Building A Practice Focused On Podiatric Sports Medicine

Author(s): 
Tim Dutra, DPM, MS, MS-HCA

Many of us who went into the podiatric profession did so because of our passion for sports. I was always interested in a career that combined sports and medicine, and podiatry was the perfect profession in which to do it.

   I have always been involved in sports and have had experience being an athlete, athletic trainer, youth sports coach, high school coach and team podiatrist. I think the more athletic experience you can bring to your practice, the better you can deal with athletes as patients. Athletes can be the most satisfying part of your practice as they are highly motivated and anxious to return to their activity. All of us see athletes and active patients in our practice. Essentially, you may already be engaged in a sports medicine practice and can easily build on your foundation.

   Networking is very important early on in private practice. Get to know your local doctors, especially the ones who specialize in sports medicine. Let them know that you are available for consultation if needed.

   I think the attitude that every patient is an athlete is a good baseline philosophy for your practice. Every patient has some level of activity and athletes suffer the same injuries as our everyday patients. By far, the most athletic injuries are overuse type of injuries and many involve the lower extremity. The key to treating athletes is to focus on getting them back to their activity as quickly as possible while preventing further injury or reoccurrence. Access to healthcare can be a challenge for all levels of athletes.

Recognizing Your Role On The Team And Interacting In The Community

Most sports involve a team approach and a sports medicine practice is no different. Podiatric sports medicine is really being part of a team of providers focusing on getting the athlete healthy and ready to return to activity. We commonly must work with the primary care physician, orthopedist, physical therapist, athletic trainer, coach and numerous other specialists to ensure we are doing all we can for the athlete. This is true in any podiatric specialty but is most evident in sports medicine. Since the majority of sports injuries involve the lower extremity, we are an essential part of the sports medicine team.

   One of the easiest and most accessible ways to begin building your sports medicine practice is to get involved in your community. Almost all communities will have active youth leagues, high school athletic teams, dance studios, club sports and numerous other opportunities for you to get involved. You can coordinate and participate in preseason athletic screening with other healthcare professionals (networking), give talks to groups, volunteer time with teams and clubs, work with the athletic trainers in your area, etc. Many communities will have colleges and student health centers that you can get involved with. The more visible and available you are, the better.

What You Should Know About The Sports Medicine Pyramid

The sports medicine pyramid (see image below) demonstrates how to build your practice and where the most athletes are, from youth sports to the professional and elite athletes. There is a tremendous need to treat our youth athletes who participate in many sports: little league baseball, girls’ softball, dance, martial arts, basketball, football, track and field, etc.

   When you are beginning your practice, this is the best place to start. Children can be a challenge as they want to return to play right away, have short attention spans and have the pressures of peers and parents. High school sports offer the opportunity to treat athletes in many different sports and help build a knowledge of the importance of preventing injuries. Many are hoping for college scholarships. College athletes, like high school athletes, are student athletes, and one must take care to minimize the risk of further injury as some athletes will have professional aspirations. Accordingly, each level of the pyramid will have different challenges.

The Importance Of Having A Strong Grasp Of Sport-Specific Footwear

It is very important to be knowledgeable of the types of athletic shoes out on the market. Not only should you have a good idea of the different brands and models, but also how the athlete’s foot type, demands of the sport and use of orthotics can influence what works best for the individual. You should be familiar with tips on trying on shoes, the three-point shoe test for stability, orthotic fit in the shoe, type of socks worn for respective sports, as well as training shoes (used for cross-training and off-season activities). Get to know the staff of your athletic shoe stores in the area, talk with them about what you feel is important and build a relationship with them.

   The three-point shoe test evaluates: 1) flexion at the metatarsophalangeal joint (MPJ)/ball of the foot area; 2) torsion from forefoot to rearfoot of shoe; and 3) heel counter stability/compressibility of the heel counter. The test enables one to assess the stability of the shoe. It also provides a good way to check for breakdown of the shoe and determine whether the shoe needs to be replaced.

