The Cohen Index is a diagnostic and predictive performance enhancement tool developed by Dr. Lee S. Cohen and utilized by the sports medicine podiatry expert team of physicians and athletic trainers at Dr. Lee S. Cohen and Associates. This systematic tool is designed to identify, diagnose, treat, and prevent injuries affecting the feet, ankles, legs, knees, hips, and lower back in athletes and active individuals of all ages.

The Cohen Index comprises an evaluation consisting of 15 lower-body assessments, which are detailed below. Each assessment is made up of several factors relevant to its specific area of focus. Findings that are deemed abnormal are assigned using a point system.

Upon completing the assessments, the points from the evaluated factors are totaled. These assessments facilitate the identification and diagnostic process while also serving as indicators of risk factors for individuals who may be at a higher risk of injury and/or suboptimal performance.

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Tim O’Donnell, ATC demonstrating The Cohen Index portion of a high school cheer athlete’s biomechanical examination.

The 15 assessments included in the Cohen Index are as follows:

1. Stance Posture Assessment
2. Limb Length Assessment
3. Core Strength Assessment
4. Hip Assessment
5. Hamstring Assessment
6. Quadriceps Assessment
7. Knee Assessment
8. Calf Assessment
9. Lower Leg Assessment
10. Heel Position Assessment
11. General Foot Type Assessment
12. Forefoot Position Assessment
13. 1st Metatarsal Phalangeal (Big Toe) Joint Assessment
14. Gait Assessment
15. Orthotic Selection (adjusted to fit the diagnosis and treatment program recommendations)

The Cohen Index, part of the Dr. Lee S. Cohen and Associates comprehensive biomechanical examination process, is a vital resource for enhancing athlete performance and injury management.

To learn more about Dr. Cohen and his award-winning team of sports medicine podiatry specialists, visit https://www.drleecohen.com/our-specialists.

To schedule your biomechanical examination, call (610)-522-9200 or visit www.drleecohen.com/contact.

“Secret Weapon” Custom Orthotic Insoles Success Story - Zachary Mangiafico, Towson High School Varsity Lacrosse Star

“My son, Zachary Mangiafico, started experiencing foot pain around April of 2023. He was a freshman starting on the Towson High School (MD) varsity lacrosse team. At the end of that season, he started experiencing some pretty significant foot pain, which eventually became excruciating, so we assumed it was Plantar Fasciitis. After a few weeks or so, the pain had not subsided, so we saw a podiatrist in our hometown of Towson, MD. This podiatrist diagnosed it as PF, and started a series of four cortisone injections. The four injections came and went with no real long-term relief. In November of 2023, we were visiting a friend of mine in Lincoln, NE, who works as the head athletic trainer for the Cornhuskers. He evaluated Zachary and said he doesn't think this in PF. He got on the phone with Dr. Cohen, and he agreed, this wasn't PF, and said "come to Philly". My friend in NE and Dr. Cohen had worked for years with the Eagles, and Chris told me that Dr. Cohen was by far the best he has ever worked with. So that is what we did, we took Zachary to Philly to meet Dr. Cohen and are so glad we did! Dr. Cohen, another doctor, and a trainer gave Zachary an examination like I had never seen before. I am used to a 10-15 block of time seeing a doctor, then said doctor is off to his next appointment, another 10-15 minute block of time.”

Dr. Lee S. Cohen with Zachary Mangiafico, Towson High School Varsity Lacrosse Star pictured at Dr. Cohen’s Cherry Hill, N.J. state-of-the-art Sports Medicine Podiatry Center

“However, Dr. Cohen and his team evaluated Zachary for roughly an hour. They were determined to figure out Zachary's issue. It was amazing to see. Dr. Cohen fitted Zachary for custom orthotics and ordered a few tests which were done closer to home near Baltimore. Once the results were in, we returned to Philly to meet with Dr. Cohen. He explained exactly what the issue was and how he was going to treat it. My friend Chris in Nebraska and Dr. Cohen were correct, it was not PF. One of Zachary's legs was 13mm longer than the other. This affected his gait and for a lack of a better phrase, it was making his PF angry. He looked at Zachary and told him, "I am going to save your life here", and boy did he. Almost immediately, the custom orthotics worked like a miracle for Zachary. His pain decreased pretty rapidly, and was able to play lacrosse this season, his sophomore year. Zachary's team, Towson High School, made it all the way to the state finals. We didn't win in the big game, but Zachary had a great season because of Dr. Cohen's help. Zachary started and played every game, making an all-county team. This simply would not have been possible without his help. We are grateful and wish we would have "gone to Philly" sooner...” -Brian Mangiafico

