Foot and Ankle

Background and Purpose: Spastic cerebral palsy is accompanied with an increase in calf muscles’
spasticity and a decrease in the ankle range of motion. The purpose of the study was to compare
muscle inhibitory with functional corrective Kinesio taping applications on children with spastic
cerebral palsy.
Methods: Thirty two children with spastic cerebral palsy were selected from the outpatient clinic of
the faculty of Physical Therapy Cairo University. Muscle inhibitory and functional corrective Kinesio
taping applications in addition to physical therapy program were applied for three successive
months. Digital Goniometer was used to assess the ankle range of motion pre and post Kinesio tape
applications.
Results: The study revealed that that the functional corrective Kinesio taping is more effective in
increasing ankle range of motion than the muscle inhibitory.
Conclusion: Functional Corrective Kinesio tape application is recommended for increasing ankle
range of motion in children with spastic cerebral palsy.

—Severe injuries of lower extremities often lead to chronic pain and reduced walking abilities. We postulated that measuring free-living gait can provide further information about walking ability in complement to clinical evaluations. We sought to validate a method that characterizes free gaits with a wearable sensor. Over one week, 81 healthy controls (HC) and 66 chronic lower limb pain patients (CLLPP) hospitalized for multidisciplinary rehabilitation wore a simple accelerometer (Actigraph). In the acceleration signals, steady one-minute walks detected numbered 7,835 (5,085 in CLLPP and 2,750 in HC). Five gait quality measures were assessed: movement intensity, cadence, stride regularity, and short-term and long-term local dynamic stability. Gait quality variables differed significantly between CLLPP and HC (4% to 26%). Intraclass correlation coefficients (ICC) revealed moderate to high repeatability (0.71–0.91), which suggests that seven days of measurement are sufficient to assess average gait patterns. Regression analyses showed significant association (R 2 =0.44) between gait quality variables and a clinical evaluation of walking ability, i.e. the 6 minute walk test, Overall, the results show that the method is easy to implement, valid (high concurrent validity), and reliable to assess walking abilities ecologically.

T he Lisfranc joint, aka the tarsal-metatarsal (TMT) joint, marks the transition between the more rigid midfoot and the relatively flexible forefoot. It provides critical stability in maintenance of both the transverse and longitudinal arch of the foot. That stability is derived from both its osseous geometry and complex capsuloligamentous architecture.

Here we present and describe comparatively 25 talus bones from the Middle Pleistocene site of the Sima
de los Huesos (SH) (Sierra de Atapuerca, Burgos, Spain). These tali belong to 14 individuals (11 adult and
three immature). Although variation among Middle and Late Pleistocene tali tends to be subtle, this
study has identified unique morphological characteristics of the SH tali. They are vertically shorter than
those of Late Pleistocene Homo sapiens, and show a shorter head and a broader lateral malleolar facet
than all of the samples. Moreover, a few shared characters with Neanderthals are consistent with the
hypothesis that the SH population and Neanderthals are sister groups. These shared characters are a
broad lateral malleolar facet, a trochlear height intermediate between modern humans and Late Pleistocene
H. sapiens, and a short middle calcaneal facet. It has been possible to propose sex assignment for
the SH tali based on their size. Stature estimates based on these fossils give a mean stature of 174.4 cm for
males and 161.9 cm for females, similar to that obtained based on the long bones from this same site.

Introduction: The consensus among orthopedic surgeons on the management of equinus deformity in cere-bral palsy (CP) children has not been reported previously despite being a prevalent deformity. The goals of this study were to examine the orthopedic surgeons' current practice regarding the management of equinus deformity in children with ambulatory CP, and analyze variations in current practice between general orthopedic and pediatric orthopedic surgeons. Methods: We implemented a brief cross-sectional self-reported questionnaire that addressed the areas of clinical examination and decision-making skills of management of equinus deformity in CP children. We targeted a convenience sample of 400 participants. Surgeons that provided complete responses to the questionnaire were 223 with a response rate of 56%, of which 123 (55%) were general orthopedic surgeons, whereas 100 (45%) were pediatric orthopedic surgeons. The target population consisted of orthopedic surgeons who were further sub-classified in accordance with practice age, general versus pediatric, and exposure to children's orthopedics during the last three years of their practice. For analytical statistics, the Chi-Square test and Fisher's exact test were used to examine the relationship between two qualitative variables. Results: The overall clinical practice preferences of all survey participants were unimpressive with discordant survey responses. Pediatric orthopedic surgeons generally demonstrated a statistically significant difference regarding clinical assessment skill items of the survey, in contrast to general orthopedic surgeons. However, we found no differences between pediatric orthopedic and general orthopedic surgeons regarding most of the decision-making/knowledge items. Discussion: Generally, there are insufficient clinical practice trends of both general and pediatric orthopedic surgeons regarding equinus treatment in CP children. This may indicate a knowledge-practice gap with potential risks to CP children undergoing surgery for equinus. There is a need for a more competent exposure to CP in orthopedic surgeons' educational curricula and an updated health referral system.

