knee pain

Prevent Foot, Knee, and Heel Pain from Soccer Cleats 

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The standard fit of soccer cleats doesn’t make any orthopedic sense (see this article on podiatrists whose patients play soccer) and yet, it’s the norm. If you play soccer in cleats, you probably know they can be pretty uncomfortable. However, when I was a new soccer mom, the first time I went shopping for cleats for my kids, I was stunned by the stiffness and narrow shape of the shoe. The uppers were stiff, synthetic leather and the sole plate was hard plastic with a thin, flat insole. I sucked it up and after twisting many a pair, I settled on some Nike cleats that I generally find are the least stiff of all the brands. Fast forward through 5 years of soccer playing, and my kids started complaining of knee and heel pain, enough to knock them out of sports for weeks at a time. 

I wish I had paid more attention to the cleat fit issue from the beginning because now I realize what I should have done from the start to help the cleats fit better. It should be standard soccer education along with “what is a shin guard?” Here is a list of the things I learned to do to help the cleat fit as much as possible:

Replace Insoles with OTC Orthotic Inserts

Far and away, the best thing you can do to make your cleats fit more comfortably is to replace the soccer cleat insoles with orthotics. Out of the box insoles on cleats are minimal drop with minimal padding. If you follow some principles behind minimalist footwear, it would seem like this is a good thing. However, the stiffness of the shoe and rigidity of the soleplate probably negates this. 

Instead, the insole should provide some of the shock absorption and protection that you will need from both the impacts and the rigidity of the cleat. There are a couple of OTC orthotic inserts that are often mentioned as fitting well in cleats: Currex CleatPros and Superfeet Carbon. We tried a couple of different Superfeet and found the Everyday Superfeet Insole (Green) to have the deepest heel cup and the most cushion for shock absorption. 

  • Tip #1: Orthotics and insoles are FSA/HSA eligible. (They can feel expensive, but then again, the visits to the orthopedists or podiatrists cost even more. We’re skipping those type of doctor visits in the future. Plus, they will just tell you to buy orthotics, too!)
  • Tip #2: When selecting orthotics, pay attention to:
    • the level of arch support, 
    • depth of heel cup, and 
    • the thickness of the insole to determine if it’s the right orthotic for you.
  • Tip #3: it’s easier to try orthotics in your cleats if it comes with a removable insole. However, it’s also possible to scrape out any glued on, out of the box insoles and slide in your orthotic inserts. See pic below.
soccer cleat insoles removed for orthotics
Glued on insoles removed from Firm Ground Nike Cleats

Stretch and Soften the Uppers

Stuff a compression or regular tennis ball or shoe-tree as far into the shoe as it can go. We were able to get into the lower toe area and leave it in for awhile. This can help resolve the squished pinky toe feeling to some degree and give a little more room in the toe box. This is player preference, but there’s a balance to be had between ball feel and painful toes.

Add Heel Lift or Heel Cup

Sometimes the orthotic insert isn’t enough shock absorption particularly on the heel. You can add a gel heel lift which increases the drop on the cleat, which is usually zero drop (i.e. completely flat). Sever’s and plantar fasciitis are common heel injuries that occur with cleat-wearing athletes. In both diagnoses, contributing factors include tight calf muscles, irritated heel pad, or muscles that just haven’t caught up in growth with the bones. A heel lift reduces the stretch on the calf muscle and heel cups can provide more shock absorption and support for the heel strike during activity. We ended up with the heel lift which I stuck to the shoe underneath the insert. Heel cups can sometimes be hard to get used to – my kids kept feeling like the cup was going to come out of the shoe, but they are also a popular option. 

Wear Cushioned Soccer Socks

Some soccer socks don’t come with extra cushioning, but many do. Cushioned socks just add that one more layer of shock absorption and some protection against blistering in cleats. 

Twist Before First Wear

I’m sure the boot guy does it for the pros. By that I mean, break in soccer shoes for fit and comfort.  On an episode of Amazon’s All or Nothing: Manchester United, the camera shows the boot room for the team and there’s an equipment guy giving all kinds of TLC to each of the players’ cleats. Wow, until my son turns pro, it’ll have to be his poor mom. Wring the cleat multiple times and knead the uppers until the shoes feel like they give more easily. Yeah, you could also let your kid break them in on the field, but then they may have a blister or two – depends on how much of a helicopter parent you are! 

Resources

Podiatrists weigh in on the problem with soccer cleats and offer advice:

Products we’ve used:

Common pains from soccer:

Heal Fast and Prevent Recurring Pain

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With two kids in contact sports and my own, easily injured, aging self, I’ve looked into ways to heal the body faster and avoid recurring pain and injury. This means doing more than just ice and rest to reduce recovery time. Below I’ve combined emerging practices from Western sports medicine and Traditional Chinese Medicine (TCM) to heal soft tissue injuries. 

heal injuries fast
Heal an ankle sprain fast!
(photo credit: Vittori Foot and Ankle Specialist)

Don’t Use Ice on an Injury

Immediately after the injury, do not apply ice. In fact, do not apply ice at any point. Instead, apply some compression and massage to help ease the pain. Most Western sports medicine recommendations are to RICE (Rest, Ice, Compress, Elevate) and even many practitioners of TCM, acupuncturists, etc. will still recommend ice in the very first moments of an injury. 

