Interesting Article on the rash of foot injuries

Blackman

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Personally I love the spin Nike tries to put on this.


http://www.philly.com/mld/dailynews/sports/8998734.htm?1c

WHAT'S AFOOT HERE?

Rise in foot injuries

By PAUL DOMOWITCH

pdomo@aol.com


RICK BURKHOLDER has been an NFL trainer for 11 years, the last 5 with the Eagles. He understands as well as anybody that injuries are a part - a very big part - of the game.

But when many of those injuries keep happening to the same part of the body, well, he starts to wonder whether it's more than just a coincidence.

When five Eagles players go down with foot injuries in a 13-month period that cause them to miss a total of 87 games, he puts on his Sherlock Holmes hat and hunts for a common denominator to those injuries. And he thinks he's found one.

The shoes.

Burkholder is convinced the lighter, less-rigid cleats that are being made by the NFL's two licensed footwear manufacturers - Nike and Reebok - are a big reason for the Eagles' recent foot-injury epidemic, as well as the rise in midfoot injuries leaguewide.

"Ten years ago, when I got to the National Football League, the game was all about power,'' said Burkholder, the Eagles' head trainer. "Bigger, stronger guys. It was a physical game. But over the last 7, 8 years, the emphasis has shifted and this game has become all about speed.

"How does that relate to the shoes? Players don't want heavy shoes anymore. They want lighter shoes that will help them run as fast as possible. But those lighter shoes also are less rigid. I believe the [increased] flexibility in the shoes is leading to Lisfranc sprains and fractured metatarsals and maybe some plantar fasciitis. Are the shoes too flexible to give players adequate protection against those injuries? I think so.''

Representatives of the companies contend their shoes are safe and that there is an ongoing effort to make them safer. And even players acknowledge that some among them are at fault for wearing shoes not suitable for their weight.

Elizabeth Langvin, the development manager for Nike's cleated footwear division, said her company has not sacrificed safety with its lighter shoes.

"Making shoes faster does not make them any less safe,'' Lang-vin said. "First, development of new, injected-molded materials with high strength-to-weight ratio in the past 10 years allows us to reduce the weight of the product without compromising support or safety.

"Second, new footwear-construction processes allow us to use less adhesives in the process, and by doing so reducing the weight without compromising the sound structure of the shoe.''

Still, a growing number of NFL trainers, physicians and players feel the lighter, less-supportive shoes are putting players at greater risk for midfoot injuries such as the Lisfranc sprains suffered by Eagles safety Brian Dawkins and former Eagles running back Duce Staley, and the fifth metatarsal fractures, which sidelined Eagles defensive linemen Hollis Thomas, Derrick Burgess and, when he was with Tennessee in 2002, Jevon Kearse.

Earlier this week, Giants tight end Jeremy Shockey had surgery on the fifth metatarsal of his right foot. He probably will miss all of training camp.

"This is an issue, a real issue,'' said Dr. Mark Myerson, one of the country's top foot and ankle specialists and the president-elect of the American Orthopedic Foot and Ankle Society. "Something needs to be done with the shoes. They need to be modified. They've become much lighter and much more flexible. There's little support in the shoe today. It's a lightweight, flimsy shoe.''

"Basically,'' said Dawkins, who missed nine games last season because of his foot injury, "a lot of these shoes are nothing more than socks, with a cleat bottom. The tops are real soft leather. You want to be as fast as possible, but also as safe as possible. Taping only really helps the ankle. The rest of the support for the foot needs to come from your shoe.''

The findings

The Daily News spent 6 weeks examining published accounts of injuries throughout the NFL over the last four seasons and interviewing players, doctors, trainers, equipment managers and shoe manufacturers to see if there is a link between the rise in midfoot injuries and the shoes that players are wearing. This is what the newspaper found:

? While the league doesn't reveal specific injury data, Daily News research found 21 cases of midfoot injuries in 2002 and 2003 compared to 10 in 2000 and 2001. Thirteen of those 21 players had fifth metatarsal fractures. The other eight had Lisfranc sprains or fractures. Those 21 players missed a total of 224 games.

? The league is concerned about the rise in foot injuries and has communicated its concerns about the safety of the players' footwear to Nike and Reebok. In February, the league's trainers met with representatives of the two companies at the NFL Scouting Combine in Indianapolis and urged them to add support to their shoes.