The term " ankle impingement " encompasses a broad range of conditions that are typically post-traumatic and often chronic. Various forms of mechanical impingement can result from synovial proliferation, bone spur formation, or ligamentous scarring and hypertrophy. Since symptoms and physical findings can mimic a variety of disorders, accurate diagnosis may remain elusive, and proper effective therapy may be delayed. The objective of this article is to define and elucidate the etiology of the various forms of ankle impingement, clarify the range of associated osseous and soft-tissue pathology, and describe the imaging features and therapeutic options.

Ankle impingement syndromes are painful conditions that may complicate ankle trauma and are characterized by chronic, progressive pain, swelling, and limitation of movement. These disorders are subclassified according to anatomical location about the tibiotalar joint. This article reviews the various forms of anterior ankle impingement, detailing the unique clinical features, anatomical considerations, pathoetiology, and imaging findings for each.

AbstractBackground: Outcomes  of  management  of  high  energy  distal  third  tibial  fractures  are  not  satisfactory and associated with complications. So use of external fixator is increased in recent years for distal third tibia  fractures.  We  intend  to  study  the  utility  of  external  fixators  in  high  energy  distal  third  tibial fractures.Materials  and  Methods: This is retrospective  observational  study included  38 patients who underwent close  reduction  and  external  fixation  with  Augmented  Wagners  externalfixator  or  Aesculap  external fixator(unilateral) or Hybrid external fixator for lower third tibial fractures in between 2009 and 2015.Results: The  Olerud  C  and  Molander  H  ankle  score  was  excellent  in  44.73%(n=17),  good  in  31.57% (n=12), fair in 15.78% (n=6) and poor in 7.89% (n=3). The ankle range of movement was near normal in 94.73% cases except in 2 patients where stiffness was encountered. The average duration ofunion was6months  and  89%(n=34)  of  fractures  united  within  7  months.  P  value  <0.05(0.066)  was  not  considered significant.
Conclusion: External Fixators with or without limited percutaneous internal fixation is a reliable method for  stabilization  of  highenergy (Tscherne 2 and 3, compound) lower third tibial fractures. It’s a good alternative to other methods of fixation in lower third tibia fracture.

„ Silastic implants for the first metatarsophalangeal joint (MTPJ) have been in use for over 50 years. Initial reports were associated with high failure rates leading to development of new designs that are currently in use. „ The aim of this article is to review the historical evolution and the outcomes of silastic implants for the treatment of end-stage OA of the first MTPJ. Databases were searched for studies reporting the outcomes of silastic implants for the first MTPJ. Various relevant search terminologies were used. Studies reporting the outcomes of metallic implants or arthrodesis were excluded. „ The literature search revealed 522 studies, of which 28 were included. Eight studies used single-stemmed implants and 20 used double-stemmed implants for their patients. Twenty-eight studies had a total of 2354 feet with silastic replacements in 1884 patients (1968 to 2003) with an average age of 53 years and the average follow-up was 85.3 months. There were a total of 5.3% (124 feet) failed prostheses. Improvement in pain was reported in 76.6% (1804 feet) with an average patient satisfaction rate of 84%. Radiological changes around the implants were found to be significantly higher with single-stemmed implants (30.3%) compared to the double-stemmed implants (14.7%) (p < 0.05). „ Significantly more single-stemmed implants failed (11%) than the double-stemmed implants (3.6%) (p < 0.05). Despite the initial reports of failed implants and complications , first-and second-generation silastic implants were associated with high patient satisfaction and pain improvement. Current literature lacks long-term outcomes of implants currently in use.

