The Special Olympics Healthy Athletes Fit Feet screening program is a great teaching and clinical experience in biomechanics and sports medicine for our podiatry students. It provides them with the experience of doing a focused lower extremity and foot exam, proper shoe fitting, and biomechanical exam including range of motion (ROM) and gait evaluation. The program teaches students to provide recommendations to athletes on podiatric treatment recommendation/referral, shoe and sock recommendations, and patient education materials specific to their needs. It is also a great benefit to have athletes from many different sports present to give the students more of a global approach to sports medicine.
Fit Feet began in 2002 and was developed through the Special Olympics collaboration with the American Academy of Podiatric Sports Medicine. I have the opportunity to serve as a clinical director for Special Olympics of Northern California, and I have participated in the Healthy Athletes Fit Feet Program for Northern California events as well as the 2015 Special Olympics World Summer Games in Southern California, and the 2018 Special Olympics USA Games in Seattle.
Training and supervising our podiatry students from California has been a great experience as we have seen a diverse amount of pathology and conditions in the Special Olympics athletes. The Fit Feet screening also provides the students with athletes from many different sports and geographical areas. Often the Fit Feet screening is the first time an athlete has had a comprehensive foot exam by a podiatrist, which helps our profession reach out and educate more of the public as to our scope and practice within medicine.
A great benefit I have found is the mentoring of the students to their classmates as we try to pair up first- and second-year students, who have not had as much clinical experience, with third- and fourth-year students, who are gaining more experience and learning how to develop and teach fellow students the necessary skills needed for podiatric evaluation.
The students become more efficient in the time and effort they spend with each patient, and learn to become more problem-focused with specific podiatric issues. It also helps reinforce the importance of a sound biomechanical foundation in their podiatric training. In addition to developing basic patient interviewing skills, students get to perform hands-on evaluation, providing both a quantitative and qualitative foot and ankle exam, review of systems, foot size measurements, and gait evaluation. Many of the athletes have not had comprehensive podiatric exams and evaluations before participating in the Healthy Athletes Fit Feet program. The athletes enjoy the teaching moments that we provide as do their families.
Currently, there are eight Healthy Athletes programs: Opening Eyes, Special Smiles, FUNfitness, Healthy Hearing, Health Promotion, Fit Feet, MedFest and Strong Minds. When time permits, we encourage podiatry students to visit the other screening programs and interact with the other health-care professionals. The athletes, coaches and families get access to a great comprehensive screening program.
Essential Elements To Patient Screening For The Healthy Athletes Fit Feet Program
Through Fit Feet, podiatry students learn to treat people with intellectual disabilities, providing lower extremity care and pertinent prevention tips to this underserved population as well as providing a referral source for follow-up professional care and treatment.
Students learn to evaluate skin, nails, bones and joints of the feet, assess gait and foot function, and examine shoes and socks. The screening forms include the following:
• Shoe and sock (type) size;
• Joint range of motion for ankle, metatarsophalangeal joint, subtalar, midtarsal and knee (normal, restricted or hypermobile);
• Foot structure (pes cavus, pes planus, metatarsus adductus, tibial varum and resting calcaneal stance position);
• Basic gait evaluation (normal, excessive pronation or supination, forefoot abduction or adduction, and heel contact);
• Nails (appearance, lesion, discoloration, blister or ingrown);
• Skin (normal, calluses, warts, blisters, maceration, split/cracks, redness, moisture and odor); and
• Foot and bone (normal, crossover toe, claw toe, brachymetatarsia, bunions, tailor’s bunion, hallux rigidus/limitus, neuralgia, Haglund’s deformity, exostosis and hammertoes).
Students can recommend follow-up care as well as footwear and products. Students become familiar with the evaluation and treatment of common athletic injuries of the lower extremities, such as plantar fasciitis, Achilles tendonitis, medial tibial stress syndrome, patellofemoral pain syndrome, iliotibial band syndrome, sesamoiditis and various skin disorders.
The athletic shoe evaluation and recommendation are very important parts of the screening as it is common for the athlete to be wearing shoes that are the wrong size. Additional challenges with proper sizing of shoes include deformities of the foot as well as asymmetry due to underlying conditions. We teach the students how to do a basic gait evaluation in a relatively short period of time, first looking at the entire body and then focusing on the foot.
Preparing Students For Clinical Rotations
I have found that podiatry students who participate in the Special Olympics Fit Feet Program tend to be well prepared for their clinical rotations for many reasons.
Students learn to be efficient in their exam due to the number of athletes coming through the venue. After participating in the program, the students have seen more interesting foot pathologies and gait patterns, and have developed a systematic approach and appreciation for biomechanics as the foundation of podiatric medicine. Students hone their communication and patient workup skills. They have a better understanding of the importance of shoe type, stability versus flexibility of the shoe, motion control of the shoe, sport-specific shoes and types of orthotics and bracing.
Most importantly, the students can apply their biomechanics course work to practical clinical situations and incorporate this experience into their skill set. As we all know, understanding biomechanics is an essential part of the foundation of podiatric medicine and surgery.
The clinical and educational benefits of Fit Feet are numerous for the students. It allows the students to network with fellow local podiatrists and health-care professionals, introduces the students to community service, and motivates the students to become involved with Special Olympics in their community when they start their practice career. Education outside the classroom and clinics provides them with valuable experience and training.
The goals of the Special Olympics Healthy Athlete Program include: increasing access; improving health care, referrals and recommendations; training health-care professionals; and collecting health data to provide us with statistics on health status.
During college pre-med student panels, people frequently ask me what my most memorable moments have been in sports medicine, and I have to say that my Healthy Athlete experience is definitely the best of the best. It has been great to interact with the staff, volunteers, students, athletes, families and coaches with this program.
If you have not had the opportunity to participate in the Special Olympics experience, you are missing out on a great opportunity to serve your community and help mentor our podiatry students. Becoming a Fit Feet clinical director is a great way to get involved in such a worthwhile experience.
Dr. Dutra is the Clinical Director for Special Olympics of Northern California. He is an Assistant Professor of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. Dr. Dutra is the Past President and a Fellow of the American Academy of Podiatric Sports Medicine, and a Fellow of the American College of Sports Medicine. He serves on the Board of Directors of the Joint Commission on Sports Medicine and Science, and is podiatric consultant for intercollegiate athletics at University of California, Berkeley.