Golfing is a fun, frustrating, and sometimes relaxing activity performed by thousands of people each day. While it is a sport that does not require a great deal of physical prowess, it can lead to injuries. Beyond the usual strain injuries to the hips, back, and knees that can occur when one contorts their body in a swing or walks long distances on uneven ground, the foot can also sustain injury on the golf course. The most commonly seen injury is not to a tendon, or ligament, or the typical type of sports injury one expects to see with increased activity in the feet. It is actually a pinching injury to a nerve that occurs not while moving about the course, but during the golf swing, when one’s feet are not even engaged in walking.
To understand this injury better, one needs to understand what happens to the feet during the golf swing. The golf swing consists of several stages. The first stage is the ball address, in which the golfer stands with equal weight on both feet while lining up their shot. This stage is followed by the backswing. During this stage the front foot rotates outward (pronates), and the back foot stays stable in place. At the end of this stage, the front heel may even rise off the ground to promote a full shoulder turn. Following the backswing is the downswing, in which one’s weight rapidly shifts to the front foot. The ball is then hit in the impact stage, where the weight once again becomes even distributed between the feet. Finally, the follow through sees the front foot rotate inward (supinate), and the back heel comes off the ground with increased weight on the big toe.
It is during the follow through that a nerve can be pinched in the foot. Called a neuroma, this injury essentially involves swelling and scarring around one of the nerves that travel in between the long bones of the foot (the metatarsals) at the ball of the foot. It can produce pain that is sharp, stabbing, burning, or tingling and is felt in the ball of the foot under the toes the nerve supplies sensation to. It can also result in numbness in the two toes. The golf swing can cause this injury by pinching the nerve in the front foot during follow through, in which the foot rotates inward. It can specifically be felt on drives and longer shots, and less on putts and shorter shots. After a while, the pain becomes frequent throughout all walking and tighter shoe use. The nerve irritation eventually needs medical treatment, but the inciting pressure can be reduced on the course by adjusting one’s foot position before the swing, as a rotation of the feet 45 degrees outward can reduce the amount of inward rotation during follow through. Medical treatment involves wider shoes, anti-inflammatory medications, a possible short series of injections containing a cortisone-like medication (corticosteroid), and orthotic shoe insert use. At times, surgery is required to remove the pinched nerve and relieve the pain if nothing else works.
Scott R. Kilberg DPM 