Dr. Nicholas Cappello

Picking a running shoe is as important as picking the mattress you sleep on.  When running, your foot absorbs up to four times your body weight every time your heel hits the ground, and this event is repeated almost 1000 times with every mile you run.  To put it in perspective, 150 pound runner absorbs about 120 tons of force during a one mile run.  Your running shoe is your first line of defense in protecting your body from these tremendous forces.  Unfortunately, running shoe technology has become so advanced; it is difficult for most runners to keep up.  In order to choose the best shoe for you, it is necessary to learn some basic facts about shoes, feet, and running.

First, find out what kind of foot you have…

Feet can easily be divided into three categories; low, high and neutral arches

Someone may have called you flat footed in the past, no it doesn’t mean you are slow. Stand up and put weight evenly on both feet. Look at your arches. Does your arch almost touch the floor? Does your foot or ankle roll in? People with low arches tend to have stability issues like over pronation

Is your arch really high? Can you almost fit a golf ball under your instep? The high-arched foot usually has the opposite problem. That means your foot rolls to the outside or “supinates”

Or

Lucky you, you’re somewhere in the middle – OK you’ve got lucky genes. The neutral foot is the easiest to fit and assuming you have no other structural issues you can run efficiently and comfortably with a lot of shoe designs.

.

Finally, put it all together to find the right shoe for you

Once you know about your feet and able shoes, putting it all together is pretty simple:

For flat feet and overpronators- Look for the keywords “motion control” and “stability” when shopping for running shoes.

For high arched and underpronatings- Look for the keywords “flexible” or “cushioned” when shopping for running shoes.

For normal or medium feet- Choose from a wide variety of shoes including shoes made for normal feet, shoes made for slightly flatfooted feet, or shoes made for slightly high-arched feet. You don’t want to get anything that mentions it has a lot of stability/motion control. You are also less likely to get injured, unless you pick a shoe that is counteracting your normal foot.
Finally, here are 12 simple guidelines to help you when you hit the running shoe store:

1.  Try on both shoes and walk, and jog around the store.  Climb stairs if possible.

2.  Try on as many pairs as need

3.  Make sure the shoe is padded where your foot needs it.

4.  Check the quality of the shoes.  Lay them on a flat surface and make sure they lay flat at the middle of the shoes.  Check the quality of the eyelets stitching, gluing, and laces.

5.  Make sure the shoes flex at the same place your foot flexes.

6.  Try shoes after a work out and later in the day. This is when your foot is the biggest.

7.  Try shoes on standing up.  Allow a half inch in front of your longest toe.

8.  Don’t rely on a break in period.  Shoes should feel good on the day you by them.

9.  The key to finding the best shoe is comfort, not price.

10.  The heel should fit snugly and shouldn’t rub or slip.

11.  Try shoes on with the socks you run in.

12.  Sizes vary among shoe brands and styles.  Chose shoes based on comfort, not the size printed inside.

13.  Ask questions.  Make sure the sales man is knowledgeable.  If the sales person doesn’t know the answers, find someone who does.

Anterior Cruciate Ligament Substitutes … Under 40 go for Hamstrings Over Allograft BTB

The most commonly used grafts are bone-patellar tendon-bone and hamstring autografts. The improvements in fixation devices for soft-tissue grafts have popularized the use of hamstring autografts in recent years; many surgeons base their graft selection on minimizing harvest-site complications. There are substantial complications in association with the use of bone-patellar tendon-bone autograft, including anterior knee pain, pain with kneeling, loss of extension, and poorer recovery of quadriceps strength.

The use of hamstring autograft avoids these complications but has been reported to result in weakness of knee flexion and internal rotation, which may be crucial for certain athletes who rely on these important hamstring functions for optimum performance.

Sensory deficits resulting from injury to branches of the saphenous nerve during hamstring harvest have been reported. It has been well documented that the hamstring tendons regenerate, but the function of regenerated tendons has been called into question as the tendon often heals in a non-anatomic position. Tiger Woods had a hamstring graft substitute in 2009

To completely eliminate harvest-site morbidity, the use of allograft for primary reconstruction is becoming increasingly popular. The use of allograft in revision settings and multiple-ligament reconstructions will continue to be necessary as autologous tissue may not be available in these situations.

A New study , presented  at the American Orthopaedic Society for Sports Medicine 2008 Annual Meeting, found that because of the almost 24% failure rate, the use of cadaver replacement ligaments might not be the best choice for young athletic patients. The older group’s failure rate was 2.4%. So although there are obvious benefits to using the cadaver ligament, such as avoiding a second surgical site on the patient, a quicker return to work, and less postoperative pain, for a young patient who is very active, it may not be the right choice.

A article in Arthroscopy in 2009″ compared, 156 (76 in the autograft group and 80 in the allograft group) were available for full evaluation. Evaluations included a detailed history, physical examination, functional knee ligament testing, KT-2000 arthrometer testing (MEDmetric, San Diego, CA), The mean follow-up was 5.6 years for both groups.

There were no statistically significant differences according to evaluations of outcome between the 2 groups except that patients in the allograft group had a shorter operation time and longer fever time postoperatively compared with the autograft group.

The postoperative infection rates were 0% and 1.25% for the autograft group and allograft group, respectively. There was a significant difference (P < .05) in the development of osteoarthritis between the operated knee in comparison to the contralateral knee according to radiographs.

However, no significant difference was found between the 2 groups at the final follow-up examination . CONCLUSIONS: Both groups of patients achieved almost the same satisfactory outcomes after a mean of 5.6 years of follow-up. Allograft is a reasonable alternative to autograft for ACL reconstruction.