"Footwear has become lighter and less rigid in an attempt to allow the athletes to perform better,'' said New York Jets orthopedist Dr. Elliott Pellman, who is the liaison between the league and its health and safety panel. "While it potentially increases their performance, there is a suspicion by some medical experts that it may increase their risk to certain types of foot injuries.''

? Speed-obsessed players are exacerbating the problem by wearing shoes that are ill-suited for them, shoe company representatives, NFL players, equipment managers and trainers agree. Super-lightweight cleats with narrow bases, such as Nike's Speed TD and Reebok's Outside Speed, which once were worn strictly by sub-200-pound wide receivers, tailbacks and cornerbacks, now can be found on the feet of 240-pound linebackers and 280-pound defensive linemen.

? The shoe companies find themselves in the difficult position of trying to serve two masters - the players, who want light shoes that will maximize their speed, and the league's medical and training staffs, who want more stable shoes that will keep players on the field.

"You've got the trainers who want the players safe and suited up for every game and then you have the players pushing everyone for faster, lighter, stronger, even flashier,'' said Don Gibadlo, the head of Reebok's cleated footwear division. "You try to get those two perspectives to merge, but it's not easy.''

Neither Nike nor Reebok disputes the fact that their shoes are much lighter and more flexible than the ones they made two decades ago. Nike's lightest football shoe, the Vapor TD, weighs just 9 ounces, which is more than 6 ounces lighter than Reebok's lightest football shoe, the Burner Speed, which weighs 15.2 ounces. Neither company agrees, though, that lighter translates to less safe.

"There are many reasons and conditions that can contribute to an injury,'' said Nike's Lang-vin. "We believe we're providing a product line that is safer and more specific to players' size, speed and position played than 10 years ago. Using Nike's sports-research lab and the great technical insight they provide enables us to strike a balance, meet the needs of the athletes, while at the same time keeping them safe in a sport where guys are paid to knock each other down.''

Langvin said the increase in midfoot injuries could be due to other factors besides the shoe.

"For example, were there any changes in training and preparation in the league?'' she said. "Were there any changes in playing surfaces? Was there any change in the size of the players? Was it a contact vs. a non-contact injury? What degree of force vs. ground contact? Those and many other factors need to be fully researched before coming to any sound judgment.''

Most foot and ankle experts interviewed by the Daily News take a simpler view. While they acknowledge there are a lot of potential contributing factors to foot injuries, including playing surface, grip and secondary force from another player, they say the lighter and less rigid a shoe is, the greater the risk of injury.

"The stiffer the shoe, the safer it is,'' said Myerson, who treats players on several NFL teams, including the Eagles.

"Shoe quality clearly is decreasing,'' said Dr. Ned Amendola, the director of sports medicine at the University of Iowa and the team physician for the Iowa football team and the NBA's Toronto Raptors. "They're not providing nearly as much support as they used to. They don't provide as much heel and foot control as they did before. The sole is much more flexible. You can twist it at the midfoot portion of the sole.

"Generally, after a player suffers a foot injury, you either do a shoe modification or [put] an orthosis in the shoe to prevent excess mobility and stress. You increase the stiffness and rigidity of the sole of the shoe so that, as you jump and run, the sole of the shoe absorbs the shock and it doesn't have to go through the foot.

"If physicians are treating the ones who have been injured with a more stable platform, it's fair to say it would make sense to treat everybody with a more stable platform as a means to try and prevent these injuries.''

Not every foot specialist believes the shoes are at fault. Dr. Lowell Weil Sr., team podiatrist for the Chicago Bears from 1975 to 2000, is one.

"There's definitely been an increase in certain types of [foot] injuries. But I really don't think the shoes have much to do with it because these injuries take such an amount of torque that you couldn't make a shoe strong enough to protect the foot against these types of things. I think it has more to do with the speed, the weight and the impact now in the league.''
 

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Many players put themselves at further risk of injury by wearing shoes that aren't suited for them. Nike makes nearly 20 models of football shoes, with each one recommended for specific positions and maximum player weights. But players often don't follow the company's recommendations.

Nike's Vapor TD and Speed TD models are recommended for players no heavier than 220 pounds. Yet players who weigh considerably more than that often wear them in an attempt to maximize their speed. The Eagles' Burgess, who weighs nearly 270, said he was wearing Speed TDs when he fractured the fifth metatarsal in his right foot in September 2002. The 265-pound Kearse said he also used to wear speed-position shoes until he suffered the same injury.