   Proper fit of the shoe is extremely important and one should give the athlete some suggestions on optimizing the fit of the shoe. Obviously, they should be wearing the socks they will be participating in as well as any orthotics, etc. The best time to try on shoes is in the afternoon or evening. Measuring both feet on a Brannock device while patients are weightbearing will give the athletes a reference point. The most common error is wearing shoes that are too tight. For most sports, you will want some room for movement. Remember, it is always easier to make a shoe smaller than bigger.

   I recommend having a shoe list for your athletes for different types of shoes, just like you should have for your patients in your practice. Make sure that when athletes are recovering from an injury that you remind them to avoid flip-flops or slippers as much as possible. Time spent in footwear that offers little or no support can prolong their healing and recovery time. For female athletes, make sure you go over acceptable dress shoes and heel height for their casual wear.

   Give the athlete guidelines for when to replace their shoes as well as orthotics, topcovers, etc. I will usually recommend replacing topcovers at least once a season for most athletes, especially when they are full length.

   Don’t forget the importance of socks in the overall picture of footwear. You should impress upon the athlete what socks offer them the best fit, support, cushioning and absorption for the athletic activity.

A Closer Look At The ‘Exercise As Medicine’ Initiative

Promoting an active lifestyle with your athletes and patients is extremely important in a podiatric sports medicine practice. The American College of Sports Medicine has been promoting “Exercise As Medicine” to all health professionals in their approach to patient care. You should actively discuss with your patients what their activity level is, how often they exercise, what type of exercise they engage in, how long they exercise, etc.

   One can adapt exercise prescription to every patient. Your job should be to motivate and encourage patients to follow their exercise program. Exercise prescription should be an important aspect of your treatment and prevention plan for your patient. Exercise should be fun to help motivate your patients and incorporate it into their lifestyle.

   You should be able to discuss current issues and trends objectively with your patients, such as barefoot versus shod running, childhood obesity, basic nutrition principles, and the benefits of exercise, weight training, stretching and strengthening and prevention of injuries. Evidence-based sports medicine is also important to keep up on by reading sports medicine journals and attending conferences.

A Guideline For Returning Patients To Activity

Return-to-activity guidelines are an important part of your practice. The level, age, fitness and motivation of the athlete are just several important considerations in coming up with a return to activity plan.

   I am careful to under-promise and over-deliver. This will make your patients happier and more satisfied with your treatment program and return to activity if they return sooner than expected. An example would be when dealing with an inversion ankle sprain in a high school athlete. You could tell him or her that it may be as long as six to eight weeks to return to athletic participation, depending on how well he or she complies with exercises and rehabilitation, uses taping or bracing, etc. If the athlete returns in four weeks, he or she is very satisfied with your care. It is basically a good idea to overestimate a return to activity date because if athletes take a longer time than estimated, they can become frustrated.

Why It Is Worth Getting Involved In Professional Sports Organizations

It is very important to be an active member in sports medicine organizations. I found that the two most useful organizations for developing my podiatric sports medicine practice were the American Academy of Podiatric Sports Medicine (AAPSM) and the American College of Sports Medicine. Both organizations have Fellow status, networking opportunities, professional meetings and the ability to get involved on numerous levels. I encourage students and young practitioners to get involved as early as they can.

   The AAPSM also offers post-graduate fellowship opportunities. You can also provide lectures at your medical staff meetings on a variety of sports medicine topics and the AAPSM provides an excellent referral source in your community.

   Dr. Dutra is an Assistant Professor of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is a Past President and Fellow of the American Academy of Podiatric Medicine, and a Fellow of the American College of Sports Medicine. Dr. Dutra is a podiatric consultant for Intercollegiate Athletics at the University of California at Berkeley. He serves on the Board of Directors of the Joint Commission of Sports Medicine and Science.

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