Fractures of the lateral and the posterior processes of the talus are uncommon and frequently missed because of a low level of suspicion and difficulty in interpretation on plain radiographs. Missed fractures can lead to persistent pain and reduced function.
Lateral process fractures are usually a consequence of forced dorsiflexion and inversion of fixed pronated foot. These are also commonly known as snowboarder’s fractures.
The posterior process of the talus is composed of medial and lateral tubercles, separated by the groove for the flexor hallucis longus tendon.
The usual mechanism of injury is forced hyperplantarflexion and inversion causing direct compression of the posterior talus, or an avulsion fracture caused by the posterior talofibular ligament. CT scans are helpful in cases of high clinical suspicion.
There is a lack of consensus regarding optimal management of these fractures; however, management depends on the size, location and displacement of the fragment, the degree of cartilage damage and instability of the subtalar joint. Non-operative treatment includes immobilization and protected weight-bearing for six weeks. Surgical treatment includes open reduction and internal fixation or excision of the fragments, depending on the size.
Fractures of the lateral and the posterior processes of the talus are uncommon but important injuries that may result in significant disability in cases of missed diagnosis or delayed or inadequate treatment. Early diagnosis and timely management of these fractures help to avoid long-term complications, including malunion, nonunion or severe subtalar joint osteoarthritis.

Submit Manuscript | http://medcraveonline.com MOJ Orthop Rheumatol 2016, 4(1): 00126 of side-effects, namely recurrence of deformity, loss of flexion strength of first MTPJ causing first ray insufficiency, first MTPJ loss of movement, and so on.

A common abnormal inherited foot structure is described which results in a structurally elevated and inverted 1st metatarsal and hallux, termed Primus Metatarsus Supinatus (aka Rothbarts Foot)

PMS is the end result of a failed/incomplete unwinding of the talar head, referred to as talar supinatus.

Clinically, the 1st metatarsal and hallux are elevated (off the ground) when the weight bearing foot is placed into its anatomical neutral position (STJ congruity).

PMS is a dysfunctional biomechanically, demarcated by its prolonged mid-stance hyperpronation.  This abnormal pronation results in a postural distortional pattern in which:

(1)  The innominates are rotated anteriorly
(2)  The pelvis unlevels (tilts), augmenting the scoliotic and kyphotic curves
(3)  The head rotates forward relative to the cervical spine
(4)  The bite shifts into a Class II Malocclusion

This global postural shift is termed BioImplosion which closely resembles the common compensatory pattern first described by Zink and Lawson.

A type of insole, incorporating a medial column bar, has been developed which reverses BioImplosion.

Avulsion fractures of the anterior inferior tibiofibular ligament from its tibial attachment, Tillaux fractures, are
usually seen in adolescents during the interval of the distal tibial epiphyseal closure. However, this pattern of
fracture is rare in adult patients, because the ligaments will usually fail before the bone fails. Avulsion fracture
of the posterior inferior tibiofibular ligament from its tibial attachment, Volkmann fracture, is the
posterolateral counterpart of a similar injury. In the present study, the cases of 2 adult patients with simultaneous
Tillaux and Volkmann fractures are reported and the mechanism of injury, diagnosis, and treatment
discussed. This fracture pattern is extremely rare and, to the best of our knowledge, has not been previously
reported.

Morton (1935) describes a foot in which the 1 st metatarsal is shorter than the 2 nd , visually identified as a deep 1 st web space (See Figure 1). Rothbart describes a foot in which the 1 st metatarsal is elevated and inverted, the Rothbart foot structure {RFS} (Travell 1995, Gilmore 1996, Dols 1997, Svae 2000, GRD BioTech Inc 2000). Both authors are describing the same foot structure. Rothbart (1988) demonstrates that it is this elevated position of the 1 st metatarsal that destabilizes {hyperpronates} the walking foot (See Figure 2). Hyperpronation shifts the posture forward. The body&#39;s center of gravity falls to the inside of the medial {inner} malleolus, the knees hyperextend, the pelvis unlevels producing a functional leg length discrepancy, the shoulder protract {become rounded} and the head moves forward relative to the spine, a process termed BioImplosion.

In this paper, the most common injuries in university beach volleyball players are studied through a 33 participant sample at the University Spanish Championship. Injuries were assessed by means of personal interviews and a validated questionnaire. Results show that the body region with the highest incidence was the ankle (33%), followed by the fingers (18.5%), knees (13.0%), shoulders (11.1%) and back (5.6%). Data was also retrieved about the moment of injury (competition or training), origin (impact or overuse) and characteristic of the injury (new or recurrent injury). Statistical processing of data for establishing significant differences was performed using the Chi-square test. Results established a

The link between joint pain and poor posture is not a new concept. However, this author links the development of poor posture to a specific embryological foot structure, which is biomechanically dysfunctional [hyperpronates]. An innovative foot orthosis is introduced which significantly reduces foot hyperpronation associated with this foot type. The result is visually improved posture and less joint pain.

