THE

PODIATRIST’S ROLE IN THE

ASSESSMENT OF THE SPORTS PATIENT: PART 1

BY MANJU MITAL, LECTURER AND TUTOR AND STEVE AVIL, LECTURER

INTRODUCTION

Approximately 70% of all sporting injuries occur in the lower limb (1). When the incidence of attaining an injury to the lower limb is this high, the role of the podiatrist becomes one of great significance in the overall combined management of the sports patient. The podiatrist can play an important part in the prevention, diagnosis and treatment of the sports injury. We start by looking at the role of the podiatrist and the initial assessment. The non- weight-bearing and weight-bearing assessments are then outlined. To conclude, we combine assessment outcomes with treatment modalities to look at the different theories drawn together for the prescription of orthoses. The evidence base will be used to support the mechanisms of assessment and treatment.

WHAT DO PODIATRISTS DO? Podiatrists assess, analyse and treat the foot, gait abnormalities and lower- limb injuries that occur in the sporting and active population. Their aim is to use orthoses, primarily simple insoles to affect the foot and its interaction with the ground during running and walking.

The podiatrist plays a significant role in the management, prevention, diagnosis and treatment of lower-limb injuries. This article looks at the role of the podiatrist and outlines non-weight-bearing and weight- bearing assessments.

This can help with conditions such as back, hip and knee pain, shin splints, Achilles pain, tendonitis, heel pain, forefoot pain and basic podiatric needs involving calluses, corns, blisters and nail disorders.

INITIAL ASSESSMENT After taking a full medical and familial history, the podiatrist questions the patient about their chief concern. What is the patient here for?

n Main complaint? Injury/prevention of injury n Type of pain? Can be indicative of causative structure (Table 1) n Site of pain? Anatomical location n Duration? How long the pain lasts n How did it occur? Training/during competition/position of play/surface n What makes it better or worse? Rest/activity, footwear, first thing/after some time. As prevention becomes a focal point for all practitioners dealing with the sports patient, it is essential for the podiatrist to have an understanding of the potential risk factors associated

TABLE 1: PALPATION AND PAIN Palpation Bone

Fascia Muscle Tendon Sheath

Nerve/subcutaneous Vascular Skin

Type of pain Dull ache/bruised

Ache may have been sharp Burning, sore aching Stiff, tender Stiff, stinging

Sharp, shooting

Ischaemic, intense Itchy, burning, sore

TABLE 2: EXTRINSIC AND INTRINSIC RISK FACTORS FOR INJURY

Extrinsic risk factors Sport

Schedule Skill level

Shoes/socks Surface/structure

WITH THE GROUND DURING RUNNING AND WALKING

20

ORTHOSES, PRIMARILY SIMPLE INSOLES, AFFECT THE FOOT AND IT’S INTERACTION

Intrinsic risk factors Sex/age Style

Stamina/strength Stretch Stability

with sporting activities. We begin by looking at both extrinsic and intrinsic factors that have been implicated in sports injuries – the “S”s of sports injury (Table 2).

sportEX medicine 2009;42(Oct):20-23