Essential Insights On Developing Expertise In Podiatric Sports Medicine

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By Amol Saxena, DPM

   When it comes to orthoses, it is important to use an orthotic lab that has quick turnaround. Plus Labs, the lab I use, has a one-day turnaround. With one day express shipping, I can cast a patient for orthoses on Monday and have the patient back in the office by Thursday. The lab can also mill devices thin and light enough (less than 1 ounce) to fit into all types of sports shoes and match the insoles exactly. Patients appreciate this speed and efficiency. This is true not only for professional athletes but high school students and those trying to make it to their first marathon.

When An Athlete Comes To You For Another Opinion

   When it comes to surgery for athletes, I do an even more thorough workup than usual. It may be construed as flattering that patients are seeing you as the “nth number” opinion with various studies and diagnoses, but you need to come up with your diagnosis from “scratch.”

   This was the case with Nike’s top distance runner, who had seen eight different types of doctors but none had looked at the imaging studies in combination or taken a weightbearing X-ray. Granted, she did have an unusual ossicle that I have never seen associated with the posterior tibial tendon at its distal insertion to the first cuneiform. However, it was apparent on both the CT and MR scans.

   After we excised the ossicle and repaired the tendon, the patient started an aggressive rehabilitation program. This included the use of a “G-trainer” at seven weeks post-op. The G-trainer is a special treadmill that reduces body weight so even an injured athlete can run sooner. She went on to break American records in distances from 3K to 10K and win an Olympic medal in Beijing.

   In addition to knowing about the availability of these devices that can facilitate rehabilitation, sports medicine podiatrists must have an ability to converse with the patient, coach, agent and rehabilitation specialists. One learns how to communicate with them through experience and exposure. Then collectively, this team draws up a timeline for the athlete’s return to activity.

Final Notes

   It also helps if you are a competitive athlete yourself. Patients will realize that you are trying to help them get better as soon as possible, and appreciate it. In fact, using this philosophy with all of your patients — facilitating a rapid return to their activities — gives credence to treating all of your patients like athletes. Who would not want to get better faster? As the astute Dr. Sheehan opined, “Everybody is an athlete. Some just do not know it yet.”

Dr. Saxena is the Fellowship Director in the Sports Medicine Department of the Palo Alto Medical Foundation in Palo Alto, Calif. He is also a consultant to Alter-G and Plus Labs, as well as a podiatrist for the Nike Oregon Project.

Editor’s note: For related articles, see “How To Develop A Thriving Sports Medicine Practice” in the September 2007 issue of Podiatry Today, “Can Foot Orthoses Help Improve Postural Control?” in the May 2007 issue and “Are Orthoses Effective Against Plantar Fasciitis In The Long Run?” in the September 2006 issue.




References:


1. Toda Y, Segal N, Kato A, Yamamoto S, Irie M. Effect of a novel insole on the subtalar joint of patients with medial compartment osteoarthritis of the knee. J Rheumatol. 28(12):2705-10, 2001.
2. Saxena A, Fullem B. Plantar Fascia ruptures in athletes. Am J Sports Med 32(3): 662-65, 2004.
3. Saxena A, Fullem B. Navicular stress fractures: a prospective study in athletes. Foot Ankle Int. 27(11): 917-21, 2006.


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