Building A Practice Focused On Podiatric Sports Medicine

Tim Dutra, DPM, MS, MS-HCA

   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.

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