Expert Insights in Sports Medicine and Biomechanics

When treating athletes, Laura Sansosti, DPM, FACFAS, emphasized the importance of proper nutrition, staying hydrated, bone health, and an awareness of the female athlete triad.
 
Dr. Sansosti urged physicians to ensure athletes get enough vitamin D, particularly through sun exposure, given that vitamin D deficiency is involved in conditions such as osteoporosis, type 2 diabetes, weight problems, and stress fractures. She advised checking vitamin D in patients with osseous injuries. She noted dehydration equivalent to more than a 2% decrease in body weight can impact athletic performance.
 
The Female Athlete Triad is currently defined as low energy availability, menstrual dysfunction, and decreased bone mineral density. Dr. Sansosti said athletes can inadvertently have low energy if they increase their energy expenditure without an increase in calories. She noted menstrual dysfunction can be one of the first signs of an energy crisis. The definition of low bone density can vary, noted Dr. Sansosti.
 
Dr. Sansosti emphasized these three factors exist in a continuum, and any female at any level who exercises is at risk for the triad, particularly those in sports that emphasize leanness. She advised screening male and female athletes for the Female Athlete Triad before starting a sports season, looking for fatigue, a decline in performance, or recurrent injury. Management is multidisciplinary, with help from physicians, dieticians, and mental health professionals, among others.
 
About 80% of runners will experience injury, noted Karen Langone, DPM, DABPM, FACPM, FAAPSM, in her session on running shoes. “No matter what we seem to do with the shoes, we find runners are still getting injured,” she said.
 
Dr. Langone said running shoes have evolved from motion control to feature different types of cushioning to minimalist shoes to maximalist shoes. She noted many changes in heel drops, topcovers, lightness, profile, streamlining, and the addition of a carbon fiber plate.
 
“All shoe technology now is really trying to redirect the foot to optimize its function rather than control it,” said Dr. Langone.
 
For a neutral running shoe, Dr. Langone recommends the ASICS 1000, ASICS 2000, and Brooks Glycerin. For stability, she recommends Brooks Adrenaline GTS, Saucony Guide, and New Balance 990. For motion control, she recommends ASICS Kayano 29 and 30, New Balance 860, Saucony Kinvara, and the Brooks Ghost.
 
Running shoes are not a good fit for every sport, noted Alicia Canzanese, DPM, ATC, FAAPSM, CAQ-SM, DABPM. Although walking shoes have a similar design to running shoes, she noted that while you can walk in a running shoe, you shouldn’t run in a walking shoe. She advised that shoes are designed for different activities, and that athletes should buy a specific shoe for their sport if they do it more than once a month.
 
Dr. Canzanese noted cross-training shoes keep athletes anchored to the ground, in contrast to running shoes, which are lightweight to propel runners. Compared to running shoes, she said cross-training shoes have less cushioning and bulk in the heel, a flatter sole, a heavier midsole for more strength, and are more flared/built up medially and laterally for cutting and shifting from side to side. Weightlifting shoes have a wider toe box and full rubber outsole so athletes will not slip when lifting, noted Dr. Canzanese.
 
Dr. Canzanese noted tennis shoes vary according to the court surface, and need to allow lateral movement. She said pickleball shoes are similar to tennis shoes. Volleyball shoes have forefoot cushioning and basketball shoes also have cushioning for shock absorption and accommodate frequent player position changes, noted Dr. Canzanese.
 
As for field sports, cleats are different for different sports and turfs, according to Dr. Canzanese. She noted soccer cleats are versatile but advised against buying them more than a half-size smaller than a regular shoe. Baseball shoes have toe cleats and fewer cleats overall due to less cutting. She noted football cleats have thicker and heavier uppers to protect the foot. Lacrosse cleats, she noted, are a hybrid between baseball and soccer cleats.
 
Missy Journot, DPM, AACFAS, FAAPSM, discussed the diagnosis and treatment of Achilles tendinopathy in various presentations.
 
Achilles insertional calcific tendinosis has an insidious onset and is aggravated by increasing activity and shoe pressure, said Dr. Journot. She treats such patients with a controlled ankle motion (CAM) walker for two weeks, a prednisone taper, and physical and occupational therapy consisting of Astym and the Graston technique.
 
Dr. Journot noted retrocalcaneal exostosis is prominent on the posterior heel and presents with a dull, aching pain. Her treatment protocol is similar to Achilles insertional calcific tendinosis.
 
Halglund’s deformity, noted Dr. Journot, presents as acute or chronic, occurring in the morning and aggravated by shoegear. Initial therapy includes open-back shoes, cryotherapy and topical analgesics.
 
Retrocalcaneal bursitis is pain anterior to the Achilles that causes swelling, and Dr. Journot said plantarflexion was the number one cause of pain. She noted treatments include eccentric stretching, ultrasound-guided therapy, and anti-inflammatories.
 
Achilles tendinopathy encompasses the entire heel and Dr. Journot advised eccentric stretching. On exam, she suggested starting at the insertion of the Achilles, palpating the mid-substance, palpating anterior to the Achilles, and palpating along the medial and lateral expansions.