Pertinent Pearls On Treating Overuse Injuries In Endurance Athletes

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This F-Scan pressure assessment maps the right and left feet, augmenting the clinician’s ability to detect abnormalities in the gait cycle. The decreased pressure inferior to the left heel suggests the presence of a functional limb length discrepancy whil
This F-Scan pressure assessment maps the right and left feet, augmenting the clinician’s ability to detect abnormalities in the gait cycle. The decreased pressure inferior to the left heel suggests the presence of a functional limb length discrepancy whil
Here one can see a digital video (DV) gait analysis, which provides a visual record of the patient’s walking/running gait cycle. Prolonged midstance and propulsive phase pronation of the foot can be qualified with a frame-by-frame review of the DV clip.
Pertinent Pearls On Treating Overuse Injuries In Endurance Athletes
This digital video (DV) cycle analysis provides a visual record of cycling under a variety of circumstances that can include spinning, pushing big gears or riding down in the cockpit.
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Author(s): 
By Kirk M. Herring, DPM, MS

Can We Effectively Prevent Overuse Injuries?
The exacting etiology of overuse injuries is often shrouded in uncertainty.6 Many have categorized the factors contributing to overuse injuries among endurance athletes with training errors, anatomical/biomechanical factors and equipment failures representing the most frequently cited circumstances associated with overuse injury. The existence of malicious malalignment continues to dominate our suspicions and is frequently described as a cornerstone to overuse injury. However, many more factors play into the development of overuse injuries.7 Contributing factors can be generalized as either intrinsic or extrinsic in nature. One would typically identify these factors via the patient history and physical examination (see “Which Factors May Contribute To Overuse Injuries?” below).
The implications for podiatric medicine are to “stay the course” or assume an expanded leadership role in the care of endurance athletes. To accomplish this, podiatric medicine must: pursue randomized investigational/experimental research; reevaluate and revise treatment protocols and recommendations; provide recommendations and preventive measures to the endurance athlete community; strengthen peer education opportunities; promote public awareness; and carefully listen to our patients.
Medicine has generally been problem-oriented in its focus on patient care and management. However, we need to help instill preventive behavior within our endurance athletes/patients. We need to encourage more rest and less intense training, and facilitate improved strength and range of motion. New shoes and orthoses alone will not be sufficient to nurture the necessary behavior modifications for the athlete to avoid future disabling overuse injuries.

Which Factors May Contribute To Overuse Injuries?
Intrinsic factors
• Age
• Gender
• Psychological factors
• History of previous overuse injury
• History of previous musculoskeletal injury/surgery
• Previous long-distance endurance sports experiences
• Body height and weight
• Muscular imbalance
• Restricted range of motion
• Biomechanical misalignment of the lower extremity
• Chronic musculoskeletal/connective tissue diseases

Extrinsic factors
• Inadequate warm-up
• Inadequate/improper stretching routine
• Training intensity/effort
• Training frequency
• Training speed/cadence
• Time of day and year
• Previous racing and training efforts
• Participation in other sports
• Racing and training shoes
• Nature of training surfaces (hard, canted, etc)
• Foot orthoses
• Improper fit and use of equipment
• Improper and poor racing/training technique

Case Study: When A Triathlon Runner Presents With Neuroma Pain And Gait Abnormalities
A 52-year-old male professional who has participated in triathlons for the past five years received an orthopedic referral for treatment. The patient exhibited gait abnormalities and complaints ranging from a chronically painful neuroma on the right foot to chronic patellofemoral pain syndrome involving the right knee and degenerative joint disease of the right hip.

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