Preventing the pain game on and off the rugby field

When the world watched the 2018 NatWest Six Nations, our experts at Plymouth looked closely at the benefits podiatry can bring to top athletes

Imagine you’re a professional rugby player about to represent your country. A massive match in the Six Nations. You’re mentally prepared. You’re trained, you’ve talked tactics, you’re ready. 

Now imagine missing the big Twickenham clash due to injury – Wales' Leigh Halfpenny and England's Jack Nowell are two star names who missed crucial games this year due to problems with their feet or ankles. 

So what happens next? Well, while they watch from home, recovering from injury, many other professional athletes are grateful for the expert help of professional podiatrists to get them back on the field again – or preferably, ensure these injuries are prevented in the first place.

We asked our podiatry team at the University of Plymouth to tell us about the importance of studying footwear biomechanics in rugby boot design, to help with the prevention of foot-related injuries.

<p>Six different nation's badges for rugby around a rugby ball<br><br></p>

Designing boots to fit your feet

As any front-row forward will tell you – a game can be won or lost at scrum time. So it was no surprise to see England head coach Eddie Jones call upon the imperious Georgia pack to help his side prepare for their Six Nations scrap with Scotland at Murrayfield. 

Despite their excellent preparation, it didn't quite go to plan for Jones' men. But whether it is training with “the biggest, ugliest, strongest scrum pack in the world” or battling for the Calcutta Cup, scrummaging at the top level places extreme demands on players’ feet. Philip Hendy, Emma Cowley and Calvin Howorth from the podiatry team within Plymouth's School of Health Professions team, explain:

"Rugby is a high-impact sport, yet fairly unique in the number of differing positions. Forces act upon the foot and lower limb from position to position and play to play. During scrummaging, these forces are predominantly head-on and lateral, whilst rucking and mauling creates very high rotational forces. Boot design must take account of these forces to reduce risk of injury to players.
"Consequently, rugby boots are designed to be much stiffer to resist rotational forces and minimise risk of injury. Other design features may include a lightweight material to aid acceleration, a raised heel and ankle support for scrummaging, or particular stud patterns to prevent mud build up and lacing techniques can help keep the foot secure in the boot during play.

"Studies of footwear biomechanics and sports physiology indicates that footwear can positively influence joint and muscle load, oxygen expenditure and improve performance. Design of rugby boots seeks to balance these performance gains on a position-by-position basis whilst attempting to reduce overall injury rates.
"The choice of rugby boot is critical to ensuring the player feels comfortable, confident, safe and able to play at full potential. The features of the most ideal boot can be discussed with this in mind, whilst also being informed by the findings of a podiatric assessment.

"Where a longer term approach is required, podiatrists with a special interest in sport also work with athletes on strength and conditioning plans and gait retraining programs which can be undertaken as rehabilitation from injury or pre-habilitation to reduce the risk of injury."

It all starts with feet

How often do we think about the important role our feet play in our daily lives? Our feet are much more than extensions of our legs, which help us stand, walk or run. They are the foundation of our body, which means keeping your feet healthy can help keep you healthy.

It goes beyond being a professional athlete. You don’t have to be a global superstar like Liverpool football club's Jordan Henderson, a recent sufferer of the foot condition plantar fasciitis, to appreciate the value of having healthy feet.

So what happens when an athlete suffers from a painful foot condition? How should it be treated? Plus more importantly, how can it be prevented to not return?

The podiatry team, shared with us:

"First of all, when assessing a new patient, podiatrists begin by taking a thorough medical history from the patient. This helps to understand the nature and cause of any foot and lower limb issues, as well as setting goals for rehabilitation. Details of an athlete’s training commitments and the position played also help the podiatrist and athlete begin to negotiate suitable footwear for their needs. 

"Following history taking, a physical assessment is typically conducted including vascular, neurological and musculoskeletal assessment of the lower limb along with gait and motion analysis of running and kicking tasks.
"Podiatrists have expertise in the use of technology to enhance this process such as in-shoe pressure analysis, which reveals the pressures under the foot when inside a shoe or rugby boot. Monitoring these plantar pressures can reveal when the tissues of the foot and ankle are potentially at risk of overuse and further aid the choice of rugby boot. 
"Where biomechanical drivers or high tissue stress is identified during the assessment process, podiatrists may decide to supplement footwear with foot orthoses which help improve foot function and reduce tissue stress where needed."

Returning to the field

There is nothing more frustrating for an athlete than being injured and not being able to go out and compete in the next match or event.

Take Exeter Chiefs star Jack Nowell for instance. During the Six Nations, England’s forwards coach Steve Borthwick revealed Nowell suffered an injury to his ankle, ruling him out of the squad for their most recent match against France. “Jack rolled his ankle in training, the same ankle that he injured earlier on this season,” Borthwick said.

Nowell, from Newlyn in Cornwall, appeared as a regular impact substitute for Eddie Jones' side, featuring in the final quarter of the previous three matches in the championship. 

He was, however, unable to get on the field to help his team mates avoid a 22-16 defeat by France.

This is a top-level example of why podiatry and the study of footwear biomechanics is so important, because it can help create the correct bespoke conditions to prevent certain injuries from occurring, and reoccurring, for an individual athlete, especially in a heavy contact sport such as rugby.

You only have to think about Tottenham's Harry Kane, who injured the same ankle for a third time in quick succession during March 2018. Setbacks like that could be devastating for both club and country in a World Cup year – his place in England's squad suddenly in jeopardy mere months before the tournament in Russia. It is just another prime example of how vital healthy feet are to confidently allow our top athletes take those first strides to victory. 

Would you like to help prevent injuries to the sports stars of tomorrow?

Follow in the footsteps of BSc (Hons) Podiatry programme lead Dr Sally Abey and colleagues, and study podiatry at University. You will graduate as a highly skilled health professional, ready to confidently work with a variety of different patients – from professional rugby players, to members of the public in NHS settings.

Learn the key concepts and theories of podiatric practice, including anatomy, biomechanics, physiology and podiatric medicine and minor surgery with work-based learning and practical teaching, on a course, where 100 per cent of our students are in professional or managerial jobs six months after graduating (Unistats) 

Study BSc (Hons) Podiatry