Tennis & Podiatry

No pain, no gain? Not in this case.

Tennis is a racket sport that requires speed, power, endurance, balance and coordination. It can be played individually against a single opponent or between two teams of two players each. The object of the game is to play the ball in such a way that the opponent is not able to play a valid return.

There are three main surfaces that Tennis is played on and each different playing surface has unique corresponding footwear considerations that are important in the way of preventing injury. Due to the high speed on racquet impact, repetition and use of your spine, legs and especially your dominant arm, there can be a variety of shoulder, elbow, wrist, knee, ankle, hip and spine injuries that develop.

The best known tennis injury is tennis elbow – but, despite its name is relatively uncommon in tennis players! Below are some injuries seen often in tennis:

  • Lower limb injuries are the most common tennis injuries. They are caused by the sprinting, stopping, pivoting, jarring and pounding nature of tennis. Can be acute e.g an ankle sprain or chronic e.g. knee tendonitis.
  • Upper limb injuries occur sometimes and they are usually caused by the high-velocity and repetitive arm movements required in tennis. These injuries tend to be overuse in nature e.g tennis elbow
  • Back injuries and pain are common due to the rotation required to hit groundstrokes, and the combination of rotation, extension and lateral flexion involved in the serve.

The ailing tennis player can benefit from a podiatrist who is knowledgeable in the intricacies of play on multiple surfaces. Those athletes who have experienced significant fatigue due to years of play on hard courts can benefit from switching to a well-maintained clay court with the appropriate shoe.


1) Hard court, a mixture of rubber acrylics, silica, asphalt or concrete and sand.
This mixture induces tremendous amounts of shock to the lower extremities with each limb supporting up to six times the player’s body weight. This produces common complaints such as:

  • Patellar tendonitis
  • Achilles tendonitis
  • Plantar fasciitis
  • Plantar heel bruising

2) Clay courts are made of crushed brick (red clay) or a proprietary mixture of natural materials with a chemical binding agent (green clay). While this surface is much softer and more forgiving on the lower extremity than hard courts, the delicate moisture balance needed to keep clay tennis courts safe can come with its own set of challenges. can induce, which can cause:

  • slipping and sliding = frequent Hamstring and Achilles strains (court is too dry)
  • The tennis shoe can “catch” on clumps of clay causing ankle sprains (court is too moist)

3) Grass tennis courts are uncommon surfaces for the routine tennis player. Grass is the softest surface on which tennis players play. Dry grass courts pose the same risks as clay courts. Players should avoid a moist grass court as the most common injuries on grass are:

  • ankle sprains
  • hyperextension injuries due to poor traction.

4) Carpet tennis courts are uncommon for routine play given their high propensity for injury. Carpet tennis courts are sanded to allow for the softness of grass and the traction of clay. However, if the sanding is not uniform, unsanded spots will snag the plantar outsole of the shoe and spots with too much sand can cause slippage.

Tennis Footwear:

  • Hard court shoe: A rule of thumb on tennis courts is that “the harder the surface, the heavier the shoe should be”. Most hard court shoes are manufactured at around 14 to 15+ ounces for a size 10.5 shoe. This bulk gives the shoe’s outsole durability and cushioning for hours on unforgiving asphalt or concrete. Those who predominantly play on hard courts should avoid lighter, clay-specific shoes.
  • Clay court shoe: Shoes with a herringbone pattern. These shoes are on the lighter end of the spectrum (10 to 13 ounces for a size 10.5 shoe). They are forgiving on wet surfaces but are also able to grip slightly dry surfaces. For patients who slide into their shots, a commonly taught technique on clay surfaces, I place a layer of adhesive felt on the underside of the shoe’s vamp to prevent the forefoot from jamming in the toe box. Such a sliding motion can cause: blisters, onychodystrophy, onycholysis, subungual hematoma, turf toe and hallux limitus
  • Grass court shoe: Shoes designed for grass court play are outfitted with rubber “nubs” on the plantar and distal outsole to grip the soil underneath the grass. If the player does not have access to these shoes, a deep herringbone pattern is acceptable. The shoe should be heavy enough to grip the dirt under the blades of grass. If a patient is going to be playing on a grass court for the first time, he or she should do an extended warm up to get a sense of the proprioceptive challenges that grass presents. Proprioceptive exercises for grass court tennis players or tournament participants in infrequent grass court events is important: drawing the alphabet with the ankle, toe curling using a towel, balance boards and single limb balancing exercises. Many players elect for a basket weave prophylactic taping or utilise bracing prior to grass court play
  • Carpet court shoe: hybrid shoe and the participant must pay close attention to the condition of the court.