If you or someone that you care for suffers from pain in the feet, ankles, knees, hips, and/or lower back, the pain may be due to misalignment caused by faulty biomechanics which can be treated and corrected with the help of custom orthotic insoles. To schedule your comprehensive biomechanical evaluation, visit drleecohen.com or call our Sports Medicine Podiatry Center and book an appointment at our Marlton, N.J. Sports Medicine Facility or Ridley Park, P.A. Office location with one of our podiatric sports medicine specialists today by calling (610) 522-9200 or by visiting us at www.drleecohen.com

Pronation is a fundamental component of daily movement that facilitates pain-free walking and mobility that frequently goes unacknowledged. However, many people have a tendency to pronate more than necessary (overpronate), which may result in gait abnormalities and lead to pain while walking or running.

PRONATION

Pronation refers to the natural inward rolling of the foot that occurs while walking and running. Everyone pronates to some extent. It is part of the gait cycle, which includes the coordinated movements that keep us mobile while standing upright, as it allows the forefoot to make complete contact with the ground. Pronation serves as nature's mechanism for reducing shock on the feet, legs, and the rest of the body.

OVERPRONATION

Overpronation occurs when a person pronates excessively for prolonged periods, placing extra stress on the tendons and ligaments of the foot and ankle. When the foot is overpronated, it has to exert significantly more effort to propel the body, which can lead to fatigue and increased mechanical stress on the lower body.

Overpronation is the most common foot abnormality which can be caused by a number of factors including foot type, weight, and genetics. Improper footwear, walking or running on hard surfaces for extended periods of time, and pregnancy can worsen overpronation. Individuals who suffer from certain medical conditions, including (but not limited to) arthritis and diabetes are more likely to overpronate.

An overpronating foot can stretch and strain its structures, causing various issues in the joints, bones, and muscles, leading to a range of foot and lower body ailments, including:

• Plantar fasciitis (heel spurs)
• Hallux valgus (bunions)
• latfeet (can cause or worsen)
• Achilles tendonitis
• Corns and calluses
• Hammer toes or clawed toes
• Iliotibial band pain syndrome
• Calcaneal apophysitis
• Shin splints
• Ankle pain
• Ankle sprains
• Stress fractures
• Medial knee pain (pain on the inside of the knee)
• Patellofemoral dysfunction (causes pain in the front of the knee)
• Hip pain
• Low back pain

Overpronation increases the risk of foot injuries and can lead to secondary issues that negatively affect the entire body. Whether you currently experience pain or not, it is crucial to have your lower body assessed regularly by a podiatric sports medicine specialist. This proactive approach ensures your lower body mechanics are monitored, and any potential issues are addressed early. 

Custom orthotics help control alignment and function in the feet, allowing the foot structures to work together as intended by nature, resulting in pain-free movement. This is why orthotics have become the preferred non-surgical treatment for many foot and lower body issues, effectively addressing and correcting faulty biomechanics and reducing and eliminating pain while helping to prevent injuries that often stem from overpronation.

If you or someone that you care for suffers from pain in the feet, ankles, knees, hips, and/or lower back, the pain may be due to misalignment caused by faulty biomechanics which can be treated and corrected with the help of custom orthotic insoles. To schedule your comprehensive biomechanical evaluation, visit drleecohen.com or call our Sports Medicine Podiatry Center and book an appointment at our Marlton, N.J. Sports Medicine Facility or Ridley Park, P.A. Office location with one of our podiatric sports medicine specialists today by calling (610) 522-9200.

RUNNERS’ KNEE Q&A WITH DR. LEE S. COHEN

Knee pain is one of the top five running injuries impacting up to 2.5 million runners in the United States. There are many features of this common malady, some of which remain obscure. Several risk factors have been cited over the years. 

Q: How does it happen?

A: Overpronation is a common issue found in athletes who actively participate in sporting activities. When the foot and arch collapses, the knee internally rotates and the Q angle increases. With this exercise, the quadriceps tendon pulls laterally. When this occurs, the knee is no longer functioning in the sagittal plane. The patella, which is a V-shaped bone that should fit in the V-shaped groove in the femur, now no longer does. As a result, the patella, with this internal rotation and foot collapse is forced to ride up the lateral side of the groove and shears down the medial side of this groove 10,000 times a day. This results in wearing out of the infrapatellar cartilage (which is only 5 cells of thickness, to begin with). Once the cartilage is damaged, you feel pain, and patellar tracking disorder becomes the diagnosis. Seventy percent of pain in runners’ knees is due to patellar tracking syndrome. Unfortunately, this pain can become so severe that ninety percent of runners are forced to stop running as a result. But it is not just running that causes pain at this point, this condition can cause pain for sufferers simply while walking up and down stairs.