OBJECTIVE: Ankle rigidity is a common musculoskeletal disorder affecting the talocrural joint, which can impair weight-bearing ankle dorsiflexion (WBADF) and daily-life in people with or without history of ankle injuries. Our objective was to compare the immediate effects of efficacy of Mulligan Mobilization with Movement (MWM) and Osteopathic Mobilization (OM) for improving ankle dorsiflexion range of motion (ROM) and musculoarticular stiffness (MAS) in people with chronic ankle dorsiflexion rigidity. DESIGN: A randomized clinical trial with two arms. METHODS: Patients were recruited by word of mouth and via social network as well as posters, and analyzed in the neuro musculoskeletal laboratory of the "Université Catholique de Louvain-la-Neuve", Brussels, Belgium. PARTICIPANTS: 67 men (aged 18-40 years) presenting with potential chronic non-specific and unilateral ankle mobility deficit during WBDF were assessed for eligibility and finally 40 men were included and randomly allocated to single session of either MWM or OM. INTERVENTIONS: Two modalities of manual therapy indicated for hypothetic immediate effects in chronic ankle dorsiflexion stiffness, i.e. MWM and OM, were applied during a single session on included patients. MAIN OUTCOME MEASURES: Comprised blinding measures of MAS with a specific electromechanical device (namely: Lehmann's device) producing passive oscillatory ankle joint dorsiflexion and with clinical measures of WBADF-ROM as well. RESULTS: A two-way ANOVA revealed a non-significant interaction between both techniques and time for all outcome measures. For measures of MAS: elastic-stiffness (p = 0.37), viscous-stiffness (p = 0.83), total-stiffness (p = 0.58). For WBADF-ROM: toe-wall distance (p = 0.58) and angular ROM (p = 0.68). Small effect sizes between groups were determined with Co-hen's d ranging from 0.05 to 0.29. One-way ANOVA demonstrated non-significant difference and small to moderate effects sizes (d = 0.003-0.58) on all outcome measures before and after interventions within both groups. A second two-way ANOVA analyzed the effect of each intervention on the sample categorized according to injury history status, and demonstrated a significant interaction between groups and time only for viscous stiffness (p = 0.04, d = −0.55). CONCLUSION: A single session of MWM and OM targeting the talocrural joint failed to immediately improve all measures in B. Hidalgo et al. / The immediate effects of two manual therapy techniques on ankle MAS and dorsiflexion ROM subjects with chronic ankle dorsiflexion stiffness. Despite this, there was an increase in viscous stiffness in people with history of ankle injury following both manual techniques, the value of which remains unclear even if it might help to prevent future abnormal ankle joint movements.

The treatment of severe rigid neurogenic clubfoot deformities still remains a challenging problem in modern paediatric orthopaedics. In those cases, in spite of being a palliative procedure, talectomy has been advocated for the correction of the deformity thus providing a stable plantigrade foot which allows pain-free walking with standard footwear. Herein, we present the results after talectomy in two patients (brother and sister) affected by a hereditary motor and sensory neuropathy type I, with rigid severe pes equinovarus deformities.

Aim : The aim of the study is to compare immediate weight bearing with below-knee cast or immobilization with plaster splint in 6 weeks in patients after operative treatment for ankle bimalleolar fractures.

Methods : Fifty-three patients with ankle bimalleolar fractures were treated operatively in 2005 to 2010 and then were randomly allocated to two groups. Immediately weight bearing in a below-knee cast (26 patients) and immobilization in a plaster splint for the first six postoperative weeks (27 patients). A mean age 37.9 (min 17; max 72). An average follow-up 26.1 months. (min 14; max 55). All fractures were classified with Lauge-Hansen classification. Functional results of both groups were evaluated with AOFAS for the postoperative one year after surgical treatment.

Results : According to the AOFAS scoring system, results were excellent and good in 17 patients in group 1. On the other hand, results were excellent and good in 14 patients in group 2.

Conclusion : As a result we think that weight bearing protocol should be advantaged for patients with ankle bimalleolar fractures after surgical treatment immediately.

