MedicalContinuing Education
Goals and Objectives
After reading this arti- cle, the physician should be able to: 1) Properly fit athletic shoes for various sports activities. 2) Know how to modi- fy the lacing of athletic shoes to accommodate different foot types. Selecting 3) Recognize the signs of excessive wear of shoes used for different the Proper sports. 4) Understand the characteristics of a good Athletic Shoe sock for the athlete. 5) Recommend appro- The correct choice of footgear priate running, soccer, football, baseball, basket- can enhance performance ball, and tennis shoes to while preventing injury. athlete patient.
Welcome to Podiatry Management’s CME Instructional program. Our journal has been approved as a sponsor of Contin- uing Medical Education by the Council on Podiatric Medical Education. You may enroll: 1) on a per issue basis (at $20.00 per topic) or 2) per year, for the special introductory rate of $129 (you save $71). You may submit the answer sheet, along with the other information requested, via mail, fax, or phone. In the near future, you may be able to submit via the Internet. If you correctly answer seventy (70%) of the questions correctly, you will receive a certificate attesting to your earned cred- its. You will also receive a record of any incorrectly answered questions. If you score less than 70%, you can retake the test at no additional cost. A list of states currently honoring CPME approved credits is listed on pg. 158. Other than those entities cur- rently accepting CPME-approved credit, Podiatry Management cannot guarantee that these CME credits will be acceptable by any state licensing agency, hospital, managed care organization or other entity. PM will, however, use its best efforts to ensure the widest acceptance of this program possible. This instructional CME program is designed to supplement, NOT replace, existing CME seminars. The goal of this program is to advance the knowledge of practicing podiatrists. We will endeavor to publish high quality manuscripts by noted authors and researchers. If you have any questions or comments about this program, you can write or call us at: Podiatry Management, P.O. Box 490, East Islip, NY 11730, (631) 563-1604 or e-mail us at [email protected]. Following this article, an answer sheet and full set of instructions are provided (p. 158).—Editor
By Mark A. Caselli, DPM formance athletes and play a sig- enhance performance. Wearing nificant role in the outcome of the wrong shoes, ones not de- thletic shoes are an im- many events. Good shoes pro- signed for the playing surface portant part of the equip- vide cushioning and stability and condition, or those that do A ment used by high per- and can prevent injury as well as Continued on page 148 www.podiatrym.com OCTOBER 2006 • PODIATRY MANAGEMENT 147 Athletic Shoe... too small are one of the major as a dress shoe. The right size causes of foot pain, and those running shoe is often a half to a Continuingnot fit properly, can lead to that are too large can cause blis- full size larger. injury. ters and lack of stability. Athletic shoes should be fit- Medical Education The clinician treating athletes Not all brands of footwear fit ted at the end of the day, or must be familiar with the type of the same. An experienced sales- after rigorous activity when the footwear used by the athlete pa- person can be of great help. He feet are their largest. Both feet tient since the wrong shoe might or she can help fit shoes proper- should be measured since they very well be the cause of that pa- ly to address the ath- are often differ- tient’s problem. One study by lete’s concerns. A good ent sizes and the NFL team physicians and train- salesperson would know shoes should be which brands are cut fitted to the larg- wider in the forefoot or er foot. The narrower in the heel. shoes should also Wearing the wrong Your patients should be fitted with the shoes, ones not have their feet measured socks that will be each time they purchase used during the designed for the shoes. sports activity As one ages, foot size and with any playing surface and often gradually changes. Figure 2: Lacing for Low special inserts or condition, or those The measurements Arches: Criss-cross lace the orthoses. should include sitting, shoes as normal halfway up. Sports shoes that do not fit standing, and heel to Use the loop lacing the rest for children toe, heel to ball, and of the way. should not be properly, can lead width. In spite of obtain- purchased with to injury. ing a number from the the thought that Brannock device, the ac- the next larger tual fit on the foot is the size will allow most important consider- the athlete to ers looked at the performance of ation. The measurement grow into them. 15 different athletic shoes on itself is only a general The exact size is grass and artificial turf under guide. The athlete should most important. both wet and dry conditions. be reminded that a prop- The shoes that They concluded that wearing erly fitting athletic shoe are being tried shoes under conditions for is often not the same size on should be re- which they were not designed laced, beginning could lead to excessive forces Figure 3: Lacing for High at the farthest and cause serious knee and ankle Arches: Begin lacing as nor- eyelet with even mal, criss-crossing and stop- injuries. pressure being ping after the first set of Sport-specific, and even sport holes. Thread the laces applied as they condition-specific, shoes should straight up each side, criss- are crisscrossed- be used by anyone who partici- crossing only before thread- laced to the top pates in a sport for more than ing the last hole. of the shoe. The three hours per week. Even shoe should fit though well-made, sport-specific with approxi- shoes have become relatively ex- mately 1/4 to pensive, choosing the right shoe 1/2 inch be- is important and is probably eco- Figure 1: Lacing for Narrow tween the Heel or Foot: Follow a nor- nomical in the long run if fre- longest toe and mal lacing pattern up to the quent foot injuries can be pre- last pair of holes. For narrow the end of the vented. feet, use shoes with staggered shoe. It should eyelets. Tighten from the have adequate General Considerations in outer eyelets, pulling the room for the Selecting the Proper body of the shoe towards the toes. The shoe Athletic Shoe center. At the last hole, tight- should bend at One of the most important en the laces and thread into Figure 4: Lacing for Wide the ball of the aspects of selecting the proper the last hole without criss- Feet: Thread the laces foot. If the heel athletic shoe is choosing the crossing. Do not pull the through the first set of eye- to ball fit is off, laces all the way through, lets and then straight up right size. Proper fitting sports then the break but leave a loop on each side. each side without criss-cross- shoes can enhance performance Cross the laces and thread ing at all. Continue this way will not match and prevent injuries. An ill-fit- them each through the loop for two or three holes past the foot and it ting shoe can be the root of on the other side before the forefoot, and then begin will create ab- many problems. Shoes that are tightening and tying. criss-cross lacing as normal. Continued on page 149
148 PODIATRY MANAGEMENT • OCTOBER 2006 www.podiatrym.com MedicalContinuing Education Athletic Shoe... portant part of the athletic shoe. sum of the foot. If It holds it all together by secur- laced too loosely, the normal pressure and irritate the ing the shoe to the foot. Improp- shoes fit sloppily and result foot. The heel should be stable in foot and ankle instability. and not move in and out of the There are three types of lacing shoe. The shoes should be worn systems: variable width with for at least ten minutes in the Worn-out shoes staggered eyelets to adjust width, store. They should feel comfort- speed lacing with plastic D-rings, able as soon as they are tried on. often result in aches and conventional eyelets. Vari- There is no break-in period. The and pains in feet, ous lacing methods, other than most common error in purchas- the standard crisscross system, ing athletic shoes, and one that legs, knees and hips, can be used to meet individual cannot be corrected by padding, needs. A narrow heel, high or insole replacement, or orthotics, signaling that low arch, or a wide foot can be is buying a shoe that is too nar- it is time to replace accommodated by changing row in the toe box. Though the way the shoes are laced these recommendations apply to the shoes. (Figures 1-4). the fitting of most athletic foot- wear, there are specific shoe fit Worn Out variations for specific sports Shoes (Table 1). er lacing can cause discomfort Wearing worn-out shoes is a and injury. Pulling laces too hazard in any sport. Worn-out Lacing System tight cuts off circulation and shoes often result in aches and The lacing system is an im- may cause tendinitis on the dor- pains in feet, legs, knees and hips, signaling that it is time to replace the shoes. As a TABLE 1 general rule, most running shoes pro- Sport Specific Shoe Fitting vide cushioning up to 500 miles, though many run- ners may find SPORT TOE AREA HEEL AREA breakdown in cush- ioning after as few Running Allow thumbnail’s length of Heel can slightly move as 350 miles. Shoes space between the end of but should not slip. with compression- the longest toe on the largest molded EVA mid- foot and the end of the shoe. soles vary in durometer. This Soccer Glove-like fit while standing Snug fit with no means that the up straight. Allow room for movement. cushioning elastici- toes to move comfortably. ty and life span of each mid-sole is Football Allow room for toes to Snug fit with no relative to the move comfortably while movement. shoe. Most shoes standing up straight. with polyurethane mid-soles break Baseball Allow room for toes to Snug fit with no down at a slower move comfortably while movement. rate. To avoid in- standing up straight. juries, it’s a good idea to rotate run- Basketball Allow thumbnail’s length of Heel can slightly move ning shoes every space between the end of but should not slip. 200-250 miles, hav- the longest toe on the largest ing two pairs of foot and the end of the shoe. shoes to wear at all times. A running Tennis Allow thumbnail’s length of Heel can slightly move shoe’s mid-sole space between the end of but should not slip. cushioning may be the longest toe on the largest worn out long be- foot and the end of the shoe. fore the tread shows signs of Continued on page 150 www.podiatrym.com OCTOBER 2006 • PODIATRY MANAGEMENT 149 Athletic Shoe... Other Signs of Wear ters. In general, socks that fit Since most cleated athletic properly should provide ample Continuingwear. Since the bottom and shoes have little or no mid-sole toe room, have a well padded tread of the shoe may look material, the in- sole, fit snugly Medical Education fine, identifying when the cush- tegrity of the without wrin- ioning is no longer effective is heel counter, Running shoes kles, and feel important. condition of the comfortable. In upper, and wear strike the ground a longitudinal, Press Test of the cleats must double-blind The “Press Test” can be used be evaluated. A about 800 times study, the effect for this purpose. When an EVA shoe with notice- per mile with of sock fiber mid-sole is compressed, it cre- ably “ground composition on ates visible lines or wrinkles in down” molded the force of about the frequency the mid-sole material that can cleats should be and size of blis- be seen from the sidewall of the replaced. Anoth- three times the tering events in shoe. As the mid-sole is further er way of deter- runner’s body long-distance compressed, the lines multiply mining whether runners was ex- and grow closer together. The a shoe should be weight. amined. It was first appearance of these lines replaced is by found that socks indicates that the mid-sole is trying on a new composed of compressing normally. A simple pair of the model that is currently 100% acrylic fiber were associat- pressure test can determine being worn. Compare this to the ed with fewer and smaller blis- whether or not the mid-sole is current shoes. If the new shoe ters when directly compared to compacted. feels much better socks composed of 100% cotton Pushing the out- than the old, fiber. sole upward into then the old The tube sock has become the mid-sole It was found shoes are proba- popular over the last decade as should show the that socks composed bly worn out. one size generally fits all. Advis- mid-sole com- Heavy athletes ing the athlete to wear two pairs pressing into of 100% acrylic and over-or of socks is another method of re- these lines. As fiber were associated under-pronators ducing friction and preventing the shoe breaks should check hot spots that may become blis- down, the mid- with fewer and their shoes fre- ters. The inner sock is usually sole will com- quently since thinner and lighter than the press less with smaller blisters they tend to outer sock. Lastly, clean socks the same when directly wear out their are a must in warding off fungal amount of pres- shoes quickly. growth and maintaining the sure. When the compared to socks overall health of the athlete’s mid-sole shows Socks feet. heavy lines, and composed of Socks are the press test 100% cotton fiber. often over- Resources yields a minimal looked as an im- The practitioner treating ath- degree of com- portant compo- letes can obtain a great deal of pression, the nent of proper information on athletic footwear mid-sole has been compacted to athletic footwear. Often, a poor- Continued on page 151 a point where little or no cush- ly fitting sock or worn sock is ioning remains. one of the major causes of blis-
Figure 5: Straight lasted motion control Figure 6: Semi-curved lasted running Figure 7: Multi-studded soccer shoe with running shoe for over-pronators shoe with gel enhanced mid-sole offer- numerous molded cleats offering both ing excellent cushioning characteristics good support and traction
150 PODIATRY MANAGEMENT • OCTOBER 2006 www.podiatrym.com MedicalContinuing Education Athletic Shoe... straight) and semi-curved (closer ioning, and wear to curved) last. longer. Softer soles are by visiting athletic shoe stores, lighter, have more cushion- reading sports specific publica- Lasting Techniques ing, and wear out faster. tions, and visiting the Internet. There are three lasting tech- For example, Runner’s World niques used in running-shoe Midsole Construction magazine publishes a “Shoe Buy- construction: board, slip, and The mid-sole is located be- er’s Guide” four times a year. combination. In tween the outer The American Academy of Podia- board lasting, sole and the tric Sports Medicine has shoe the upper mate- foot bed. It is lists recommending running, rials are glued to When recommending the most impor- aerobic, basketball, hiking, walk- a fiberboard be- a specific shoe, tant part of the ing, soccer, and volleyball shoes fore they are at- running shoe. It on its web site www.aapsm.org . tached to the it is important to absorbs shock, These sources can be very help- mid-sole. determine the flexes at toe-off, ful in guiding athlete patients to Straight, board- and adds stabili- the sports shoe that meets their lasted shoes runner’s basic foot ty to the shoe. needs. aren’t very flexi- Mid-soles are ble, but are firm type and any constructed Sports-Specific Shoes and provide a running-related from various good platform if types of foams. Running Shoes orthoses are complaints and Air-bags, gels, Getting a good pair of run- needed for ex- and other mate- ning shoes is the most important cessive prona- injuries. rials may also be investment any runner can tion. With slip inserted to in- make. This is easy to understand lasting, the crease cushion- when you realize that the only upper materials are stitched to- ing. Their shock absorbing prop- thing that separates the road gether and then glued to the erties deteriorate with use. Stud- from the runner are the shoes, mid-sole. This makes a lighter, ies have shown that mid-soles each of them striking the ground more flexible shoe with a softer may lose a significant amount of about 800 times per mile with feel. Combination lasting uses their cushioning when exposed the force of about three times the board method in the heel for to running in cold temperatures. the runner’s body weight. A stability and the slip method in properly selected running shoe the forefoot for flexibility. Many Heel Counter can definitely decrease the num- runners prefer combination-last- The heel counter stabilizes ber of running ed shoes that the shoe, and therefore, the foot. injuries. Each of provide some A rigid counter covering the en- the five major benefits of both tire heel is desirable, especially components of The mid-sole types. for pronators. It’s usually made the running is located between from plastic. Above the counter shoe: the last, Treaded is usually a cushioned ankle col- outer sole, mid- the outer sole and Outersole lar, which provides protection sole, heel The treaded and helps prevent Achilles ten- counter, and the foot bed. outer sole is de- dinitis. A heel wedge, located upper, should be It is the most signed to resist above the mid-sole, adds height considered in its wear, provide to the heel, increases shock ab- selection. important traction, and ab- sorption, and reduces strain on sorb some the foot and leg. Last Shape part of the shock. It should The shape of running shoe. not wear out Shoe Uppers the last affects quickly, and will Most running shoe uppers are the shape, fit, often be in good either nylon, nylon mesh, or a flexibility, and shape after the combination. This creates a stability of the shoe. The two shoes are discarded due to loss of light-weight, breathable, wash- basic shapes used for the last are mid-sole cushioning. The outer able, soft shoe that is comfort- straight and curved. A straight sole should wear primarily on able and dries fast when wet. last has little or no curve from the extreme outer edge of the The mesh upper also makes the the heel to toe and provides heel and in the center of the ball shoe cooler in the summer. greater support under the medial of the foot. There are many sole arch. A curved last turns inward designs, most providing ade- Considerations from the heel to the toes. There quate traction. In general, soles When recommending a spe- are variations that include are either hard or soft. Harder cific shoe, it is important to de- slightly curved (closer to soles are heavier, offer less cush- Continued on page 152 www.podiatrym.com OCTOBER 2006 • PODIATRY MANAGEMENT 151 Athletic Shoe... best for overpronators (Figure 5). have high, curved, rigid arches, These runners tend to have high- curved-lasted shoes, which pro- Continuingtermine the runner’s basic ly flexible feet with low arches vide plenty of cushioning and a foot type and any running-re- flexible forefoot, is recommend- Medical Education lated complaints and injuries. ed (Figure 6). These runners Running shoes come in three don’t absorb shock well and are basic categories, those specializ- Traction is prone to lateral ankle sprains, ing in stability, motion control, stress fractures, shin splints and or cushioning. If the runner has not desirable knee pain. a medium-arched, semi-curved foot that properly pronates, then when it resists shoe Soccer Cleats shoes that offer stability should rotation. Soccer is a game that is pri- be recommended. These shoes marily played with the feet; should have adequate mid-sole therefore, the most important cushioning, as well as medial piece of soccer equipment is the support. footwear. A good pair of cleats, A straight-lasted shoe with a and they often breakdown shoes or boots, as they are sometimes hard heel counter and firm mid- on the inner borders. For under- called, is essential. There are sole offering motion control is pronators, those runners who variations of the basic soccer cleat designed for different skill levels, weather conditions, and field types. Great care must be exercised in the selection of soccer shoes since each part of the shoe must serve a unique function. Players wear cleated shoes for better traction while running. Cleats give them in- creased speed and maneuverability. The outsoles of the cleated shoe perform a dual Figure 8: Soccer shoe with exchangeable cleats Figure 9: Football shoe with molded studs offering function, providing and studs that can be customized for different both good traction for a variety of playing surfaces both support and field conditions and durability traction. Since the cleats often do not penetrate fully into the playing surface, a base of support is formed on top of the cleats. This con- dition is exaggerat- ed on hard dirt. For this reason, cleated shoes should be se- lected such that the cleats along the shoe edges are posi- tioned as close to the edge as possi- ble. Sections of the sole without cleats will be relatively Figure 10: High-top football shoe incorporating Figure 11: Metal spikes on baseball cleats less supportive, es- screw-in studs to deliver grip on very soft natural offer good traction but can cause injury when pecially in the fields sliding. Continued on page 153
152 PODIATRY MANAGEMENT • OCTOBER 2006 www.podiatrym.com MedicalContinuing Education ing rotational fixation is overlays along the lat- to maximize cleat number eral edge of the fifth and diameter, and mini- metatarsal head and base, mize cleat height. In gen- to serve as reinforcement and eral, multi-studded mod- provide a stiff heel counter to els are preferred by most anchor the rear-foot. A unique players (Figure 7). These footwear requirement for soccer can be worn both on grassy fields and on hard ground. For rainy weather, Baseball and screw-in studs are better because their length can softball are considered be adjusted (Figure 8). The low to medium softer the field and the taller the grass, the longer impact sports where the studs. The longer screw-in studs should not approximately Figure 12: Only molded baseball cleats are permit- be used on synthetic turf, ted for Little League play. four to six times as they might get caught in the fibers and cause se- body weight rious knee and ankle in- is transferred to Athletic Shoe... juries. On synthetic turf, special- ly designed shoes with short the feet. mid-foot arch area. studs are advisable. Since the Shoes with fewer cleats often feet and legs often end up in a include internal tangle during reinforcement. the match, soc- is to serve as an impact surface To accomplish cer cleats must for the ball. To this end, extra this, a stiff syn- Turf shoes be no less than stitching is placed along the me- thetic or even a usually use molded 1/2 inch in di- dial and lateral sides of the metal plate is ameter and may shoe, which both reinforces the added to the rubber cleats not project upper and forms a ball control shoe to ensure more than 3/4 surface. adequate sup- to give spring and inch from the port. This prac- traction on sole. Football Cleats tice has also Football cleats are made both been used in an the harder turf Shoe Upper for the position played and the attempt to re- The main type of field played on. Football duce the inci- surface function of any cleats come in three styles, or dence of “turf shoe upper is to heights, to accommodate the toe” on synthet- center the foot varying needs of players by po- ic turf fields. The negative side- squarely over the base of sup- sition. High-tops extend up the effect of this modification is a port. In order to accomplish ankle to provide extra support, reduction of forefoot flexibility this, most soccer shoes have Continued on page 154 across the metatarsal heads which could result in irritation of the plantar fascia.
Traction The other function of the outsole is to yield adequate trac- tion on a given surface. The two modes in which traction is de- sirable are along the length of the shoe and in resistance to lateral motion. Traction is not desirable when it resists shoe ro- tation. Fixing the foot against rotation has been cited as pre- disposing the knee and ankle to Figure 13: High top basketball shoe of- Figure 14: Low cut basketball shoes, injury. fering both good ankle support and ex- sometimes preferred by fast players, are The best method of minimiz- cellence for court traction light but offer less ankle support www.podiatrym.com OCTOBER 2006 • PODIATRY MANAGEMENT 153 Athletic Shoe... games are played on both grass small metal spikes designed to and turf, multipurpose cleats provide maximum traction on Continuingespecially for lateral move- can be used. Molded cleats are the field (Figure 11). These are ments. Linemen benefit from permanently attached to the beneficial on extremely hard Medical Education this support because of the outsole on the shoes’ bottom fields. The shoes are usually pressure put on their ankles by (Figure 9). made of leather, the numerous lateral move- Turf shoes have cushion ments during the course of a usually use mid-soles, and game. A mid-cut shoe offers molded rubber The main are fit much like good support while still allow- cleats to give function of any a standard ing maneuverability. This style spring and trac- sneaker. Metal best fits the game of skill play- tion on the shoe upper cleats are not ers; the defensive backs, run- harder turf sur- permitted in Lit- ning backs, wide receivers, and face (Figure 10). is to center the foot tle League and quarterbacks. Low-cuts are pre- Molded cleats squarely over the base instructional ferred by some players because are generally less levels because of they are light-weight. The lower expensive than of support. the potential for cut provides extra maneuver- shoes with de- injury, happen- ability to allow for quick cuts tachable cleats. ing most often on the field. Detachable when players Cleats are either molded or cleats use studs that can be re- with metal cleats slide into a detachable. Most are designed moved and replaced to fit field base and the spikes are exposed. for either grass or turf fields. If conditions on all types of grass, Molded cleats feature molded hard and dry, or wet and soles with several small plastic sloppy. Their versatility cleats (Figure 12). Molded cleats makes detachable cleats are most often used on Little preferable for athletes who League and instructional levels play primarily on grass. since they are significantly less Shorter studs can be used dangerous than metal cleats. for hard, dry surfaces and longer studs for a wet, Basketball Shoes sloppy field. Replacement Basketball shoes must offer cleats generally run in 1/2, durability, support, stability, and 5/8-, 3/4, and 1-inch sizes. shock absorption. The constant Having all four sizes gives starting, abrupt stopping, high the player more options jumps, and quick side-to-side for different field condi- movements involved with bas- tions. ketball make these features abso- lutely essential in a shoe. Person- Baseball Cleats al playing style is also an impor- Figure 15: Mid high cut basketball shoe offering a Baseball and softball tant factor in shoe selection. wraparound leather stabilizing strap to protect are considered low to Power players will need shoes against ankle rollover medium impact sports with maximum cushioning and where approximately four stability. They may have to play to six times body weight is with heavier shoes to get those transferred to the feet. The benefits. The all-around player impact can even be greater can use shoes with moderate on artificial surfaces. Un- ankle support and cushioning. like soccer cleats, baseball There are many shoes to choose cleats have a mid-sole to from in this category, and most help cushion some of this are fairly lightweight. The fast impact. There isn’t much player will prefer a lightweight repeated motion in base- shoe that offers moderate sup- ball, but a lot of lateral port, cushioning, and flexibility. (side-to-side) movement. Shoes with a lower cut are Many players prefer a often desired by this type of higher or mid-cut cleat to player. offer better ankle support. Baseball shoes are designed Understanding Figure 16: “High tech” tennis shoe incorporating with either metal or mold- Construction an advanced cushion mid-sole, a mid- and fore- ed cleats. Understanding the construc- foot stability system, and a high abrasion court Metal cleats feature tion of basketball shoes is essen- gripping outsole molded soles with several Continued on page 155
154 PODIATRY MANAGEMENT • OCTOBER 2006 www.podiatrym.com MedicalContinuing Education Athletic Shoe... or untie, thus increasing stability ioning without much during play. Some shoes feature extra weight. Stiff materi- tial in determining which fea- a strap that wraps around the als are used in some basket- tures are most important for the upper arch of the shoe to add ball shoes on the medial or player. The function of the more stability and protection inner side of the shoe to reduce upper part of the shoe is to keep against ankle rollover (Figure inward rolling of the foot. Heav- the foot snug and securely in 15). ier densities of place during play. There are Zippers are a cushioning ma- three shoe cuts available, high-, fairly new terials may also mid-, or low-tops. The majority choice for secur- Proprietary cushioning be used in the of players, around 70 per cent, ing the foot in a technologies medial area to choose high tops for their abili- basketball shoe. increase a shoe’s ty to provide maximum ankle These are usual- are usually stability. The support (Figure 13). Power play- ly covered by mid-sole can ers and all-around players usual- some sort of found in the heel negatively affect ly prefer the stability of this protective mate- and forefoot stability if the style. rial. Velcro, cushioning ma- For players who feel restrict- while good for of the shoe and terials are too ed in high-tops, and who use younger players, add an extra thick. speed as their greatest asset, mid- is not reliable tops, which extend right to the in terms of stay- degree of cushioning Outsole ankle level, are their choice. ing closed, and The outsole Only about 10 percent of players doesn’t offer good without much of a good bas- wear low-tops for regular play support. extra weight. ketball shoe (Figure 14). These shoes are should be flat lighter, but don’t offer the built- Midsole and moderately in ankle support that high-tops The mid-sole wide to create a do. is often considered the most im- stable base and help prevent portant part of the basketball ankle rollover. The herringbone Uppers shoe because the construction pattern is most common and All leather uppers have been and the materials used will im- provides enough traction to replaced with lightweight combi- pact the levels of cushioning and keep the player steady during nation uppers, mixing the stabil- shock absorption and can affect quick stops and starts. Most ity and durability of leather with the players’ ability to explode off shoes are designed for indoor the breathability and flexibility the floor. The mid-sole is usually play. If play is most often on of synthetic mesh. High-tech, all made of EVA, compressed EVA, outdoor courts, a shoe with a synthetic uppers, which are polyurethane, or a combination more durable outsole should be more durable than leather, are of these materials. Proprietary used. Some basketball shoes are gaining popularity for their abil- cushioning technologies are designed specifically for outdoor ity to offer stability in a super- also found in many brands play and feature heavier rubber lightweight ma- of basketball outsoles terial. shoes. EVA of- fers lightweight Gender-Specific Closure System Basketball cushioning, but Most women should not buy A good clo- not as much sta- men’s basketball shoes. Men’s sure system is shoes must offer bility and dura- shoes are built on a wider last necessary to durability, support, bility. EVA can than women’s shoes and are gen- keep the foot be compressed erally too wide for a woman’s snug and secure stability, and shock to make it some- foot, and do not offer an appro- in the shoe dur- what more priate degree of stability. ing the sudden absorption. durable. Poly- stops and starts, urethane is a Tennis Shoes frequent side-to- more dense and Tennis shoes are very impor- side motions, durable cushion- tant to the player, owing to the and quick turns encountered in ing material. It can add stability quick start and stopping, cut- basketball. Laces are an accept- to the shoe, but also adds ting, pivoting, and jumping that able choice for keeping the foot weight. is part of the game. Tennis is a stable in the shoe. Several manu- sport that is rough on shoes, par- facturers offer new lacing sys- Cushioning Technology ticularly the sole and toe area, so tems designed to offer greater Proprietary cushioning tech- finding a shoe that is durable stability. A good lacing system nologies are usually found in the enough is important. The shoes should lock the laces in place, heel and forefoot of the shoe should have a fairly wide heel making them less apt to loosen and add an extra degree of cush- Continued on page 156 www.podiatrym.com OCTOBER 2006 • PODIATRY MANAGEMENT 155 Athletic Shoe... essential. Appropriate shoe-wear sorption properties of running for these players includes a large shoes. Clin J Sports Med 15(3), Continuingand good heel counter for toe-box to provide adequate 2005 rearfoot control. The traction room so the toe will not slam 9. Dick’s Sporting Goods: Deter- Medical Education surface of the heel should be against the end of the shoe. mining your shoe size.
156 PODIATRY MANAGEMENT • OCTOBER 2006 www.podiatrym.com MedicalContinuing Education EXAMINATION
See answer sheet on page 159.
1) Sports-specific athletic shoes B) Curved slip lasted which one of the following should be recommended: C) Straight slip lasted conditions? A) Only for competitive D) Curved combination A) Soft field in the rain athletes lasted B) Hard cold ground B) Only when engaged in a C) Synthetic turf sport more than three days 6) Which of the following is not D) Long studs should not be a week a characteristic of the treaded used for any of the above C) Only when used in outer sole of a running shoe? conditions competitive play A) Designed to resist wear D) For anyone participating B) Primary shock absorber of 11) Which one of the following in a sport more than three shoe football positions usually prefers hours per week C) Provides traction high top cleats? D) The harder the material, A) Running back 2) Which one of the following the heavier B) Wide receiver is not correct concerning C) Lineman proper athletic shoe fitting? 7) The best running shoe to rec- D) Quarterback A) Feet should be measured ommend for an athlete with each time shoes are high, rigid arches is: 12) A stiff plate is sometimes in- purchased A) A shoe offering maximum corporated into the sole of a soc- B) Athletic shoe size should motion control cer shoe to reduce the incidence be the same as a B) A straight-lasted shoe of which one of the following comfortably fitting dress C) A stability categorized conditions? shoe shoe A) Subungual hematoma C) Shoes should be fitted at D) A curved combination-last- B) Turf toe the end of the day or after ed shoe C) Plantar fasciitis exercise D) Ankle sprains D) Shoes should be fitted to 8) The proper fitting of a soccer the larger foot shoe includes: 13) The main disadvantage of A) 1/2 - 3/4 inch of space be- metal cleats on baseball shoes is 3) A running shoe should be tween the end of the longest that: replaced at least every: toe and largest foot A) They afford poor traction A) 100 miles B) Slight heel movement on hard fields B) 250 miles C) Snug, glove-like fit B) They result in an increased C) 500 miles D) Fit one size larger than risk of injury D) 750 miles dress shoe C) They can only be used in Little League 4) Studies have shown that the 9) Which one of the following D) They offer no cushioned best material for an athletic does not affect the shock absorb- mid-sole sock is: ing quality of a running shoe? A) Cotton A) Running on a cold day 14) Which one of the following B) Nylon B) Running over 10 miles a basketball shoe cuts would be C) Acrylic day safest to recommend for most of D) Polyester C) Running in a shoe with a your basketball playing athletes? gel insert A) High tops 5) The best running shoe last D) Both a and c B) Mid tops for an over-pronated heavy C) Low tops athlete is: 10) Soccer cleats should have D) It makes no difference A) Straight board lasted longer studs when playing in Continued on page 158 www.podiatrym.com OCTOBER 2006 • PODIATRY MANAGEMENT 157 EXAMINATION PM’s Continuing (cont’d) Medical Education CPME Program 15) Which of the following closure systems made Welcome to the innovative Continuing Education for basketball shoes is usually the least desirable Program brought to you by Podiatry Management for offering good support? Magazine. Our journal has been approved as a A) Laces sponsor of Continuing Medical Education by the B) Zipper Council on Podiatric Medical Education. C) Velcro D) Laces and straps Now it’s even easier and more convenient to enroll in PM’s CE program! 16) Stiff materials are commonly used on the me- You can now enroll at any time during the year dial side of the mid-sole of a basketball shoe pri- marily to: and submit eligible exams at any time during your A) Increase shock absorption enrollment period. B) Reduce inward rolling of the foot PM enrollees are entitled to submit ten exams C) Prevent ankle sprains published during their consecutive, twelve–month D) Increase shoe life enrollment period. Your enrollment period begins with the month payment is received. For example, 17) The main reason why many women should if your payment is received on September 1, 2003, not use men’s basketball shoes is that: your enrollment is valid through August 31, 2004. A) Men’s shoes are too heavy If you’re not enrolled, you may also submit any B) The lacing system is not designed for a exam(s) published in PM magazine within the past woman’s foot twelve months. CME articles and examination C) Men’s shoes are not permitted in women’s questions from past issues of Podiatry Man- professional and collegiate play agement can be found on the Internet at D) They often do not offer an appropriate de- gree of stability http://www.podiatrym.com/cme. All lessons are approved for 1.5 hours of CE credit. Please read 18) A tennis shoe without adequate toe-box room the testing, grading and payment instructions to de- is likely to result in which one of the following cide which method of participation is best for you. conditions? Please call (631) 563-1604 if you have any ques- A) Turf toe tions. A personal operator will be happy to assist you. B) Subungual hematoma Each of the 10 lessons will count as 1.5 credits; C) Sesamoiditis thus a maximum of 15 CME credits may be D) Plantar fasciitis earned during any 12-month period. You may se- lect any 10 in a 24-month period. 19) Which one of the following conditions is not as- sociated with athletic shoes that are fit too large? The Podiatry Management Magazine CME A) Blisters program is approved by the Council on Podiatric B) Ankle sprains C) Instability Education in all states where credits in instruction- D) Nerve impingement pain al media are accepted. This article is approved for 1.5 Continuing Education Contact Hours (or 0.15 20) The individual that should select the most ap- CEU’s) for each examination successfully completed. propriate sports shoe for the athlete is: A) The sports medicine doctor B) The athletic coach C) The athlete D) Each of the above must be involved in the selection. Home Study CME credits now See answer sheet on page 159. accepted in Pennsylvania
