Podiatry & Orthotics Clinic London UK
2024 CAMPAIGN
Tackling the ‘epidemic’ of knee injuries in Women Football – From The Ground Up
Dedicating each year to a new mission:
1 Sport, 1 Goal, 2024 is for Women Football
At PODO, we are dedicating 2024 to women's football and calling clubs and players to join us on our journey, because we are convinced that an improvement in both women’s orthotics and women’s boots will make a massive contribution to reducing ACL injuries.
There is no ignoring the significance of ACL injuries in women’s football. Football-focused studies suggest women are six times more likely to suffer ACL (Anterior Cruciate ligament) injuries compared to men, and 25 per cent less likely to return after recovery.
To illustrate the scale of the problem more clearly, consider that approximately 25 to 30 players missed the Women's World Cup last summer because of ACL tears. Not something that happens when it comes to the men’s game.
While numerous individuals and groups are – quite rightly - asking why and calling for action, very little seems to be being done or achieved at this stage.
Here at PODO, through our experience of regularly working with women’s football players, we have a pretty good idea what a large part of the problem is and are taking action in the form of PODO – FROM THE GROUND UP.
The campaign is looking very closely at women’s football boots and exploring fitting customised insoles for female players that suit female feet. The aim is not only to understand the role footwear plays in ACL injuries but also to tackle the epidemic, as the campaign name suggests, from the ground (or the feet) up.
THE BIOMECHANICAL CHALLENGES
The answer is not a one-size-fits all, as there are multiple factors that contribute to the reasons a woman might suffer an ACL injury. This makes the problem more complex.
If we talk about the human body in terms of factors, some of those factors are structural, while others are postural. Those are the two factors we aim to address during the course of our campaign. Other factors, such as the environment, and the player’s biology will be acknowledged and allowed for, as far as possible, but won’t be modified specifically using our approach.
For example, factors, such as the width of the pelvis (women generally have wider pelvises than men – perfect for childbirth, less efficient for movement), or bowleggedness would require a more radical approach in order to be modified. However, we intend to adapt and work around those factors, assessing each of them to integrate the uniqueness of a player into their unique treatment plan.
Conversely, factors such as a foot/ankle over-pronating, a knee rolling inwards or being pushed outward or pelvic tilting – all of which are among the most common sources of injuries - will be addressed, from the ground up, by applying the rules of biomechanics, and crafting a pair of asymmetrical orthotics.
How bones affect the performance of muscles
In short, the bones tell the muscles what to do. That means that any misalignment that affects either a bone or a joint, will create a muscle imbalance with one (group of) muscle(s) overworking and its opposite (group of) muscle(s) underworking.
This is why a player’s alignment, balance, and posture must be optimised at every level of her body, and in any body plan. By doing so, the risk of muscle damage is reduced.
Since your two feet are different, and you do have a dominant leg, there is a naturally-occurring misalignment – or asymmetry. If you put your asymmetrical form into a pair of symmetrical football boots, it will inevitably put strain on your muscles, increasing your risk of injury.
Therefore, it makes sense to match your asymmetry, in your symmetrical pair of football boots, with an asymmetrical pair of orthotics.
These are not the orthotics that you can buy off-the-shelf, they must be custom made. PODO believes that this should become a preventive measure for every woman playing football.
The effect of hormones
Every month, women have to deal with significant hormonal fluctuations. Ups and downs in the production of sex hormones (among others) affect the structure and elasticity of the tissue that is supposed to both secure a joint and safely control its range of motion. And there appears to be a general consensus that oestrogen, when elevated, can affect a joint’s stability, interfering with the collagen in the joint, making it loose.
At the same time, we can also all agree that football is a physically demanding sport, and that any vulnerability will add an unnecessary challenge for the player who already has to deal with a sport that is mainly played on the forefoot, with knee bent, and with every muscle surrounding the knee working hard.
The Anterior Cruciate ligament (ACL) is the main knee stabilising ligament and will be at even greater risk of injuries when both the biology and the biomechanics of the player are out of balance.
Women’s Football Insoles
Good muscle strength can be aided by good conditioning and stretching sessions, for example, and this can help in creating magic on the field. But don’t forget that muscles are still susceptible to pain, fatigue and injuries. Not only that, while women on average are shorter in stature than men, but the length of the football pitch is also the same and they still play for 90 minutes every match.
This is where a properly designed pair of football boots, with a properly moulded pair of orthotics come in. Both must be specifically fitted to each woman’s feet and to the requirements for playing football. Only then can the player feel secure, physically, at a foot level and mentally, thus increasing her confidence and trust in her body. And that is how PODO intends to contribute to tackling knee injuries in women’s football - with the PODO Women’s Football Insoles.
After trying the new insoles, Lucy Spours, Midfielder on the Clapton CFC Women’s First team, and physiotherapist by background, said:
“I really enjoyed wearing my insoles for our first training session back, my feet felt more secure, and I felt like my legs were able to do what I told them!”
