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A CCORDING TO RUNNING USA, there are more than 45 mil- lion runners or joggers in the country, with one in two experiencing some type of running-related injury in the past year. If well-informed and armed with the basics on foot types, assessments on gait patterns and different shoe designs, medi- cal providers have the opportunity to assess biomechanical faults in their patients while potentially treating or preventing injury, thereby saving months of recovery and agony. Foot type and mal-alignment compounded by the wear and type of running shoe can translate into major risk factors for overuse injuries in runners and endurance athletes in general. A short office visit can make a world of difference for a runner. The first question to ask a patient is, "Did you get fitted for your running shoes?" It's important for runners to bring a log of their weekly mileage for at least past three months as well as their current pair of running shoes. There are two rules of thumb: running shoes are only for running, and the "10-percent rule." An increase in mileage per week greater than 10 percent per week is consistent with an increased injury rate. Shelf-life of running shoes is typically 6–12 months. New shoes can lose some of their shock-absorbing cushion even if they have not been used. It's helpful to write the date of purchase and first run on side of shoes with a Sharpie. Most shoes on average last 300–450 miles By George Friedhoff, DO before the integrity is compromised and the risk of injury exponentially grows. An even more revealing approach than questioning the age of the shoes is to examine the shoes themselves. A quick test to assess the wear pattern of a pair of shoes is to place the shoe on a level surface such as an examina- tion table and obser ve the heels for tilt. To support suspicions a subsequent gait analysis, including if possible on a t re a d m i l l or out side to clo sely observe if patient tends to under- or over-pronate, possibly demonstrating predisposition to biomechanical risk factors for overuse injuries. Runners with flat (pes planus) and low-arched feet will have hyper-mobility leading to over pronation. The pronation phase is responsible for shock absorption and joint control. During this phase, tibial and femoral internal rotation occurs increasing the potential risk for tibial and femoral stress fractures. It can also lead to detrimental-patella- femoral syndrome. To illustrate, a 38-year-old novice run- ner training for her first half marathon presents with four weeks of right anterior knee pain. She was not fitted for her current running shoe and her exam revealed that her symptoms were consis- tent with patella-femoral syndrome. Shoe and gait assessment while walking and running in the office demonstrated pes planus and over-pronation. The patient was referred to a local running store for motion control shoes and physical therapy. She went on to complete three half marathons that year, injury-free. Runners with high arches (pes cavus) are guilty of under pronating and therefore have a less flexible foot with their pro- pulsive phase compromised. The lack of flexibility within the intrinsic foot muscles starts a domino effect throughout the kinetic chain, including tight gastrocne- mius-soleus complex predisposing these individuals to Achilles tendonitis and plantar fasciitis. Finally the right shoe prescription is vital to a runner's success while individual- ized based on the patient's foot complex in motion. The patient with flat arches who over pronates will benefit from a Motion Control shoe. These tend to be the heaviest shoes as well as the most expensive. Cushioned shoes have most flexibility and are built with curved or semi-curved shape while being ideal for mid-weight runners with under pronation and high arches. Stability shoes have a good mix of cushioning and are suited for mid-weight runners who have neutral stance and medium-low arches. Ultimately when evaluating runners in the clinic always take the comprehensive approach that includes ensuring the patient has the right shoe fit for them and do not hesitate to include the friendly experts at the local running store. George Friedhoff, DO, is board-certified in Internal Medicine and Sports Medicine. He is a member of the Spine and Orthopedic Institute at St. Vincent Charity Medical Center in Cleveland, OH. ■ in Preventing Running-related Injuries ++++++++++++++++++++++++++++++++++++++ + +++ + +++ ++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: ORTHOPEDICS Impact of Shoes 1 4 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ JA N UA RY/ F E B R UA RY 2 0 1 5