However, in reviewing the literature, the use case for any healing benefits with ice is murky. In TCM, cold is an enemy to the body’s natural healing reaction and invasive to the body. Even in Western studies, there is recent research that suggests ice actually damages muscle fibers as highlighted in this New York Times article, “Ice for Sore Muscles? Think again.” Furthermore, even the original coiner of the term RICE (Rest, Ice, Compression, Elevation), has recently come out against using ice at all in the healing process – except to numb the area and relieve initial pain. If there is so little benefit to using ice, and some possible damage – why bother at all with the ice?  

Integrative Treatment for Soft Tissue Injuries

In all stages of recovery, the guiding principle involves keeping the blood circulating properly and quickly through the area of injury as blood flow is the key to healing the area.  Certain tissues in the body have different levels of blood flow and that is why some tissues, like muscle, heal much faster than ligaments or cartilage. (Here again, ice would only serve to slow this process.)

TCM offers external application of herbal medicines as well as herbal medicines to be taken internally – all with the aim of circulating more blood through the injury. Emerging Western sports therapy recommends that patients work on continuing to move the area of injury almost immediately – they call this method, METH (Movement, Elevation, Traction, Heat). 

For the first few days to weeks, depending on the severity of the injury:

  • Apply an external TCM. We apply the Yunnan Baiyao patch or spray continuously for the first few days. If there is an open wound in the area that makes the patch or dit da jow sting or uncomfortable, you can cover that small area with a nonstick pad or Tegaderm which will allow you to apply the spray, patch or medicinal wine to the non-open areas of the injury. If the area is not painful to massage, then in between applications of the Yunnan Baiyao, we also massage with a Chinese herbal liniment, dit da jow (though there are many types and brands to choose from), which purportedly also improves the circulation to that area. We taper off external application after the first 1-2 weeks. Towards the middle to end of recovery, we typically just do daily massage with dit da jow to the area. I did this diligently with a recent, moderate grade ankle sprain, and surprisingly did not go through the bruising stages.  
  • Take a Chinese herbal medicine that helps with improving blood flow throughout the body. In this category, I am only familiar with Yunnan Baiyao capsules or The Great Mender Tea Pills, although I have seen other products mentioned online. The product dosing typically recommends taking these medicines for just a few days to a week at a time, so in the initial stages of the injury. When ingesting Chinese herbal medicines, you should be cautious or check with a practitioner if you know one. Some can have contraindications and depending on dosage, may be too strong for your constitution. 
  • Keep the injured area moving and stretching as much as you are able without inducing pain. Elevate the area as appropriate to keep too much blood from stagnating / pooling at the injury. If you rest the injury too long, stiffness can settle in and make it more difficult to retain or regain mobility as the tissues heal. Google the METH method or MOVE method for guidance in this area. 
  • Apply a warm compress to the area, which can help with pain relief, and again, encourage blood flow to the injury. 

Integrative Treatment for Chronic Pain Avoidance 

Post-injury, not having a thorough recovery can lead to chronic problems in the area of the original injury. Towards the final days/weeks of recovery, I’ll feel that my injury is more or less recovered and I don’t want to mind it so much anymore. Just because you don’t feel pain anymore doesn’t mean your injury is fully healed. In fact, that final phase could be going on for quite some time.

I’ve learned that this phase is critical and long in terms of making sure the injury is thoroughly healed to avoid developing some chronic weaknesses, aches, pains, or arthritis in that injured area as we grow older or continue to be active. I suspect this phase could be as long as months or even years for many people, but that complete healing is possible.

Even though you may feel healed from your injury, it would be ideal to do the following:

  • Try to avoid allowing recent injured areas to be cold – even if it feels fine to you.
  • Massage with dit da jow on days where you might feel achy or if you used the formerly injured area a lot that day. 
  • Apply warm compress, keep the area warm as much as possible. People who tend to have cold hands / feet (which means poorer blood circulation to formerly injured extremities), keeping those areas warm in the last recovery stages can be particularly important.
  • Keep the area moving and stretching as much as possible as long as there is no pain. Protect or enhance your strength and range of mobility in that area. For example, some therapists recommend wearing a protective brace during exercise and doing preventative exercise for up to a year post ankle sprain. This probably feels like overkill when your injury feels healed, but it would likely prevent chronic pain long term.

Resources

Time it takes for different tissues to heal:

Stop the ice (study shows that ice can cause damage to the muscle fibers and could delay healing):

Western sports medicine starting to recommend METH or MOVE, over RICE as an approach for speedy and thorough recovery:

Posts on how to heal injuries quickly with TCM:

Posts on getting through the chronic stage with TCM or Western sports medicine:

TCM products for soft tissue injuries: