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Vitamin D: deficient? What does it mean when you play sports?

Vitamin D affects a lot of systems throughout our bodies. This includes muscles, bones, and cartilage. Normal levels of Vit. D level; aka: 25(OH)D on a blood test; greater than 30 to be sufficient. Another blood test that goes along with Vit. D is phosphorus, normal 2.5-4.5 mg/mL. When you have low vit. D, this also means low phosphorus absorption. When Vit. D is low, phosphorus levels are higher in the blood stream. This high phosphorus causes the calcium to be pulled away from the bones; this in turn causes a weakening of the bone. This may lead to an increase risk of fracture.

A recent study of NFL football players, about 20% had adequate Vit. D levels while about 80% had either insufficient or deficient levels. This data demonstrated that those with low levels had more incidence of either muscular strain/pull (primarily hamstring and calf) or fracture during their careers.

1www.footandanklewell.com 678-513-8777 facebook @ footanklewellnesscenter The FDA states the vitamin D of 400 IU for an adult. 800 IU for children during adolescence. Endocrinologists have published their recommendation of 2000-3000 IU each day.

Minimalist Shoes: Have you tried them yet?

During the survey, 31% of the runners have tried minimalist shoes. Of those who have tried, 29% have experienced pain or injury while using them. Of those surveyed, 61% reported a new injury or pain, 22% reported recurrence of injury or pain, and 18% had combo of both old and new injury or pain. Most common areas were in the foot. This included heel pain, Achilles and peroneal tendonitis, forefoot and midfoot pain, and anterior ankle pain.

While wearing them, runners have experienced less anterior knee pain. This is because the minimalist shoe has caused a different foot strike from heel strike to midfoot or forefoot striking. This will change the mechanics of the run, but it will also transfer these stress to other parts, such as the Achilles tendon and plantar arch.

2www.footandanklewell.com 678-513-8777 facebook @ footanklewellnesscenter Cycling: I have orthotics for running do I need them for cycling?

When it comes to cycling shoes, light weight and small comes to mind. These are usually custom shoes designed to fit each person differently. Carbon shoes have been shown to increase the peak plantar pressures by 18%. With customizing a cycling shoe, this may present with an issue of tightness and cramped foot during long rides. And cyclists have neuromas, flat feet, stress fractures, capsulitis, and ischemia. As first this may seems good but as the length of the ride extends the compression of the shoes will result in more pain, change of position during the ride, and increased stress to other areas. According to cyclist research, the arch flattens 32,000 times during a 100 mile ride. This will also include internal rotation of the lower leg, inward position of the knee and the upper leg, and IT Band pain. This then transfers to the hips and lower back. These occur while in the saddle and out of the saddle as with climbing or sprinting.

3www.footandanklewell.com 678-513-8777 facebook @ footanklewellnesscenter Another problem that has occurred and has been modified from its introduction is the cleat. A cleat is a device that attaches to the shoe directly. The cleat then fits into a specific pedal designed to accommodate the cleat. Several different designs of cleats exist. They were initially presented as a way to increase power during the ride. At first it was rigid which allowed minimal movement in the shoe which also related to greater knee pain. Then a float was developed to go along with the cleat. This allowed movement and less knee pain followed. With orthotics, the material makes all the difference into how it fits into an already tight cycling shoe. Experts in the field have recommended the material should be semi-rigid. The rigid orthotic as first just like the cleat was too rigid and created more pain during longer rides. Why orthotics during the cycling? Orthotics have demonstrated to reduce the flattening of the arch, internal rotation of the lower leg and the knee, and IT band issues that occurs. This is achieved because the proper alignment has occurred in the entire leg.

Picking and using the correct material and orthotic will help reduce pain and allow you to have a better alignment during riding. From experience, I, Dr. Miller, have been riding for more than 25 years, primarily mountain because I don’t trust drivers. I started putting my orthotics into my cycling shoes about 8 years ago, and it made such a difference.

4www.footandanklewell.com 678-513-8777 facebook @ footanklewellnesscenter Knee Osteoarithritis: What affects my knee pain?

Knee osteoarthritis (OA) remains one of the most common musculoskeletal disorders and represents a major burden to patients and the healthcare industry. Due to its vital biological role, research has linked low levels of vitamin D with a host of conditions, including rickets (children), osteomalacia (adults), osteoporosis, fracture risk, diabetes, cancer, and decreased immunity.5 Researchers have theorized that vitamin D deficiency may also impact the course of knee OA, since it’s known to influence bone quality and could affect cartilage as well. Some evidence has identified a link between Vitamin D deficiency and the prevalence of knee OA. Again the research has shown that < 20 ng/mL deficient, 21-29 ng/mL to be insufficient and 30 ng/mL or greater to be sufficient.

5www.footandanklewell.com 678-513-8777 facebook @ footanklewellnesscenter Various studies in the literature have provided a link between both low serum blood and low dietary intake of Vit. D to progression knee OA. These studies demonstrated that with low serum and low intake of Vit. D increased level of pain and radiographic progression with patients diagnosed with knee OA. Several other factors were associated with progression of knee OA. A study between 2001-2004, demonstrated that 70% of White Americans had insufficient serum levels and 97% of African Americans had insufficient levels. The darker the skin the longer exposure to sunlight one needs in order to absorb adequate Vit. D by this means. Within this study, researchers also demonstrated an association between obesity and Vit D intake and serum levels. The highest prevalence of Vit. D deficiency was associated with a BMI of greater than 40 kg/m2.

Researchers also concluded that one cannot obtain adequate Vit. D levels from diet alone. All of these references came from Lower Extremity review magazines. www.lermagazine.com

6www.footandanklewell.com 678-513-8777 facebook @ footanklewellnesscenter