Q: What is the treatment?

A: Physical therapy can help by strengthening the quads and stretching the posterior muscle groups. But that is not going to cure it. The cure comes from increasing the arch height and preventing foot collapse, so the V-shaped patella sits in the V-shaped groove in the femur where it belongs (where you have cartilage on cartilage vs bone on bone). The use of an orthotic can restore this foot position to a neutral position with the heel perpendicular to the ground, prevent internal rotation of the leg, and reduce the Q angle.

Q: How are you and your medical team at Dr. Lee S. Cohen and Associates able to help stop runners’ knee in athletes?

A: First, our medical team of experienced sports medicine physicians, and athletic trainers conduct a three-part evaluation to accurately diagnose the issue that consists of:

1. A Gait Analysis
2. The Cohen Index: Our signature diagnostic, assessment, and treatment tool which is composed of a 14-point testing system.
3. An X-Ray Examination

Once the issue has been diagnosed, we can then determine that the best course of action will be to prescribe our non-invasive customized treatment solution, our signature “Secret Weapon” custom orthotic insole.
Woman placing custom orthotic insole into running shoe

The “Secret Weapon” custom insole is clinically proven and designed using state-of-the-art technology and custom fabrication to treat runners' knee, sports injuries, foot pain, ankle pain, and pain of the lower extremities in athletes of all ages from preschool to professional and everyone in between. 

Our “Secret Weapon” custom orthotics can not only help your athletic performance, but they can also help to relieve your pain so that you can bounce back from an injury much more quickly.

If you feel that you or someone that you care for needs a sports medicine physician to help evaluate, diagnose, and potentially treat foot pain, ankle pain, knee pain, or any painful biomechanical issue of the lower extremities schedule your appointment by calling our office at (610) 522-9200 or visit our website www.drleecohen.com to learn more and reach out to us by completing the contact form.

NEW BALANCE, NIKE, UNDER ARMOUR, AND MORE…..

New Balance Freeze LX V4 Low

• Lightweight, breathable material
• QUIX outsole provides extra traction
• Cleat placement on foot placed for ease when cutting
• Hybrid tongue designed to keep your ankle in place

New Balance Freeze LX V4 Mid

• Breathable, lightweight material
• QUIX outsole provides extra traction
• Mid-Cut provides additional ankle support
• Cleat placement on foot placed for ease when cutting

Nike Alpha Huarache 8 Elite

• Great fit for any position
• Mid-cut provides stability & mobility
• Breathable & lightweight
• X fit system locks heel in place

Nike Alpha Huarache 8 Pro

• Great for sharp cuts
• No Sip tongue
• Flexible TPU plates and triangular spikes for sharp cuts
• Foam cushioning for extra support

New Balance Freeze LX 3.0

• Breathable material throughout
• Hybrid tongue provides extra ankle support
• Quixrail outer cleats for lateral cuts
• Hybrid tongue provides extra ankle support

New Balance Burn X2 Mid Cut

• Offers functionality, comfort, and control
• Extreme durability
• Thermoplastic polyurethane to reinforce the base and sides

Under Armour Command MC Low

• Extremely lightweight
• Built-in support cage keeps the heel in place
• Sock-like ankle collar provides additional support
• Comfortable and secure fit

Under Armour Turf Command

• Lightweight materials throughout
• Mini spikes provide good traction
• Die-cut EVA sockliner providers great comfort

Nike Alpha Huarache 7 Pro Turf

• Nike's first low-cut turf lacrosse shoe
• Breathable & lightweight
• Flywire cables provide extra foot security
• Hexagonal rubber studs provide great traction

New Balance Freeze LX V4 Box

• Comfortable yet lightweight materials throughout
• Die-cut EVA sock liner provides great comfort
• Mini spikes provide great traction on all kinds of turf surfaces

Source: LAXDRIP

Just as your feet are the foundation of your body, your cleats are the base for everything you do on the lacrosse field. With that said, you need to choose a pair of cleats that provide support to keep your feet and ankles stable and comfortable so that you can outperform throughout the season.

We recommend that every athlete be evaluated by a sports medicine podiatry expert prior to every season. To schedule your comprehensive biomechanical evaluation, visit our contact page or call our Sports Medicine Podiatry Center and book an appointment at our Marlton, N.J. Sports Medicine Facility or Ridley Park, P.A. Office location with one of our podiatric sports medicine specialists today at (610) 522-9200.