158 PODIATRY MANAGEMENT www.podiatrym.com ✄ MedicalContinuing Education Enrollment/Testing Information and Answer Sheet Note: If you are mailing your answer sheet, you must complete exam during your current enrollment period. If you are not en- all info. on the front and back of this page and mail with your rolled, please send $20.00 per exam, or $129 to cover all 10 exams credit card information to: Podiatry Management, P.O. Box (thus saving $71* over the cost of 10 individual exam fees). 490, East Islip, NY 11730. Facsimile Grading To receive your CPME certificate, complete all information and TESTING, GRADING AND PAYMENT INSTRUCTIONS fax 24 hours a day to 1-631-563-1907. Your CPME certificate will (1) Each participant achieving a passing grade of 70% or be dated and mailed within 48 hours. This service is available for higher on any examination will receive an official computer form $2.50 per exam if you are currently enrolled in the annual 10-exam stating the number of CE credits earned. This form should be safe- CPME program (and this exam falls within your enrollment period), guarded and may be used as documentation of credits earned. and can be charged to your Visa, MasterCard, or American Express. (2) Participants receiving a failing grade on any exam will be If you are not enrolled in the annual 10-exam CPME pro- notified and permitted to take one re-examination at no extra cost. gram, the fee is $20 per exam. (3) All answers should be recorded on the answer form below. For each question, decide which choice is the best an- Phone-In Grading swer, and circle the letter representing your choice. You may also complete your exam by using the toll-free ser- (4) Complete all other information on the front and back of vice. Call 1-800-232-4422 from 10 a.m. to 5 p.m. EST, Monday this page. through Friday. Your CPME certificate will be dated the same day (5) Choose one out of the 3 options for testgrading: mail-in, you call and mailed within 48 hours. There is a $2.50 charge for fax, or phone. To select the type of service that best suits your this service if you are currently enrolled in the annual 10-exam needs, please read the following section, “Test Grading Options”. CPME program (and this exam falls within your enrollment peri- od), and this fee can be charged to your Visa, Mastercard, Ameri- TEST GRADING OPTIONS can Express, or Discover. If you are not currently enrolled, the fee Mail-In Grading is $20 per exam. When you call, please have ready: To receive your CME certificate, complete all information 1. Program number (Month and Year) and mail with your credit card information to: 2. The answers to the test Podiatry Management 3. Your social security number P.O. Box 490, East Islip, NY 11730 4. Credit card information There is no charge for the mail-in service if you have already In the event you require additional CPME information, enrolled in the annual exam CPME program, and we receive this please contact PMS, Inc., at 1-631-563-1604.
ENROLLMENT FORM & ANSWER SHEET
Please print clearly...Certificate will be issued from information below.
Name ______Soc. Sec. #______Please Print: FIRST MI LAST Address______City______State______Zip______Charge to: _____Visa _____ MasterCard _____ American Express Card #______Exp. Date______Note: Credit card is the only method of payment. Checks are no longer accepted. Signature______Soc. Sec.#______Daytime Phone______State License(s)______Is this a new address? Yes______No______
Check one: ______I am currently enrolled. (If faxing or phoning in your answer form please note that $2.50 will be charged to your credit card.) ______I am not enrolled. Enclosed is my credit card information. Please charge my credit card $20.00 for each exam submitted. (plus $2.50 for each exam if submitting by fax or phone). ______I am not enrolled and I wish to enroll for 10 courses at $129.00 (thus saving me $71 over the cost of 10 individual exam fees). I understand there will be an additional fee of $2.50 for any exam I wish to submit via fax or phone. Over, please 159 ✄ (cont’d) www.podiatrym.com 11. A12. B A13. C B A14. D C B A15. D C B A16. D C B A17. D C B A18. D C B A19. D C B A20. D C B A D C B D C D (Caselli) EXAM #8/06 Athletic Shoe Selecting the Proper Selecting 1. A2. B A3. C B A4. D C B A5. D C B A6. D C B A7. D C B A8. D C B A9. D C B A D C B D C D 10. A B C D LESSON EVALUATION exam Please indicate the date you completed this ______the lesson? How much time did it take you to complete ______hours ______minutes How well did this lesson achieve its educational objectives? ______Very well ______Well all ______Somewhat ______Not at lesson? What overall grade would you assign this A B C D Degree______Additional comments and suggestions for future exams: ______Circle: ENROLLMENT FORM & ANSWER SHEET & ANSWER FORM ENROLLMENT PODIATRY MANAGEMENT • OCTOBER 2006
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