Men’s boots, Women's boots, Kid's boots, and Unisex boots
Last summer, the Women and Equalities Committee Chair, Caroline Nokes MP, wrote to football boot brands, including Adidas and Nike, questioning the lack of football boots designed specifically for women and girls.
In my opinion, this was a fantastic move and one that had been sorely needed. However, it has yet to change anything significantly.
On paper, it seems as though it may have done but, in reality, it seems things are heading in altogether the wrong direction.
The response from one of the boot manufacturers questioned in the letter particularly worried me in respect to the future of female footballers.
The manufacturer boldly stated that: “We have a gender-neutral football approach to football footwear informed by our partnerships, industry experience, and research.”
As far as I can see, a “gender neutral” approach can only lead to the production of more unisex football boots, which are, frankly, hazardous for feet, and the joints and muscles supported by those feet, including the knee and ACL.
Looking at the differences between a man’s foot and a woman’s foot, a unisex pair of boots is liable to be seriously detrimental for both men’s and women’s feet and biomechanics.
We use moulds in our London practice and with our mobile clinic to shape players’ orthotics. Here is a foot mould of a man next to a foot mould of a woman.
Our question to unisex products developers is very simple:
HOW can a unisex boot possibly secure this narrow feminine heel (right), and HOW can it not compress this wide masculine heel (left)?
The reality of buying women’s football boots on the high street
Being located near Oxford Circus and most flagship stores, I regularly take the opportunity to check shoe stores and outlets that sell football boots, simply because no orthotics maker wants to send a patient to a shoe shop with bad products and / or poor advice.
Having trained over 50 sales assistants myself for 9 Decathlon stores in the past and contributed to the store strategy, I am often surprised by the low level, or total absence, of merchandising, marketing and staff training when it comes to women’s football boots. I have been handed size 45 boots and told these were the women's version, I’ve been told women’s football boots are all marketing nonsense and that all boots are now unisex, and even that women’s boots don’t exist! This is just not acceptable.
That said, all credit to PUMA on Carnaby street, as none of the above happened there. Their sales assistant was honest, helpful, and informative, saying that one must bring the player into the store to try different brands, and not buy a men’s pair as a substitute when the right size is not in stock. She also showed and explained to me that women’s football boots come with less volume in the forefoot and mid foot area, and a lower instep.
CONCLUSION
In recent years, since the mediatisation of the outbreak of knee injuries in women’s football, many experts have been looking at the physiology of female athletes. I believe the examination of that physiology should start with the feet and biomechanics. Then it needs to look at how footwear can support both.
I do believe some manufacturers have seriously worked on developing specific moulds or ‘lasts’ to construct the shape of their women's football boots - including a narrower heel cup and lower instep, at least.
I also recognise that it is, indeed, challenging to design multiple models that consider a player’s age, size, biomechanical needs, game intensity, past injuries, problems dealing with fatigue and recovery, or even the impact of hormonal ups and downs on her body.
But, as much as shrinking a pair of male shoes will never provide us with a female version, developing “unisex football boots” will simply undermine the problems female footballers currently face, mislead the customer and put thousands of girls and women around the world at risk of injuries that will prevent them playing football in their future, whether they are professional or play at an amateur level. It also has the potential to create entirely new and significant problems in men’s football.
Unsuitable, damaged or ill-fitting shoes in general have a devastating impact on a patient’s biomechanics and their ankle, knee, hip and back health. The consequences of those uneven wear patterns are just exacerbated in football boots, because playing football properly increases challenges to your body. That’s why, women’s foot morphology, biomechanics, and her lower average body weight, must be considered to really optimise the safety, agility and responsiveness of her football boots.
Because stores are facing the challenge of having to stock extra insoles specifically designed for women in football when the demand is actually pretty low, it is time for the clinics to step in. Custom orthotics might be as expensive or, indeed, even more expensive than the boots themselves but they can save a player from ACL, rehab and, quite possibly, loss of career.
For custom orthotics make a big difference, we understood they should provide the following:
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A tough layer under the forefoot. Because non-reinforced shoe-soles encourage a problematic twist and turn under the forefoot, increasing knee instability.
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Customised supports – the foot’s medial, lateral, and sometimes transversal arches must all be supported, by moulding multiple thin layers directly onto the player’s foot. Because of the natural strength of the arch, and of both the intrinsic and extrinsic muscles, women will benefit a lot more from a thin support made to measure, particularly while going through hormonal changes.
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A custom-moulded narrower heel cup. Because a wide and loose heel reduces the stability of the ankle and knee joints and reduces the engagement of the femur at a hip level.
PODO ON WOMEN'S FOOTBALL PODCAST
Lionesses choke on Swedes
Mon, 08 Apr 2024
Luke Edwards
Go further with your orthotics
Orthotics are only one piece of the puzzle in helping your body work better.
Below you will find a wealth of information that has been helping patients around the world get the ‘big picture’.
The following resources (articles, videos and tutorials) do not just strive to give out the right advice, they also set the record straight on common misconceptions.
