Popularity of CrossFit has Increased Rate of Lower Extremity Injuries


In my sports medicine practice, the majority of injuries come from runners and triathletes. However CrossFit workouts are presenting with injuries to the Foot, Ankle and Leg at an alarming rate.

CrossFit is based on three principles: Mechanics or the technique. Consistency describes execution of movement. Intensity varies based on fitness level.

One of the basic movements is the squat and its variations: air - without weight; front squat - holding a weighted barbell; overhead squat - holding the barbell pressed in the air above your head; back squat - holding the barbell against your shoulders behind your neck.

Other movements include the shoulder press, push press, push jerk and deadlifts, agility drills, handstand push-ups, ring dips, pull-ups, chin-ups, push-ups, sit-ups, burpees and box jumps.

There is cardiovascular exercise, including rowing and jump rope.


There must be an understanding of the correct footwear for the activity. Workouts involve agility drills, linear exercises, side to side movements and static stance.

Training shoes or CrossFit-specific shoes are a good option. They have more flexibility in the forefoot, added support to the lateral sides and rearfoot and cushioning for extra shock absorption. Poor shoe choice can lead to injury.

Flexibility Can Avoid Injury

Studies have determined a lack of flexibility is a factor responsible for sports-related injury. There is a strong correlation between tight ligaments and muscle groups in association with lower extremity injuries.

For example, adaquate ankle dorsiflexion is necessary for squatting movements. Dorsiflexion of the Great Toe is necessary for lunges, burpee movements, planks and push-ups. Be sure the warm up includes stretching before workout for flexibility in an attempt to prevent injury.


Common CrossFit Injuries

Ankle sprains. Lateral (outside) ankle sprains are most common in CrossFit, from jump rope, burpees and box jumps.

Injury usually results from lack of proprioception or a reduced sense of joint position, especially with movements that involve jumping up and landing back.

There is swelling and tenderness and difficulty bearing weight. Treatment is based on severity of the symptoms. Once the acute pain has resolved, the focus turns to strengthening and stability in order to prevent re-injury. Re-injury is the most common reason for chronic ankle instability.

Fractures. Fractures can occur in a variety of different situations. Most commonly, fractures result from blunt trauma to the foot, dropping a weight, hitting the anterior shin on a wooden box during a box jump or with a Lateral ankle injury and fracture to 5th Metatarsal.

Stress fractures

With certain CrossFit activities, there is repetitive trauma to the foot and lower leg such as squatting, jump rope and box jumps. Stress fractures are abnormal repetitive loads on the bone causing it to fail. The pain is usually of gradual onset, worsening over time but usually a patient can recall when and how the trauma might have happened. The pain often begins with an ache in the lower leg or foot that not limiting, so exercise routines continue until the pain becomes severe and disabling. Pinpoint tenderness over the area is a hallmark sign. Initial X-Rays may appear normal. There may be a mild sclerotic line in the cortex of the bone, on repeat X-Ray, two to three weeks after injury, indicating the site of the break. A magnetic resonance image (MRI) or bone scan would be warranted early for definitive diagnosis.

Stress fractures are usually treated conservatively. Immobilization is often appropriate and partial weight bearing with off loading. Non weight bearing activities are recommended until healing occurs.

Fractures of the Sesamoid Bones

The Sesamoid Bones are located in the ball of the foot where the Great Toe connects to the First Metatarsal. This is the location of a major pressure point in a triangle formed with the Fifth Metatarsal and Heel. Often injured, due to their anatomic location, in sports with repetitive trauma. These bones function to mechanically assist toe off power of the Great Toe and for stability. Burpees, push-ups, planks and lunges make this ares susceptible to injury.

Symptoms can vary from an ache with high-impact activity to a sharp pain with simple walking. The clinical exam will include pain on palpation to the injured sesamoid and pain with range of motion of the first MPJ, especially dorsiflexion. Injury may be difficult to diagnose on X-Ray if the fracture is not severe. An MRI may be necessary.

Initial conservative treatment consists of rest, ice, compression, elevation, activity modifications, offloading. If symptoms persist for greater than six months and there is minimal improvement surgery becomes an option.

Subungual Hematomas

Subungual hematoma is bleeding beneath the nail plate, usually in the Great Toe or second toenail. It occurs due to the repetitive trauma in shoes that are too short or blunt trauma to the toenail.

Large hematomas are painful, disabling and prevent shoe wear. Relief of pressure may require total nail avulsion.

Plantar Fasciitis

Plantar Fasciitis is a most common type of heel pain. There is sharp pain on weight bearing usually on the bottom-inside aspect of the heel and into the arch. Exacerbation with repetitive activities, such as jump rope, burpees or running. Tight Achilles is a contributing component in many cases.

Conservative treatment for Plantar Fasciitis includes rest from high-impact activity, stretching, off-loading, Physical Therapy, changes to footwear and custom Orthotics. This injury requires patience, allowing time for your body to heal. CrossFit workouts are not recommended until healing occurs.

Achilles Tendonitis

Injury to this tendon can be linked to overuse in almost every sport. This injury, seen more often due to inadequate warm up and stretching, heavier and stronger athletes, increased weight loads, abrupt repetitive movements and middle-aged men and women participation. Pain, pulling and discomfort during squat, when the Achilles is at full stretch, is a sign to back off. Achilles injuries may also occur during jump rope and burpees when kicking out into plank position. On clinical exam, there may be pinpoint tenderness and swelling in the Achilles Tendon, palpable pain and painful walking. Don't ignore these signs. Often a Tendonitis progresses to a partial rupture.

Conservative treatment has variable results and will depend on the severity of the symptoms. Treatment of Achilles tendonitis can include immobilization, anti-inflammatories, heel lifts, stretching and strengthening and other physical therapy modalities.


In Conclusion

Popularity of CrossFit has increased rate of lower extremity injuries. Early diagnosis and treatment is essential. Allow your body to heal before return to participation.


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Wolf Podiatry

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Oceanside, CA 92054

Phone. 760-230-9031