Tennis Injury Risk Factors

  • Different court surfaces.
  • Condition of tennis balls used. (Pros change them every seven games).
  • Type of tennis racquet.
  • Tennis shot technique.
  • Weather extremes.
  • Inappropriate footwear.
  • Poor physical conditioning.
  • The amount and level of participation.
  • Poor injury rehabilitation.

Common Tennis Injuries:

  1. Achilles Tendon Rupture
  2. Achilles Tendonitis / Tendinitis
  3. ACL Injury
  4. Adductor Tendinopathy
  5. Anterior Ankle Impingement
  6. Avascular Necrosis of the Femoral Head
  7. Back Muscle Pain
  8. Bicep Tendonitis
  9. Bulging Disc
  10. Bursitis Knee
  11. Bursitis Shoulder
  12. Calf Muscle Tear
  13. Chondromalacia Patella
  14. Cramps
  15. de Quervain’s Tenosynovitis
  16. Degenerative Disc Disease
  17. Dislocated Shoulder
  18. DOMS – Delayed Onset Muscle Soreness
  19. Facet Joint Pain
  20. Fat Pad Syndrome
  21. Femoroacetabular Impingement (FAI)
  22. Gluteal Tendinopathy
  23. Golfers Elbow
  24. Greater Trochanteric Pain Syndrome
  25. Groin Strain
  26. Hamstring Strain
  27. Heel Spur
  28. High Ankle Sprain
  29. Hip Arthritis (Osteoarthritis)
  30. Hip Labral Tear
  31. ITB Syndrome
  32. Knee Arthritis
  33. Knee Ligament Injuries
  34. Lateral Collateral Ligament
  35. Medial Collateral Ligament Sprain
  36. Meniscus Tear
  37. Metatarsalgia
  38. Morton’s Neuroma
  39. Muscle Strain
  40. Neck Arm Pain
  41. Neck Headache
  42. Neck Sprain
  43. Osgood Schlatter’s
  44. Osteitis Pubis
  45. Overuse Injuries
  46. Patella Tendonitis (Tendinopathy)
  47. Patellofemoral Pain Syndrome
  48. Peroneal Tendonitis
  49. Pes Anserinus Bursitis & Tendinitis
  50. Pes Planus – Flat Feet
  51. Pinched Nerve
  52. Piriformis Syndrome
  53. Plantar Fasciitis
  54. Plica Syndrome
  55. Poor Hip Core
  56. Posterior Ankle Impingement
  57. Posterolateral Corner Injury
  58. Retrocalcaneal Bursitis
  59. Rotator Cuff Calcific Tendinitis
  60. Rotator Cuff Syndrome
  61. Rotator Cuff Tear
  62. Sacroiliac Joint Pain
  63. Sciatica
  64. Severs Disease
  65. Shin Splints
  66. Shoulder Impingement
  67. Shoulder Tendonitis
  68. Side Strain (Abdominal)
  69. Sinding Larsen Johansson Syndrome
  70. Spondylolisthesis
  71. Spondylolysis (Back Stress Fracture)
  72. Sprained Ankle
  73. Stress Fracture
  74. Stress Fracture Feet
  75. Tarsal Tunnel Syndrome
  76. Tennis Elbow
  77. Thigh Strain
  78. Tibialis Posterior Tendinopathy
  79. Trochanteric Bursitis

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