury has always been a hotly debated topic, with the key argument against the use of orthotics being “if the tissues are able to tolerate the stressors being placed upon them, why would you look to redirect or attenuate those forces?” in other words “if it’s not broke, why fix it?”.
That argument now seems to hold less weight with the release of a systematic review and meta-analysis identifying the benefits of orthotics in reducing the presence of common lower limb injury.
Bonanno et al 2016, looked at 16 trials (11 custom orthotics, 7 shocking absorbing insoles) in the prevention of lower limb injury. Their findings indicted that the use of custom orthotic devices in the prevention of lower limb injuries was effective in the case of stress fractures and overall injury rate, however, was not effective in the prevention of soft tissue injuries. Furthermore, the use of shock absorbing insoles was not found to be effective in the prevention of injury.
A previously published systematic review without meta-analysis concluded that custom orthotics were effective in the prevention of lower limb stress fractures and shin splints but not effective in the prevention soft tissue injuries or back pain.

So what does this actually mean for us clinically?

Well, one thing that becomes clear from the research is there is no proven reason for why orthotics work in the prevention of injury. We have an abundance of theories and mechanisms toward their prescription and manufacturing but yet no definite agreement amongst professionals.
I take the approach that the orthotic is only one piece of the puzzle. I use the orthotics or similar devices to offload areas of increased pressure or repetitive stress and move on to other modalities to provide the best outcome for a patient, such as exercise prescription.

shutterstock_195157721Strength and Conditioning
When studying at University the concept of strength and conditioning was not a topic or subject that seemed to be largely taught, or at least not in depth. Despite the over whelming amount of evidence available describing well prescribed and executed exercise programs as being effective in the prevention and rehabilitation of lower limb injuries, there was more focus on diagnosis and identification of contributing factors.
This is where my further study as a strength and conditioning coach has really helped me in a clinical setting. Being able sit down with a patient and map out a sustainable exercise program which best prepares them for the up-coming season or identifying a spike in the patients acute: chronic workload that may have contributed to the injury is a skill I wish more practitioners had available to them.
As previously mentioned, the use of custom orthotics has not been found to be effective in the prevention of soft tissue injuries. Therefore, developing and conditioning those soft tissues is of the upmost importance. When developing a strength and conditioning program for a patient it is important that you have an accurate description of past injury (of any kind) and physical activity levels over the last four weeks, as a minimum.
Rehabilitative exercises should be put in place for any injury which has occurred. Within the rehabilitative process the practitioner should be looking to re-establish proprioceptive awareness, muscle activation and control before increasing the resistance of the exercise and looking to develop strength.
Strength development should be the basis of all sport specific exercise programs. Strength development is a neurological adaption to repetitive force production and as such is the underpinning principle for the development of Power Production (Force x Speed) and Muscular Endurance (Repetitive Force x Time).
Developing a good report with the patient’s sports coach or strength and conditioning coach will really help in creating an understanding of what you wish to achieve as a practitioner and what the coach or club needs from the athlete.
By instigating the use of offloading devices, correct footwear and appropriate exercise program, most of which can be placed back on the responsibility of the patient to comply with, your time as a practitioner can be used to help maintain and improve tissue viability through the use of soft tissue management.

Soft Tissue Treatmentshutterstock_377153422
Different types of soft tissue treatments have been used to help people’s quality of life and athletic performance for centuries, many of which are still used today. From eastern medicine based practices such as; acupuncture, acupressure, cupping and reflexology to their westernized counter-parts of dry needling, slides & glides and trigger point therapy.
Soft tissue therapy helps an individual relax and prepare for further activity by releasing adhesions within muscle tissues. This in turn can contribute to an increase in a client’s range of motion and a decrease in the muscular inhibition as a result of pain. Additionally, for those who are continuing to train during their rehabilitation process massage may help disposed of by-products and blood pooling.
A multi-faceted and at times multi-discipline approach to patient management should be taken when looking to both prevent and rehabilitate lower limb injury. The use of a number of injury management strategies can lead to a faster and more complete recovery of a patient, setting them up for the season or competition ahead.
Using offloading devices such as custom orthotics, wedging or domes to attenuate forces in areas of high stress can limit the impact of repetitive trauma to an athlete. Simple shock absorbing insoles have been found to have no effect on the prevention of lower limb injury.
A lot of time and effort goes into creating sport specific footwear to help athletes of all levels get an advantage in play as well as trying to protect them from both intrinsic and extrinsic influences which may contribute to injury. This can be seen in something as simple as a lateral forefoot flange on a tennis shoe to interchangeable studs on football boots.
Strength and conditioning training not only prepares an athlete for the physical demands of a sport but the psychological demands as well. Neurological adaptions associated with the movement patterns and physical needs help to improve athlete balance and proprioception.
Previous history of injury to the lower limb is the biggest predictive factor for recurrent or secondary injury to the lower limb. Thus, the adequate and complete rehabilitation of any sustained injury should be a high priority when preparing a patient for future competition. Inhibition of muscle activation due to pain or muscle atrophy as a result of detraining can have a serious impact on the prevention of lower limb injury.

When a patient comes to see an allied health professional for injury management their motivation to address the issue is at its peak, it is important that we take advantage of this motivational factor to get the best compliance from our clients. Although in a single consult we may not have time to put all the modalities discussed today in place, having a number of appointments in quick secession targeted toward the integration of these strategies is paramount to enabling a fast recovery.

Until Next Time

Jackson McCosker
Director/ Chief Editor

Trent Croad and Finals Mid-Foot Trauma: An Interview By Sam Davies Part I


 

This Article was first published on behalf of Frankston Foot Clinic

TCroad3rent Croad played 222 AFL senior games. Made All Australian in 2005. Fremantle leading goal kicker and in 2008 became a premiership player with the Hawthorn Football Club. Yet during the 2nd quarter of the grand final, Trent suffered a severe left foot injury that forced him to go off. Sixteen months later he retired from AFL football- unable to get his foot conditioned to perform at such a high level again. Frankston Foot Clinic was fortunate enough to be able to sit down with Trent and discuss the injury including rehabilitation and the specific trauma it went through.

Sam Davies: Thanks Trent. The reason we wanted to chat to you today was in regards to the injury you sustained in the 2008 grand final. I recall before the game started that Dr Peter Larkins as well as other media/medical personalities stated they were keeping a close eye on you due to your foot.
Were you having any pain in the lead-up? What was the worry there?

Trent Croad: If I can remember correctly I had given it a little tweak during the Qualifying Final against the Western Bulldogs.I can remember being in the goal square with Will Minson, the bulldogs ruckman. I was having a big wrestle with him, went up on my big toe and went down very quickly. It felt like a sprain so considering we had the game covered, I went off as a bit of a precaution, as we had the grand final coming up. I went in and had scans to check it all out and it was all clear. I mean it was pretty sore but there was no structural damage. No ligament damage. No skeletal worries. I think I went back and instead of training all three nights, I trained one or two of them and then was all cleared to play.

SD: So was there any concerns from the medical staff leading into the game? Obviously if the scans were alright, you were pretty good to go?

TC: Well that’s the assumption isn’t it? Mentally I was alright. Nothing was going to stop croad 2me playing. You could’ve held a shotgun to my head and I still would have played. But as far as I’m concerned all precautions were taken, and if you are declared fit to play, you’re declared to play.

SD: The injury was sustained in the 2nd quarter over in the pocket of the Punt Road end. How was it feeling during the warm-up and 1st quarter when you were playing on Mooney? Was it feeling ok?

TC: I was aware of it, but couldn’t feel too much. When I look back at past footage I pride myself on being explosive off the mark. Campbell Brown and I pride ourselves on being the fastest over 40 metres. Clarko (Alistair Clarkson) plays what he calls his “Brutus Boys” on the last lines that can accelerate very quickly. Looking back at the footage I thought I could go with Cam Mooney for speed, but to see myself accelerate fully off the mark, I thought I was a bit slow in that regard.But still, it’s funny looking back. There was no structural damage, there was slight pain but nothing more than that. Which is just the life of an AFL player, playing every week.

SD: Some newspaper reports stated you fractured your left foot. Others state you dislocated it. Can you tell us what happened?

TC: I ended up having what’s called a navicular-cuneiform-cuboid fusion. So basically what’s happened, I’ve completely smashed those bones in the midfoot, which is a big release point just down from the big toe. And at the same time, I’ve broken my little toe, the toe next to that as well as the middle toe. So those three toes were completely shattered. But the exact operation by Mark Blackney was called a navicular-cunieform-cuboid fusion. So basically I have half of Bunnings in my foot there.

SD: Were you able to partake in the post Grand Final celebrations or were you straight off to hospital?

TC: If you look back at the footage of the game, my foot was just blowing up by the second. The best thing I did (and being out of the game now, I can admit this), was go down to the rooms after I had just ran on my broken foot and grab a handful of those pethidine sticks. I started sucking on those as much as I could, I was that keen to get back out there. It’s funny, you see people who break their legs suck on one of those sticks and they come out waving. But it was when that wore off that I really felt the pain. It was a pain I’ve never felt before. It (the injury) has been likened to the Crusty Demon motorcycle guys with the research the senior physios and sports people at Hawthorn did. If you can imagine when they accelerate and go up to do a double backflip, when they come down from this massive height it would be like a hard solid structure lying under the midfoot, and landing on that without a motorcycle boot on. There was no other sport we could compare my injury to. It’s a rare injury but we are starting to see them. I’m sure at your clinic you’d be able to handle them very well.

Croad1SD: So when you said that it was pain you’ve never experienced before, what did it feel like?

TC: Basically when I first did it, I was running out towards the boundary and the foot felt like it had dislocated. When I say dislocated everyone thinks of an arm being out of place, yet with a foot you as a podiatrist would know with treatment you can bend it, you can manipulate it. It is a very vigorous, very tough structure.

It was like someone had grabbed my toes with one hand and grabbed my midfoot with the other and just twisted it, like doing a “Chinese burn” on an arm. It rolled, twisted but then stayed fixed in that position. So I reached down and try and knock the midfoot back into place. The worst thing was that it wasn’t moving at all. It looked like a cramped foot, but bony.

Then Joel Selwood came into view about 20 metres away and I thought that I was gone. I just knew I was gone. It still gives me goosebumps thinking about it now. You just get this feeling as a player when you know you’ve done something very serious. So I knew I had to go. I ran, and every step I took it basically felt like I was walking on baked beans but something was crackling every time. Almost like biting into chicken bones. There were noises going off from my foot but it was all soft. It was just excruciating.

SD: And then you went in to bump Joel Selwood. Did you feel like you got him?

TC: It’s all a blur. Afterwards I got told I did. All I saw was a Cat’s jumper in the vicinity and thought “you’ll do.”

SD: How long were you in hospital for?

TC: Oh god, I think they (the surgeons) had to wait two weeks before they could even operate due to the swelling. Mark Blackney did the operation and I didn’t end up walking for 4-5 months. I lost all my calf definition. Lost everything.

Don’t forget we were in premiership mode. We were in peak condition. We (Hawthorn) were doing outrageous things with weights. Power to weight ratios. Especially the power backmen. We were doing serious weights but with speed. I’m not talking about trying to be body-builders. I’m talking about being able to transfer a specific weight very very fast. We were trained that way by being a part of a program for 4-5 years. We got there but the sheer force that was going through our bodies was why these sort of injuries happen. So basically recovering from that injury my whole body was ready to go on from the grand final but my foot didn’t work. So it was an incredibly frustrating time.

SD: At what stage did you realise that the 2009 season may be a long shot?

TC: It’s easy answering now in hindsight, almost 10 years later. I was 28 years old playing full back with Hodgey (Luke Hodge) playing in front of me and Brent Guerra there. My job was to control the big power forward. It was kind of nice halving a contest with those guys at your feet. I had hope (of getting back) and so I just kept trying and trying but then I had to go back in for another operation.

The rehabilitation was so intense. As I said earlier, no one really knew what was going on or how to treat it. We tried building arches up with orthotics from podiatrists but they hurt as it was pushing straight through the midfoot. I also tried trampoline work and then started running over 80 metres but then I’d have another set-back. Remember, I also had the broken toes so needed pins in them.

Jumping forward I did try to come back after retiring with De La Salle football club. And what was quite evident, and in your field you can probably answer it better, the work you have to do on a crutch during rehab for people with foot injuries is an area that I believe is not talked about. In the sense that if I have serious foot injury I am told to stay off it, get given a boot and that sort of thing. And then I start my rehab and the number 1 thing that I believe isn’t spoken about is the other foot. So I came out (for De La Salle) and in the first 5 minutes I snapped my right Achilles. Now I may have been unconditioned and all those sort of things, but I genuinely believe that it was due to the amount of work it had been doing for my left foot.

So if you are an extreme athlete people don’t realise that when they finally come back from a serious foot injury you start thinking “yes, I can walk now. There’s no pain,” but the stress that the other foot does- it almost becomes a sitting duck.

SD: When did it become apparent that AFL senior football may be unrealistic?

TC: Probably when I had the 2nd set-back with it. With the trauma to the foot and loss of muscle, I mean we were squatting 200kgs at a time, due to losing all that muscle strength and trying to rebuild I started to develop spurs in my ankles. So I had to go back into surgery and have those removed because they were causing pain as well. So having such a traumatic injury all these other little things start popping up.

Then I have to start playing on Jonathan Brown standing 15 metres out from goal with no one else around me, or running with Riewoldt or whoever else it may be, these little things make it unrealistic considering the demand of the role within the team. So it became the inevitable in the end.

SD: Now that you are retired and are heading up a landscaping business through retirement villages, are you in any long-term pain?

TC: Yeah so I’m doing landscape gardening through age-care at the moment but it’s good to have six young punks to tell what to do. Trying to run it like a football club.

Look, my legs and quads were always good. My hamstrings and upper body were always strong. But my biggest problem are my hands and feet. So I’ve had wrist reconstructions, scaphoid removal and fusions. Both thumbs broken, wrist problems, achilles and what I did with my feet. So my pain is at the ends of my body.  The biggest problem I have, even as I’m now only 35, is arthritis.

I believe it is arthritis. It’s a slow release pain. My back is okay but my feet get really stiff. Obviously when you finish from AFL footy you don’t have the body maintenance that you used to have at the club. Instead of five-a-day yoga I have to go out and get a real job.

SD: So you have all this pain and stiffness now but correct me if I am wrong, didn’t you use to hold the record for vertical leap at AFL draft camp back in 1996?

TC: Yeah I did, that’s right. I was shattered when that record was broken. All my mates were texting me and reminding me when that got beaten. If you look at the results, my brother Cameron wasn’t too far behind me as well.

SD: So what keeps you busy these days? I see you are the director of Croad Gardens.

TC: Yeah so I’ve started a landscape gardening business company that specialises in aged-care. Commercial projects, client to client, and also looking after seven retirement village grounds. It keeps me very busy. Controlling the staff is that hardest part.

Part Two Will Be Release Later In The Month

 

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Sam Davies
Podiatrist
FootNotes Publishing Contributor