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1.  Pediatric Flexible Flatfoot; Clinical Aspects and Algorithmic Approach 
Iranian Journal of Pediatrics  2013;23(3):247-260.
Flatfoot constitutes the major cause of clinic visits for pediatric foot problems. The reported prevalence of flatfoot varies widely due to numerous factors. It can be divided into flexible and rigid flatfoot. Diagnosis and management of pediatric flatfoot has long been the matter of controversy. Common assessment tools include visual inspection, anthropometric values, footprint parameters and radiographic evaluation. Most flexible flatfeet are physiologic, asymptomatic, and require no treatment. Otherwise, the physician should treat symptomatic flexible flatfeet. Initial treatment options include activity modification, proper shoe and orthoses, exercises and medication. Furthermore, comorbidities such as obesity and ligamenous laxity should be identified and managed, if applicable. When all nonsurgical treatment options faile, surgery can be considered. Our purpose in this article is to present a clinical algorithmic approach to pediatric flatfoot.
PMCID: PMC3684468  PMID: 23795246
Flatfoot; Pes planus; Hyperpronation; Orthosis; Exercise; Algorithm; Children
2.  Patellofemoral Pain Syndrome and Modifiable Intrinsic Risk Factors; How to Assess and Address? 
Patellofemoral pain syndrome (PFPS) is a very common disorder of the knee. Due to multiple forces influencing the patellofemoral joint, clinical management of this ailment is particularly intricate. Patellofemoral pain syndrome has a multifactorial nature and multiple parameters have been proposed as potential risk factors, classified as intrinsic or extrinsic. Some of the intrinsic risk factors are modifiable and may be approached in treatment. A number of modifiable risk factors have been suggested, including quadriceps weakness, tightness of hamstring, iliopsoas and gastrosoleus muscles, hip muscles dysfunction, foot overpronation, tightness of iliotibial band, generalised joint laxity, limb length discrepancy, patellar malalignment and hypermobility. In general, the routine approach of physicians to this problem does not include assessment and modification of these risk factors and therefore, it may negatively affect the management outcomes. Changing this approach necessitates an easy and practical protocol for assessment of modifiable risk factors and effective and feasible measures to address them. In this review, we aimed to introduce assessment and intervention packages appropriate for this purpose.
PMCID: PMC3690728  PMID: 23802050
Anterior Knee Pain; Predisposing Factor; Assessment; Exercise; Management
3.  Congenital Adrenal Hyperplasia in an Elite Female Soccer Player; What Sports Medicine Clinicians Should Know about This? 
Asian Journal of Sports Medicine  2012;3(3):209-213.
Background
Congenital Adrenal Hyperplasia (CAH) refers to a group of congenital conditions characterized by disordered cortisol synthesis. The correlation between CAH and sports performance has been less studied before and there is very limited information regarding the impacts of this congenital disease on sports performance. Probably, there are some limitations for patients who suffer from CAH in sports, but at the same time, they may enjoy some advantage due to the probable effect of endogenous hyperandrogenism on their exercise performance.
Case Presentation
The case is a 14 - year old girl with male phenotype who is a known case of congenital adrenal hyperplasia. She plays in the women's national soccer team of under 16. She has been in the first division league of indoor soccer for 4 years and was also selected in the preparation training camp of women's football team for Singapore's youth Olympic Games. Her illness and dependence on corticosteroid have caused some concerns for her participation in the international competitions of women. However, following consultations with the Therapeutic Use Exemption (TUE) Committee of games organization, she received TUE to use corticosteroid only within the games period. Despite all her problems, she is now playing in the Second Division League of indoor soccer.
Conclusions
A female adolescent with CAH may compete at the high level of outdoor and indoor soccer. However, there are many questions regarding the advantages and disadvantages of this congenital disorder and its treatment on sports related issues.
PMCID: PMC3445650  PMID: 23012642
Congenital Adrenal Hyperplasia; Doping; Gender Identity; Sports; Soccer; Therapeutic Use Exemption
4.  Travelling Fellowship Program for Football Medicine; Report on an Experience 
Asian Journal of Sports Medicine  2012;3(3):216-224.
