Essential Insights On Developing Expertise In Podiatric Sports Medicine
- Volume 21 - Issue 12 - December 2008
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Over the decades, the concept of podiatric sports medicine has evolved. In years past, educators at podiatry schools directly and indirectly implied that it was primarily making orthoses for runners. Certainly, this was the case in the early 1970s running boom as George Sheehan, MD, a cardiologist, urged runners to seek the biomechanical benefit of foot orthoses.
However, as more patients from other sports gravitated to podiatrists for biomechanical help, the knowledge base of the practitioner had to expand. One of my mentors, John Durkin Jr., DPM, advised me, “Do not just get good at treating runners.” Furthermore, when athletic patients had to undergo surgery, they often wanted a doctor with an understanding of their ability to return to sport. A current podiatric sports medicine practitioner has to be a “triple threat” in that he or she needs to know when and how to incorporate rehabilitation, orthoses/shoes and surgery into the treatment regimen.
In my opinion, the current training programs in undergraduate podiatry school have minimal exposure and lectures in sports medicine. Most schools do not have formalized lectures. In this case, students should try to attend meetings conducted by sports medicine groups such as the American Academy of Podiatric Sports Medicine, be involved in the sports medicine clubs, and read journals such as the Journal of Sports Medicine (British and American versions), Medicine and Science in Sports and Exercise, and the Journal of Orthopedic and Sports Physical Therapy. In addition, the student should try to shadow sports medicine practitioners including orthopedists, physical therapists and athletic trainers. This is exactly what I did and still do.
Doctors can always have the excuse they are too busy but there is no time like the present, even for established practitioners who want to learn. Residencies also have minimal exposure to sports medicine unless you are fortunate enough to train under a residency director who has strong knowledge of these issues. I did my residency training under John Grady, DPM, who is truly one of the few podiatrists to be a specialist in all aspects of podiatry.
Post-residency, there are a few certified sports medicine programs such as the one I direct. Even without formal rotations, one can get training. There are two great sayings: “Never let your education get in the way of your learning” and “What you learn after you know it all is what counts.”
Keys To Being A Successful Sports Medicine Podiatrist
One should know when an orthosis will treat or actually cure something. Unfortunately, orthoses for sports injuries have not been studied with rigid criteria. For instance, I know I can modify an insert or orthosis to take the pressure off a toe joint or metatarsal. However, we have not studied cohorts with and without this modification to see if one group gets better faster or not. The reality is, in sports medicine, faster is better.
As a podiatrist who specializes in sports medicine, the most common injuries I see are ankle sprains, Achilles tendon ruptures and tendonosis, stress fractures, ankle osteochondral and transchondral defects, Lisfranc injuries, hallux rigidus and peroneal tendon pathology. Other than hallux rigidus, very little in the formalized educational process has traditionally concentrated on these pathologies.
Physicians should spend time with practitioners who treat these conditions. If one cannot treat them surgically, you can at least recognize them and facilitate a possible referral. I can honestly say one can stay busy full-time just treating these entities as a podiatrist.
One also has to know if the shoe gear is helping or hurting the situation. A sports medicine podiatrist should be as familiar with shoe gear as he or she is with medication.