THE ATHLETE'S FOOT

The high-stakes world of young elite athletes is intensifying, whether you're an Olympic gymnast like Simone Biles or a college football phenom like Derrick Henry. Consequently, foot and ankle injuries are becoming increasingly common. In adolescent basketball players, for example, foot and ankle injuries account for about 45 percent of all injuries. At Southwest Medical Imaging, the imaging group of choice for one of Arizona's largest college athletic programs, the musculoskeletal radiologists have extensive experience consulting for high school, college, and professional sports teams around the country. We spoke with SMIL radiologists and top doctors about how they collaborate to treat athletes competing at the highest levels.

Jason Kayce, DPM, a surgeon at Paradise Valley Foot and Ankle, emphasizes the need for speed and teamwork when treating athletes.

"Our methods differ dramatically between an elite athlete and a sedentary individual. We tend to be a lot more aggressive with treatment and when we order advanced medical imaging. With professional or collegiate athletes, the goal is returning the individual to the sport as soon as possible. The sooner we gain an accurate diagnosis, the sooner we can implement a proper treatment protocol. So, I have a much lower threshold to order advanced imaging... with an elite athlete there are many people involved - a team physician, the physical therapy team, personal trainer, primary care physician, a multitude of physicians that you have to stay in tune with so everyone's on the same page."

Ray Murphy, MD, PhD, a musculoskeletal radiologist at SMIL, says diagnosing elite athletes "starts with investing in really good scanners and equipment that allows us to get the best quality image.

We also have top-notch technologists who obtain the images using high-level techniques. With all patients, and particularly athletes, you can't cut corners in terms of image quality; athletes stay on the scanner as long as we need to get the answers. Oftentimes the radiologists will participate and say, 'I need one additional image from a different angle.' Then we interpret the images, and that's where radiologist's experience comes in - not just fellowship training in orthopedic or musculoskeletal radiology but experience in sports medicine. There are a lot of subtleties that go into interpretation."

Peter Mitchell, MD, an orthopedic surgeon at OrthoArizona, is the foot and ankle consultant to Ballet Arizona and consulted for the Arizona Diamondbacks for 15 years.

He values the collaborative relationship he has with musculoskeletal radiologists. "when I order a CT or MRI, I look at the study myself then I look at what the radiologist said. So, I get two opinions. Hopefully, they agree. They don't always, and sometimes I go back and say, 'Oh yeah, they saw something I didn't.' Or I see something they didn't. Sometimes I call the radiologist to clarify things. They pull up the imaging study while I'm on the phone, and I can say, "do you see this here? What do you think of that? They can be very helpful."

Jeffery Fitzgerald, MD, a musculoskeletal radiologist at SMIL was previously a consulting radiologist for the Cincinnati Reds.

He says experience diagnosing a variety of athletes makes all the difference. "If you don't have somebody who has experience with this and know what they're looking at and how to appropriately describe injuries in a succinct way that makes sense to people who are managing these patients and injuries, some patients can really get lost. Radiologists who do this on a day-to-day basis for a long period of time get a lot of clinical, orthopedic, and surgical feedback. They develop a sub-specialized expertise and can add a lot more value to those doctors and those particular patients than somebody who doesn't have that level of expertise."

Gregory Evangelista, MD, an orthopedic surgeon at Evangelista clinic says that when treating young athletes it's crucial to be aware of anatomical differences.

"There are definitely differences in the injuries children and adolescents versus adults. You have to know the sport and be very mindful of the things that will prevent them from being able to play in the future. That's another reason advanced imaging is important, because with something like a sprain, as long as they can tolerate the pain, they can play through it. But if it's a stress fracture, they need to be rested to let it heal. We might not necessarily know that at the time they present in the office, which is another reason we would be a lot quicker to get an MRI."

Kyle Vaughn, DPM a surgeon at Paradise Valley Foot and Ankle says athletes face intense scrutiny which has implications for treatment.

"In the world of million-dollar athletes, professional organizations want to invest their money in an athlete they feel had not been 'compromised' surgically. If they see a surgical scar, they respond to that and put that athlete through much more rigorous testing and physical fitness vetting. So, any opportunity we have to perform minimally invasive surgery or more aggressive nonsurgical treatment is typically in the athlete's best interest... The relationship between the surgeon and the radiologist cannot be overstated. We've formulated a relationship that allows us to collaborate with the musculoskeletal radiology team. It helps us really laser in on the patient's problem."