Digital image running injury prevention program.

It is a fact that hundreds of soldiers who run as a part of their unit or individual physical training regimen incur injuries. This often is due to wearing the incorrect type of shoes for the running gait. The TeleShoe program was initiated to prevent or reduce running-related injuries by diagnosing an individual's running gait, prescribing running shoes based on biomechanics and bodyweight information, and providing education.

Running History Recorded

The TeleShoe program uses a secure, password-protected Web site with a store-and-forward Web-enabled database to diagnose and prescribe running shoes to patients nationwide. The TeleShoe program consists of four segments: online patient registration, an initial interview, digital video gait analysis, and the running report.

The interview process is completed online by a trained technician once the participant registers with the TeleShoe Web site. The interviewer asks the individual about any past running-related injuries or pains and obtains details of the runner's training regimen--such as the frequency, duration, speed, and distance of running and experience with strength training, cross-training, and agility/flexibility training. This information on running history helps the technician to identify training errors and to offer corrective measures to avert a runner's pain.

If the individual presents multiple training errors, recommendations can be made that potentially will prevent injuries from recurring. Education on these training variables is addressed at the end of the visit to help maximize injury-free running. All data is recorded into the TeleShoe database, along with information gained at the actual visit, where shoe wear patterns, the height of the arch, and the shape of the foot are examined. Additional data consisting of body weight, the estimated degree of pronation, and foot shape all will be correlated with the type of shoe that needs to be worn.

Running Gait Analyzed

The running gait analysis involves making two digital video recordings of the runner's gait on a treadmill, first barefoot and then in running shoes. The running gait is determined by examining the posterior view of the bare leg, foot, and ankle joint during the support phase at the midstance position of running.

Each individual's running gait can be described as pronation, neutral, or supination. The neutral position is known as the most efficient gait, wherein the least amount of stress is placed upon joints of the lower extremity. Malalignments at the subralar joint place stress along the kinematics of the lower extremity, especially during running, and are commonly diagnosed as overpronation or supination.

Once the running gait is determined, the correct shoe is prescribed. This shoe should be comfortable to the wearer, fit properly, be functionally correct, and have the appropriate construction for the individual's needs and running gait.

Up to 12 digital clips from the video may be stored in the TeleShoe database during the interview portion. Once the interview is completed, an e-mail is sent automatically to the supporting exercise physiologist (or other medical professional, perhaps at the Pentagon), stating that a patient record has been submitted to the TeleShoe program. The health professional then accesses the patient's record, diagnoses the running gait, and prescribes a type of running shoe for the patient. Both barefoot and running shoe recordings are analyzed from the digital clips and stored in the patient's online medical record.

The ultimate goal of the gait analysis is to prescribe the type of running shoe that will correct biomechanical abnormalities (such as pronation) and allow for a neutral running gait.

There are three main types of running shoes that can be selected: cushioned, stability, and motion control. The different types of shoes are categorized according to their midsole construction. Use of the digital video gait analysis when prescribing the proper running shoe and correcting biomechanical errors is beneficial in reducing or eliminating pain associated with running injuries.

Injuries also can be attributed to a combination of training errors and the incorrect running shoe. The running history and the diagnosis are collated into a report that details for the patient the information gained from the running gait analysis and includes a list of running shoes best suited to that gait. When training errors are indicated as a contributor to an injury, the health professional will offer recommendations for a modification of the exercise program. Using the TeleShoe program, health professionals at the health facility where the patient was interviewed and had his or her running gait digitally recorded may view and print out the patient's final reports immediately after a diagnosis is made and submitted.

Running gait analysis has been used in military health clinics across the country to encourage safe training and injury prevention by providing proper equipment to soldiers. An unpublished study conducted by Tomasetti' reported that 83 percent of injured runners bought the recommended running shoe after an initial evaluation, and 56 percent had a decrease in running pain (n=36). This suggests that wearing the correct running shoe leads to a decrease in pain.

Providing access to these diagnostic tools through relemedicine technology offers a convenient, reliable, and costeffective method of extending the benefits of an injury prevention program via digital visual gait analysis to service members, dependants, and Department of Defense civilians around the world.

The TeleShoe program is a joint effort of the Walter Reed Army Medical Center's Department of Telemedicine, the Army's Telemedicine and Advanced Technology Research Center, and the DiLorenzo TRICARE Health Clinic located in the Pentagon.

Reference

Tomasetti S.M. (2002). Effects of running shoes on correcting and preventing running injuries. Unpublished raw data.

Shari Tomasetti received her bachelor of science in exercise physiology from East Carolina University and her master of science in exercise, fitness, and health promotion from George Mason University. She has been active in preventive medicine along with completing and publishing research and presenting award- win fling scientific information on the topic of biomechanics. She is currently working at the Pentagon in the DiLorenzo TRICARE Health Clinic as the Biomechanic Program administrator.

Mark Jacobs earned a master of arts in exercise science from George Washington University and currently serves as director of wellness at the DiLorenzo TRICARE Health Clinic in the Pentagon. Prior to government service, Mr. Jacobs owned his own corporate wellness company