Foot bone marrow edema after a 10-wk transition to minimalist running shoes.

PURPOSE: Minimalist running shoes are becoming a more popular choice for runners in the past few years. However, there is little conclusive evidence about the advantages or disadvantages of running in these shoes. Although performance benefits may exist, injury may also occur from the added stress of running without the benefit of cushioning under the foot. Bone marrow edema can be a manifestation of added stress on the foot. This study measured bone marrow edema in runners' feet before and after a 10-wk period of transitioning from traditional to minimalist running shoes. METHODS: Thirty-six experienced recreational runners underwent magnetic resonance imaging (MRI) before and after a 10-wk period. Seventeen subjects were in the control group (ran in their traditional shoes only for 10 wk), whereas the other 19 were in the experimental group (gradually transitioned to Vibram FiveFinger running shoes for 10 wk). The severity of the bone marrow edema was scored on a range of 0-4 (0 = no bone marrow edema, 4 = edema in more than 50% of the length of the bone). A score of 4 represented a stress fracture. RESULTS: Pretraining MRI scores were not statistically different between the groups. The posttraining MRI scores showed that more subjects in the Vibram group (10 of 19) showed increases in bone marrow edema in at least one bone after 10 wk of running than that in the control group (P = 0.009). CONCLUSION: Runners interested in transitioning to minimalist running shoes, such as Vibram FiveFingers, should transition very slowly and gradually to avoid potential stress injury in the foot.

The athletic heart syndrome.

The cardiovascular system adapts to exercise. With conditioning, the heart modifies its physiologic and morphologic structure. When those changes occur in athletes seeking clearance for sports participation, they comprise the athletic heart syndrome. With detraining, many of those modifications normalize, which is a diagnostic feature of the athletic heart syndrome. It is important for practitioners who care for athletes to be cognizant of those adaptations and to differentiate them from pathologic changes that may warrant restriction from sports participation or place the athlete at risk for sudden cardiac death.

Pulmonary and Chest Wall Emergencies.

In brief Sports-related chest trauma can Produce a number of injuries that may be medical emergencies: pneumothorax, diaphragmatic paralysis, chest wall trauma, and sternoclavicular dislocation. Severe acute bron- chospasm is another pulmonary condition common in active people. Team physicians must therefore work through the differential diagnosis quickly and initiate on-site treatment as soon as possible. Many of these conditions require definitive treatment at an emergency facility, but on-field clinicians can stabilize the patient and ensure a successful outcome by taking measures such as providing an open airway, resolving a pneumothorax, or reducing a dislocation.

How Exercise Can Benefit Older Patients.

In brief Physical activity has both preventive and therapeutic benefits for the frail elderly, and the ultimate goal is improved quality of life. The greatest impact on functional capacity comes from physiologic changes that affect mobility. Walking programs and flexibility and strength training can prevent muscle weakness and impaired gait and balance, which are risk factors for falls in the elderly. In addition, changes in functional capacity can result in greater independence in daily living. Physical activity also provides therapeutic benefits for patients who have arthritis or dementia.

Can Residents Be Team Physicians?

Our experience shows that residents can be team physicians during their training years if they undertake independent study and have appropriate training, supervision, and a good working relationship with the staff of a local high school.

When Sciatica Is Not Disk Disease.

In brief Piriformis muscle syndrome is an often unrecognized cause of sciatic pain. The sciatic nerve, which normally passes beneath the piriformis muscle deep in the midbuttock, can be compressed when the muscle goes into spasm or is injured. The resultant pain is often confused with discogenic disease, but a thorough history and physical exam can pinpoint the true cause. Conservative treatment of piriformis syndrome-with a focus on stretching-is often successful.