Sports Medicine and Biomechanics Track Highlights from the APMA National

This lecture track dove into practical and contemporary thinking on a variety of scenarios likely presenting to podiatric practices. In this piece, Podiatry Today shares just some of the pearls discussed by the dynamic faculty.

Alicia Canzanese, DPM, ATC kicked off the session by touching on office-based running gait analysis. Stressing the importance of gait analysis, she stressed the audience that statically, some biomechanical issues may not appear, but in motion, they may become more evident. It all comes down to treating the source of a patient’s issue, the root cause, not just the pain or symptom itself, she said. This may contribute to avoiding recurrence of pain, and possibly even prevent pain itself, especially from overuse. For example, in a patient with plantar fasciitis, what muscle imbalance led to the condition in the first place?

However, she noted, especially when it comes to running gait analysis, that she’s observed clinicians with concerns that follow a few different themes. Some may feel that it is too time-consuming, that they aren’t sure what to look for, or that it is not a reimbursable service. Dr. Canzanese then reminded the audience that evaluation and management coding can be selected by time spent, and that this may be an option to consider.

She then reviewed several key findings in running gait analysis across multiple planes and discussed the pros and cons of different methods of running and gait analysis. Clinicians may choose live observation versus video analysis, and she shared that there are several mobile apps that are either free or inexpensive and allow for angle measurement and other features. Evaluating in multiple planes is key, as is observing full-body mechanics, then zooming into the lower extremity. Depending on one’s practice environment, it may make sense to use a treadmill, or a long hallway, or even the office’s parking lot, depending on what is best for the patient’s normal stride patterns and available resources. A patient’s running strike (heel, midfoot, or forefoot) and evaluating not just foot to proximal, but proximal and down as well are both important, she explained. Dr. Canzanese then pointed out several biomechanical abnormalities that may arise in running and how she addresses them in her practice.

Next, Karen Langone, DPM, took to the podium to discuss updates in athletic shoe gear. Change is inevitable, she shared, and this is evident in the historic evolution of athletic shoe technology and trends. No matter the design, she said she finds it wise to advise at least yearly foot measurements, as many factors throughout someone’s life can influence these results, such as foot length, width, volume and ratios thereof. Another factor to consider is the influence of heel drop. She pointed out that whereas traditional heel drops were in the range of 12 mm, contemporary styles are usually less than this, possibly around 6 mm. However, what heel drop is best for a patient likely depends on their foot type and how they strike in running. For instance, Dr. Langone added that heel strikers may benefit from a relatively higher heel drop of 8-10 mm, midfoot strikers around 6-8 mm, and forefoot strikers at 0-4 mm. In order to distribute pressures more fully and efficiently, Dr. Langone recommended patients switching among several different pairs of shoes, as well.

According to sources she shared from Bartold Biomechanics, she then touched on several observations about various shoe types. Among these trends and patterns are the concept that comfort seems to translate into performance for these athletic shoe wearers, and that the geometry of a shoe’s midsole is more important than how hard it is. She presented similar points on barefoot or minimalist shoes, and for more recent “super shoes.”

In her practice, she has gotten to know many different shoe styles and their categories and features. She reviewed examples including cushioned shoes, stability shoes, and stable neutral shoes. Overall, she encouraged clinicians to consider the materials used, including recent innovations, and how they may contribute to achieving various results for patients.

Then Priya Parthasarathy, DPM, rounded out the panel by addressing regenerative medicine in sports medicine and biomechanics. Specifically, she delved into extracorporeal shock wave therapy (ESWT), or when acoustic, high-energy peak waves interact with tissues and may influence cell growth, tissue repair, pain control, and mobility. Originating in Europe, she shared that ESWT is considered among the standard of care for musculoskeletal conditions in many places worldwide.

After discussing some of the proposed mechanisms of action of ESWT, Dr. Parthasarathy addressed some concepts on radial versus focused shockwaves. Primarily, she explained that they have different localization of treatment and depth penetration, with each having preferred applications for different conditions.

She then reviewed case examples and commented on pros and cons of incorporating an ESWT system into one’s practice. She feels there are affordable systems available and that there is a relatively short learning curve for clinicians. However, cost and time can be challenges to consider. She finds from her review of the literature and her experience that several sessions are usually necessary at a minimum, and that athletes can continue activity and training under many circumstances. She concluded by noting that in her practice, treating primary pathology leads to better results compared to secondary pathology. She schedules 3 sessions minimum, spaced weekly, using 15-30 minute blocks, and administering the treatment herself to maximize opportunities for tailored clinical decision-making.