"We try to help educate the players on what shoes they should and should not wear,'' Langvin said. "But at the end of the day, it is the athlete's decision.''

NFL trainers and equipment managers try to steer players to the safest shoe for their body type. But they can't force players to wear something they don't want to wear.

"If a big guy wanted to wear Speed TDs and he wouldn't take no for an answer, I'll get him documentation [showing] why he shouldn't wear that shoe,'' said Eagles equipment boss John Hatfield. "Most of the time, these guys, at least on our club, they'll listen.''

Hatfield said the Eagles no longer have any 220-pound-plus players wearing speed shoes.

"Everybody wants to be fast,'' said Reebok's Gibadlo. "Even the linemen. Defensive ends, linebackers, tight ends, they all want the speed shoe, even if their body shape makes it tough to accommodate them. You have some guys trying to cram a very wide foot into a narrow shoe. You have guys with size-12 feet trying to cram them into size-10 and 10 ? shoes because they want to be sleek. I'm not sure why. But there's some that do it. And it's painful as hell.''

Buffalo cornerback Troy Vincent, president of the NFL Players Association and an ex-Eagle, says there's enough blame to go around.

"You've got a combination of the athlete not making the right equipment call and the shoe manufacturers,'' he said. "The shoe companies aren't in the business for safety. They're in the sales business. They're making stuff that's going to sell.''

Vincent, who had been a longtime Nike wearer, recently switched to Reebok.

"Reebok has been doing the best job [with players]. They've been customizing shoes for the athletes,'' Vincent said. "They try to form-fit them for us. They bring you in, get your foot sized right, put you in orthotics and really mold the shoe to fit your foot.

"If you're having problems with your shoes, if you have an arch problem, if you need a shoe that needs more thickness or less thickness, they'll bring you up to their corporate offices [in Massachusetts] and try to put you in the best footwear possible.''

Said Nike's Langvin: "Providing 1,200 [NFL] players with great personal attention and special services is always going to be a challenge, but it is what we are totally committed to do. We believe the better job we do working with the athletes before we build the shoes, the less work we have down the road to 'fix' things.''

Speed a priority

What NFL players primarily want is a shoe that's going to make them as fast as possible, regardless of whether they are a running back trying to burst through a hole, a cornerback trying to cover a wide receiver or a defensive end trying to beat an offensive tackle around the corner.

"The name of the game is speed these days,'' Vincent said. "Thanks to [former Cowboys and Dolphins coach] Jimmy Johnson, your linebackers are guys with 4.6 speed. Your defensive ends are former linebackers. These are truly speed guys that want to wear shoes that are going to make them as fast as possible. Even if what they're wearing increases the risk of injury.''

The Eagles' Dawkins said he was wearing Nike Speed TDs when he suffered his Lisfranc sprain last year. He since has switched to another Nike model: "You really don't think about [the risk of a foot injury] until something happens. In my case, something did happen. I won't wear that shoe anymore. The support wasn't there like it needed to be.''

Nike and Reebok are sympathetic to the NFL's concerns and are trying to meet the trainers halfway. While they insist their shoes are safe, both companies are coming out with a speed shoe specifically designed for linemen.

"We're giving them the same look and same materials that the speed guys get and putting on wider bottoms,'' said Reebok's Gibadlo. "It seems to be going over well with the bigger players. They appreciate the fact that finally, they've got something that's styling and lightweight, yet still gives them a stable base of support.''

Said Burkholder: "We'll see. They are listening. They want to do what's right. They don't want to have any bad press on their shoes. Because all the kids underneath our game wear what our guys wear. They don't want a big name like Jevon Kearse getting hurt and saying, 'I got hurt because my shoes are too flexible.' They want to avoid that at all costs.''

While there is concern among many in the league that lighter, less-rigid shoes are contributing to the recent increase in midfoot injuries, they aren't ready to legislate shoe safety or tell the shoe companies what kind of shoes to make.

"It takes a long time to really determine whether there really is a significant change [in the number of foot injuries] or if it is just a blip on the screen,'' Pellman said.

"When it comes to equipment safety, we're much more comfortable in terms of rules and regulations with other equipment. With footwear, it's difficult. With helmets, there is an organization that certifies helmets. They have to meet a certain qualification. With footwear, there is no such body. In effect, the people making the footwear are answering to what the consumers want.

"Ultimately, the players have to make up their mind as to what's more important - running faster or wearing a more rigid shoe.''
 
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