PROTECTING THE FLEET FOOT INJURIES THREATEN PRO AND AMATEUR ATHLETES ALIKE.

Byline: Mariko Thompson Staff Writer

THE LAKERS' three championship runs may be traced in the anatomy of a foot.

In the first championship run, Kobe Bryant, hobbling from a left-ankle sprain, hit the game-winning shot in overtime to lead the Lakers to a Game 4 victory over the Indiana Pacers. The Lakers went on to win the 2000 NBA Finals in six games.

In the second championship run, scrappy point guard Derek Fisher spent most of the season sidelined with a stress fracture in his right foot. Returning to the lineup in March 2001, Fisher's hustle helped spark the Lakers, who scorched their opponents with a 15-1 run in the playoffs.

In this year's championship run, Shaquille O'Neal overcame pain in his arthritic big toe and gave a dominating performance worthy of yet another MVP trophy. Earlier this month, O'Neal underwent surgery to remove bone spurs from his toe joint. The Lakers, who open training camp on Oct. 1, hope the procedure will enable their star center to lead them to a fourth title.

Whether the Lakers achieve dynastic status may well rest on the health of their collective feet. As a contact sport with a lot of twisting, pivoting and pounding, basketball players are highly susceptible to foot injuries.

``For one thing, you leave your feet, which means you have to land,'' Lakers trainer Gary Vitti said. ``You might land on someone else's foot, or someone might land on your foot. Basketball and volleyball are both sports where you're going to see traumatic foot injuries.''

Agony of the feet

There's a lot that can go wrong in the foot. According to the American Podiatric Medical Association, the foot contains 26 bones, 33 joints, 107 ligaments, and 19 muscles and tendons. The 52 bones in the two feet make up one quarter of all bones in the human body. When running, the pressure that feet endure is enormous, equaling three or four times the body weight.

In general, contact sports, including basketball, soccer and football, where players run and frequently change direction, carry a higher risk of acute foot injuries. Though baseball might appear to be a less vigorous sport by comparison, the acceleration, deceleration and sliding required in base running makes baseball players prone to foot injuries as well, said Dr. Phillip Kwong, a foot specialist with Kerlan-Jobe Orthopaedic Clinic and HealthSouth in Los Angeles.

Kwong, who works with the Lakers, Dodgers and Angels, characterized foot injuries as either acute or cumulative. Bryant's ankle sprain was an acute injury, sustained in the heat of the game. The stress fracture that Fisher suffered and the arthritic joint in O'Neal's toe are considered cumulative, developing over time.

Cumulative injuries may be linked to the player's biomechanics. Trainers and physical therapists may work with the athlete on mobility or recommend orthotics for their shoes. With acute injuries, there are fewer preventive measures at the athlete's disposal, Kwong said.

``There are more limitations to what we can do,'' he said. ``We can keep the athlete's conditioning to a maximum and make them aware of their balance.''

Lakers trainer Vitti emphasizes three areas to minimize risk:

-- Use a logical progression to increase the intensity of the workout. A jogger who runs one mile shouldn't suddenly run five. Increase the distance gradually over time, Vitti said.

-- Keep workouts on the same surface. Vitti wouldn't want his players, whose bodies are accustomed to playing on more-forgiving hardwood courts, to go run around on asphalt courts.

-- Wear a shoe with the proper fit. Athletes should not buy the most expensive or fashionable shoe, but the one that provides the right combination of cushioning and support. Shoes should be replaced frequently. The American Academy of Podiatric Sports Medicine recommends replacing running shoes every 350 to 550 miles. Once athletes find the proper shoe, they should stick to the same model if possible.

``A change in shoes is also going to change where the distribution of stress is across the foot,'' Vitti said. ``If you have to change the shoe, you want to back off the workout, and gradually break yourself into the shoe. Don't toss out the old pair of shoes.''

For female athletes, dress shoes may cause more problems than athletic shoes, said Dr. Carol Otis, founder of the Kerlan-Jobe Women's Sports Medicine Clinic. Dress shoes designed with a narrow forefoot and toe can lead to bunions or hammer toes. Wearing high heels can cause a tightened Achilles tendon.

``Beware of the pitfalls of the fashionable shoe,'' she said.

The female athlete, because of her build, also may be more prone to shin splints and arch pain. Women with broad pelvises often have a knock-kneed alignment. This can lead to flatter feet that are more susceptible to shin splints and arch pain, Otis said.

Standing procedures

Before Lakers games and practices, it's not unusual to find Vitti loosening his players' feet. He'll have the player sit on a table while he manipulates the foot's bones and joints. Players with rigid feet also are assigned strengthening exercises.

``Guys will curl a towel up in their toes,'' Vitti said. ``We have a big cup of ball bearings. They'll pick up the bearings with their toes and drop them in the cup.''

O'Neal, too, will have his share of strengthening exercises while he recovers from surgery. O'Neal will do toe flexion exercises to keep his big toe strong and mobile, Vitti said.

Professional athletes have teams of doctors and trainers attending to every ache and pain. But what about the occasional athlete? The average person who experiences pain following a workout often tries to ignore the injury and hope for the best, physical therapists and doctors say. Recreational athletes often ask at what point they should seek treatment for an ailment.

Dr. David Thordarson, associate professor of orthopedic surgery at USC Keck School of Medicine, offers the RICE rule: rest, ice, compression, elevation. A short course of anti-inflammatories for those who can take them is also helpful, he said.

``If after a week you're not getting better, or if despite treatment you're getting worse, you should see your regular doctor,'' Thordarson said. ``If you can't walk, go in right away.''

Recovery time often depends on the patient's fitness level and how soon they sought treatment, said Judy Seto, a physical therapist with HealthSouth.

``People will say, 'I had the same injury that Kobe had; how come I'm still hurt?' '' Seto said. ``Athletes tend to be in better shape than us lay people. When we get hurt playing weekend basketball, the doctor probably hasn't looked at it, we're not icing it everyday, and we still have to go to work. But for the professional athlete, their job is to get better.''

CAPTION(S):

7 photos

Photo:

(1 -- 4 -- cover -- color) trouble afoot

Take steps to guard against serious sports injuries 

(5 -- 6) CSUN athletes Aisha Margain, left, and Jesse Servin illustrate typical workouts for track and soccer, respectively - both sports carry significant risk of foot injury due to constant pounding and sudden shifts in direction.

Tina Burch/Staff Photographer

(7) Basketball especially punishes the feet, as Shaquille O'Neal, who had recent surgery on his big toe, can attest.

Tom Mendoza/Staff Photographer