Football

Fiona Rosamond – Podiatry in Football – Injury Rehab Network Event

A global audience of eighty sports rehabilitation professionals and students joined the August event of the Injury Rehab Network with BASRaT.

Expert guest speaker Fiona Rosamond is a podiatrist with over 10 years’ experience of working as part of multi-disciplinary teams in Scottish professional football and as Director of her podiatry clinic, Hands for Feet Irvine.

Fiona’s online presentation provided unique insight into the importance of podiatry care within professional football. The recording of Fiona’s presentation is available to watch on YouTube.

As well as working in professional football, Fiona is the owner of a successful Private Practice, Hands for Feet, with over 10,000 registered patients and four staff in her established town centre business for 10 years. In 2016, Fiona won the Association of Scottish Businesswomen “Professional of the Year” and 2017 “Ayrshire Businesswoman of the Year”, the youngest ever winner of both awards.

Fiona is also a clinical placement provider & mentor for Glasgow Caledonian University Level 3 Students for their private practice module.

The Importance of Podiatry Care within Professional Football

Fiona’s presentation, “The Importance of Podiatry Care within Professional Football”, explored podiatry in professional football including work as part of multi-disciplinary medical teams and the impact on performance.

Podiatry: What is it?

Fiona started by discussing what podiatry is and stated that podiatry is the study, diagnosis and treatment of the foot, ankle, and lower limb. Podiatry is an allied health profession and is the same this as chiropody. Podiatry is the modern/ current title for the discipline.

Fiona discussed the differences between Podiatrists and Foot Health Practitioners. Podiatrists study a 4-year undergraduate degree programme and can be checked on the Health Care Professionals Council (HCPC) register and the registers for the governing bodies, Royal College of Podiatry and Institute of Chiropodists and Podiatrists.

Foot Health Practitioners play a valuable role in helping people to maintain healthy feet but for medical problems and injuries, a podiatrist is recommended.

Why is podiatry needed in football?

Fiona discussed podiatry in football and how FOOT is in the name of the sport, meaning significant use and potential injury to the foot and lower limb. Fiona advocates for multi-disciplinary teams and the need for specialists to work together and provide relevant support to the team.

Fiona considered, from a competency and legal perspective, that professionals with different specialisms can add greatest value and used the analogy that you would now allow a dentist to cut your hair and vice versa! Fiona has previously seen local anaesthetic injected as a treatment for ingrowing toenail when a simple treatment or nail surgery would have solved the problem.

Professionals working together can save time by addressing biomechanical issues through delegation and enabling players to avoid injury.

Fiona explored foot problems and injuries in football with boot choice being an important factor. Players and the medical team should also be aware that foot volume increases throughout the day.

Challenges faced

Many football teams do not have specialists such as podiatrists working as part of the medical team. Fiona discussed some of the challenges faced including clubs believing in the role of podiatry and gaining trust from players.

From a practical perspective, it can be challenging for orthotics to function in a boot that is too small. Fiona finds that basic insoles with a heel lift are often as good as any and have much greater uptake. Insoles can be low profile with players provided with a second pair for training shoes. Fiona discussed how stud positioning can also have an impact and should be considered when addressing foot problems.

Football and podiatry

Fiona considered some of the trends around football and podiatry with pre-season, winter break and close season often when problems can occur.

Pre-season

Fiona discussed some common pre-season foot injuries including:

Blisters – caused by friction and located in weight bearing/ pressure areas. New boots, the condition of the surface, new kit and heat can all contribute to blisters. Blisters are managed by popping, draining, and dressing.
Toe nail trauma – can be cause by new boots or trauma/ impact to the foot/ toe.
Corns/ callous – pressure and weight bearing areas can cause corns and callouses. New kit and new surface can add to problems.
Verruca – Contagious and often picked up on holidays. New players can be susceptible. Players should be educated about how to avoid verruca (through use of flip flops in communal areas).
Achilles tendon complaints – training and playing on a new surface can contribute to Achilles tendon injuries.
Plantar fasciitis – can be linked to new surface, new boots, as a secondary foot complaint, or due to a sudden increase in training.

Fiona looked at the role of pre-season screening for foot problems and stated that whilst screening for foot problems could be better, in some ways it is not needed as if you start screening you will always find something. Screening should be physio led and baseline data can help to prevent injuries. Screening can include weight bearing lunge testing, treadmill gait analysis and MSK tests. Screening is part of the MDT with the medical team working together with the strength and conditioning team.

Mid-season – winter break and winter months

In Scotland there is a winter break due to the weather and in 2022 there will be an international 5-week winter break due to the World Cup in Qatar. Fiona discussed how during this time, players may be fatigued, often with a backlog of fixtures to play. New players may also join the team during the January transfer window.

Close season

Fiona discussed how as the season draws to a close it is important to help players to be injury free and to manage any injuries as they compete in cup games and finals, play off matches, end of season fixture backlogs and international fixtures.

Surface – Astroturf

Kilmarnock FC train and play on Astroturf and Fiona discussed the impact of this including increased heat due to fibres, the surface is less common with two SPL teams playing on Astro. The shock pad system is excellent, although some people comment that Astro turf can lead to unpredictable play.

Multi-Disciplinary Team (MDT) – the role of a Podiatrist

Fiona is part of the MDT at Kilmarnock FC and discussed the benefits of delegating expertise, prioritising player care, working smarter not harder, and how professional sport should not be treated differently to other branches of medicine where specialist branches are common place. From a cost perspective, podiatry treatment is a good investment compared to the cost of an injured player or lawsuit.

Impact on performance

Fiona considered the benefits and impact of podiatry on professional football performance including:

All issues dealt with in house fast.
Less stress on other medical team members.

More trust from players.
Faster injury recoveries through team work and more time for the physio team to work with players.
Attractive for players to come to a club with a solid medical team.
A cheap addition.
Feet are under constant stress during training and matches.

Kilmarnock FC Medical Team

Fiona works as part of the Kilmarnock FC medical team which is led by the Head of Medicine and includes 2 x Physiotherapists, Club Doctor, Massage Therapist, Podiatrist (Fiona), Dentist and Optician. Fiona, the dentist, and optician all work with the club on a consultancy basis.

How to get into football

Fiona shared her tips to any professionals or students who are looking to get into football:

Volunteer.
Offer your time to speak to academy players through their educational sessions.
Get qualified in pitch side first aid/ emergency care.
Join the Football Medicine and Performance Association (FMPA)
Get involved with CPD including the Sterosport Injury Rehab Network Events with BASRaT
Use LinkedIn to research and contact professionals in football
Help at junior football

Pitch side first aid and emergency care

Fiona discussed the benefits and added value of having a pitch side first aid of emergency care qualification. The FA has a range of courses from the Introduction to First Aid in Football through to the level 4 Intermediate Trauma Medical Management in Football.

The SFA UEFA approved courses are endorsed by the Scottish Football Association, Scottish Rugby, and the Sport Scotland Institute of Sport. These courses are good value and valid for three years.

For those working in rugby in England, England Rugby run the Emergency First Aid in Rugby Union and Pre-Hospital Immediate Care in Sport courses.

Summary

Fiona concluded with a summary of the points covered and impact of podiatry in football:

Podiatry has a huge impact
Delegation in the MDT is vital for effective team work
Player trust
Performance
Results

Q&A

Fiona kindly answered questions put forward by the practitioners who attended the session.

Q1. Would you recommend off the shelf orthotics for football players?

A1. Yes, off the shelf orthotics are easy to get players to adopt and as they are cheaper are more cost effective for football clubs. Customised orthotics are expensive and not always successful. Players like snug boots so a low profile orthotic can work well. Good brands include Interpods, Slimflex (long lasting) and Vasyli.

Q2. Are there any concerns regarding FG (firm ground) boots for use on Astro turf?

A2. I have put forward my concerns as it is best to wear the footwear most suitable for the surface being played on. Manufacturers of Astro turf pitches recommend that studs not blades should be worn as the blades can catch in the surface. Due to the extra heat of Astro turf pitches, artificial grass boots have studs with holes in to improve cooling and the studs are designed to allow players to turn easily. Players will always wear what they want, and we can only educate and advise around the safest and most suitable boot choice.

Q3. How often are you at the club providing podiatry services?

A3. I attend every two weeks and work alongside the physios and medical team to address any injuries and problems. Nail surgery is usually done after a match to promote recovery and provide the player with the longest time possible to recover ahead of the next game. I also assist with any podiatry issues pitch side.

Q4. What would your recommendation be for a Plantar Fibroma?

A4. As a starting point it may be useful to assess the football boots used, stud position and other footwear worn by the player. Pressure can be reduced with a full-length insole to off load force.

Q5. What are the most common injuries associated with Astro turf?

A5. Some of the injuries that have occurred during play on Astro turf include a ripped fascia (this is unusual), compartment issues such as shin splints, plantar fasciitis, hamstring injuries and heel pain.

Q6. How would you splint broken toes?

A6. It depends which tow is broken but a simple method of using a piece of gauze in between the toes and securing with micropore tape is effective.

Presentation recording

The recording of Fiona’s presentation is available on YouTube here https://youtu.be/rHLwNCyBdkU

Follow Fiona Rosamond

The next event of the Injury Rehab Network

The next event of the Injury Rehab Network with BASRaT is taking place on Tuesday 20th September at 7pm. The expert guest speaker is Dr Monna Arvinen-Barrow who will be discussing the psychosocial processes of sport injury and rehabilitation. Find out more about this event, future events planned and catch up on previous events in our Injury Rehab Network blog.