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.