Nutrition in Combat Sports

10 Children in Combat Sports 159
If a technique is poorly executed, the board will not break, resulting in much of the
force being applied to the tissues of the hand or foot. Physeal fracture of the proximal
phalanx of the great toe has been reported in a young judoka performing a
footsweep and falling onto a hyperflexed hallux. [31] Most fractures in children heal
twice as fast as in adults, and purely epiphyseal separations tend to heal in half the
time of long bone fractures in children. [32]
10.5.2.3 Calcaneal apophysitis (Sever’s Disease)
Most martial arts are practiced barefoot on mats or a hard floor. Children who practice
martial arts are at risk for overuse injuries to the apophyses of the feet, with the calcaneal
apophysis being the most frequently involved. Calcaneal Apophysitis typically
affects children between 8 and 13 years of age. [33] This overuse injury presents with
gradual onset of pain in the heel, exacerbated by training barefoot on a hard dojo
floor. Repetitive movements such as jumping or basic techniques practiced stepping
across the floor typically aggravate this condition. When symptoms of Calcaneal
Apophysitis first present, there is pain during physical activities. As the injury
progresses, the pain may last for some time after cessation of training, and ultimately
even be present at rest.
On physical examination, there is typically pain with compressing the calcaneal
apophysis medially and laterally (squeeze test). There is frequently tenderness at the
insertion points of the Achilles tendon and the planter fascia into the calcaneal apophysis.
In more severe cases, secondary Achilles tendinopathy or plantar fasciopathy may
develop, possibly due to alteration in gait to reduce pressure under the heels. Pain with
resisted plantarflexion may be present, localized to the calcaneus or Achilles tendon.
Management involves the use of heel cups attached to a neoprene sleeve [34]
(Fig. 10.3 ) to allow the young athlete to wear the device while barefoot. This cushions
Fig. 10.3 A heel cup attached to a neoprene sleeve (Cheetah) helps to cushion and support the
heel, reducing pain in Sever’s apophysitis