Treating Lower Extremity Conditions Of Special Olympics Athletes

David W. Jenkins, DPM, FAAPSM

One of the most rewarding aspects of my 34-year career in podiatric medicine has been my involvement in Special Olympics. Besides the joy of working and interacting with these amazing athletes, we are able to provide a valuable service via foot screening exams (Fit Feet) that have been instrumental in the prevention of lower extremity problems, and helpful in improving comfort and performance.

   Likewise, in working with the intellectually disabled athlete, I encounter some very unusual podiatric conditions, some of which I had never seen in many years of practice. Sharing these clinical experiences with my students has been a wonderful spinoff of working with Special Olympics athletes.

   I hope that having a greater awareness of the podiatric challenges these athletes face will encourage practitioners to get involved in screenings of Special Olympics athletes (Fit Feet) and provide definitive treatment if required.

   Special Olympics provides year-round sports training and athletic competition in a variety of Olympic-type sports for over 3.7 million children and adults with intellectual disabilities.1

   The Healthy Athletes Initiative developed in 1997 in part because people with intellectual disabilities may experience a higher rate of numerous medical conditions in comparison to the general population and many of these affect the lower extremities.2-4

   The purpose of this initiative is providing health screenings to participating athletes.1 The screenings educate athletes on healthy lifestyle choices and identify problems that may need additional follow-up. Healthy Athletes offers health screenings in seven areas: Fit Feet (podiatry), FUNfitness (physical therapy), Health Promotion (better health and well-being), Healthy Hearing (audiology), MedFest (sports physical exam), Opening Eyes (vision) and Special Smiles (dentistry).

   Fit Feet is one of the newest additions to the Healthy Athletes initiative. It entails a screening of the feet, ankles and gait of Special Olympics athletes at competitions. Additionally, we check athletes for proper shoes and socks, and provide them with community referrals as needed. Lastly, we educate the athletes, their families and coaches on preventative foot care.

Pertinent Insights On Common Lower Extremity Conditions Associated With Intellectual Disabilities

There are many medical conditions with associated intellectual disability. The following overview is in no way complete but attempts to focus on the most typical ones I see in Special Olympics athletes with an emphasis on those with lower extremity manifestations. It is noteworthy that the top three conditions are responsible for one-third of all intellectual disabilities.5

1. Down syndrome
2. Fragile X syndrome
3. Fetal alcohol syndrome
4. Prader-Willi syndrome
5. Phenylketonuria
6. Apert syndrome (acrocephalosyndactyly)
7. Birth injury/cerebral palsy
8. Ectrodactyly
9. Malnutrition
10. Klinefelter syndrome
11. Neurofibromatosis
12. Congenital hypothyroidism (cretinism)

   Down syndrome. Many of the findings below are attributable to the significant hyperflexibility that occurs in Down syndrome. Indeed, many of the pedal deformities are related to joint laxity with excessive pronation in gait and stance.6-10

   Down syndrome lower extremity findings include short lower extremities, external hip position/abducted gait, metatarsus adductus, brachymetatarsia, patellar instability, genu valgum, hypermobile pes valgus/pes planus, metatarsus primus varus, hallux abducto valgus/varus, clinodactyly, syndactyly and hip dislocation.

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