Football medicine has developed in the world in recent years. AFC Medical Committee, established the idea of football medicine travelling fellowship two years ago and provided high-level healthcare services to football players in Asian countries. This is a report on my one month experience in a travelling fellowship program for football medicine which is attempting to tell the reader about the interesting event that I experienced. This course has been held between Jan 15 to Feb 10, 2012 in 3 Asian countries: Qatar, Thailand and Malysia. The experience provided me with the valuable suggestions for future travelling fellowship periods.
PMCID: PMC3445652  PMID: 23012644
5.   
PMCID: PMC3289206  PMID: 22375229
Sudden Cardiac Death; Athletes; Asia
6.  Sudden Cardiac Death in Young Athletes; a Literature Review and Special Considerations in Asia 
Sudden cardiac death (SCD) in a young athlete is rare, but catastrophic. Exercise acts as a risk factor for SCD in people with cardiovascular disease. A diversity of cardiovascular disorders including hypertrophic cardiomyopathy, congenital coronary anomalies, arrhythmogenic right ventricular dysplasia, dilated cardiomyopathy, aortic rupture due to Marfan syndrome, myocarditis, valvular disease and electrical disorders (Wolff–Parkinson–White syndrome, long QT syndrome, Brugada syndrome), as well as commotio cordis represent the common causes of SCD in young athletes.
As the outcome of lethal cardiovascular disorders is not reversible except in few cases, effective measures should be addressed to reduce the burden of sudden cardiac death in young athletes. Currently, two types of recommendations are proposed by American and European countries.
It seems that there are some special considerations in Asia, entirely different from North America or Europe, which warrant more comprehensive research on epidemiology and etiology of SCD in young Asian athletes by country and evaluation of current national preventive strategies and their achievements in decreasing the risk. Using these data and considering regional restrictions, an expert group will be able to plan a practical and feasible preventive strategy.
PMCID: PMC3289188  PMID: 22375212
Athletes; Young Adult; Sudden Cardiac Death; Asia; Sports
7.  Injury Profile in Women Shotokan Karate Championships in Iran (2004-2005) 
Journal of Sports Science & Medicine  2007;6(CSSI-2):52-57.
The aims of this paper were to record injury rates among Iranian women competitive Shotokan karate athletes and propose possible predisposing factors. A prospective recording of the injuries resulting from all matches in 6 consecutive women national Shotokan Karate Championships in all age groups in Iran (season 2004-2005) was performed. Data recorded included demographic characteristics (Age and Weight), athletic background (rank, years of experience, time spent training and previous injuries), type, location and reason for the injury, and the result of the match. Results indicate 186 recorded injuries from a total of 1139 bouts involving 1019 athletes, therefore there were 0.163 injury per bout [C.I. 95%: 0.142-0.184] and 183 injuries per 1000 athletes [C.I. 95%: 159-205]. Injuries were most commonly located in the head and neck (55.4%) followed by the lower limb (21%), upper limb (12.9%) and trunk (10.8%). Punches (48. 4%) were associated with more injuries than kicks (33.3%). The injuries consisted of muscle strain and contusion (81, 43.6%), hematoma and epistaxis (49, 26.3%), lacerations and abrasions (28, 15. 1%), concussion (13, 7%), tooth avulsion or subluxation (3, 1.6%), joint dislocation (3, 1.6%) and fractures (3, 1.6%). In conclusion, as the majority of injuries are minor, and severe or longstanding injuries are uncommon, it can be argued that shotokan karate is a relatively safe for females, despite its image as a combat sport, where ostensibly the aim appears to injure your opponent. Further research is needed to evaluate the effective strategies to minimize the risk of injuries.
Key points186 injuries were recorded during women competitions.Incidence rates of 0.163 injury per bout and 183 injuries per 1000 athletes were calculated.The injuries were most commonly located in the head and neck.Muscle strain and contusion, hematoma and epistaxis constitute the majority of injuries.
PMCID: PMC3809047  PMID: 24198704
Karate; martial arts; athletic injuries; risk factors; safety; sports

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