Background: Musculoskeletal disorders of the lower extremities are commonly affected by chronicity and disability. One of the most commonly affected areas is the ankle. Epidemiological information is limited for chronic musculoskeletal ankle disorders in the general community, particularly in the developing world. This study aimed to determine the prevalence and impact of chronic musculoskeletal ankle disorders in the Sri Lankan community. Methods: A cross-sectional stratified random sample of people (n = 1000) aged 18 to 85 years in Sri Lanka was undertaken by questionnaire in the general community setting. Of those questionnaires, 827 participants provided data. Point prevalence for no history of ankle injury or ankle disorders, history of ankle injuries without chronic ankle disorders, and chronic ankle disorders were obtained. Point prevalence of chronic musculoskeletal disorders and causes for chronicity was evaluated. Results: There were 448 (54.2%) participants with no ankle disorders, 164 (19.8%) with a history of ankle injury but no chronic disorders, and 215 (26.0%) with chronic ankle disorders. The major component of chronic ankle disorders was musculoskeletal disorders (n = 113, 13.7% of the total sample), most of which were due to ankle injury (n = 80, 9.7% of the total). Sprains were responsible for 17.7% of the total ankle injuries. Arthritis was the other main cause for chronicity of ankle disorders with 4% of total participants (n = 33).

Background: Radial extracorporeal shock wave therapy (RSWT) has been previously demonstrated as an efficient treatment option for chronic plantar fasciitis (PF) when administered in three sessions. The present study tested the hypothesis that chronic PF can also be treated successfully with RSWT when only two treatment sessions are performed. Materials and Methods: A total of 50 patients with unilateral, chronic PF were randomly assigned to either RSWT (n = 25) or placebo treatment (n = 25). RSWT was applied in two sessions 1 week apart (2,000 impulses with energy flux density = 0.16 mJ/mm 2 per session). Placebo treatment was performed with a clasp on the heel. Endpoints were changes in the Visual Analog Scale (VAS) score and the modified Roles & Maudsley (RM) score from baseline to 4 weeks, 12 weeks and 24 weeks followup. Results: Mean VAS scores were reduced after RSWT from 8.5 ± 0.3 (mean ± SEM) at baseline to 0.6 ± 1.5 at 4 weeks, 1.1 ± 0.3 at 12 weeks and 0.5 ± 0.1 at 24 weeks from baseline. Similar changes were found for mean RM scores from baseline after RSWT but were not observed after placebo treatment. Statistical analysis demonstrated that RSWT resulted in significantly reduced mean VAS scores and mean RM scores at all followup intervals compared to placebo treatment (each with p < 0.001). No serious adverse events of RSWT were observed. Conclusion: RSWT was successful in the treatment of chronic PF even when only two sessions with 2,000 impulses each were performed 1 week apart. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Proprioceptive stimulation is a holistic technique in which a tactile stimulation is applied to the bottom of the foot. Through this stimulation, a message is sent to the cerebellum (the balance center of the brain) (See Fig 1). Acting on this signal, the cerebellum initiates a postural correction affecting the entire body.

This postural correction (bioimploded to erect posture, encourages the body to readjust itself towards a state of harmony and well being.

Visceral Improvements noted with postural corrections include:
(1) Improved respiration
(2) Improved GI function
(3) Facilitates Menstration cycles

Introduction: Recent department of health guidelines recommend that bunion surgery should be performed as a day case to reduce hospital costs and improve patient outcomes. Following an audit between 2012 and 2013, we noted a significant proportion of patients undergoing first ray surgery were being admitted following surgery, often for 24 hours or even longer. Preoperative physiotherapy has been shown to decrease length of stay in such procedures. We therefore implemented a preoperative physiotherapy ‘foot school’ to address this. In this paper we reaudit the rates of same day discharge in first ray surgery to assess its efficacy.
Methods: We performed a prospective case note review of all patients undergoing first ray surgery from 2012 to 2013, and found the rates of same day discharge to be lower than set out in these standards at just 24.19%. The most commonly cited reasons for delayed discharge were that patients had either not been assessed by physiotherapy, and were unable to have their take home medication (TTO’s) dispensed as pharmacy had closed.
We therefore implemented a preoperative therapy led foot school, and organized ward analgesia packs which may be dispensed by ward staff. We then a re-audit one year later to ascertain if these measures had been effective at increasing the rate of same day discharges.
Results: We identified 62 first ray procedures in the preliminary audit, with an average age of 50.5 years (range 17-78 years) and a M:F ratio of 1:5. The most commonly performed procedures were scarf osteotomy, 1st MTPJ fusion, and distal chevron osteotomy. We compared this to 63 first ray procedures post implementation of therapy led foot school. The average age was 55.3 years (range 15-78 years) and the M: F ratio was 1:2.5. The spread of procedures was nearly identical. We found the average length of stay had reduced from 1.22 to 0.65 days (p= 0.0363), and the rate of same day discharge had increased from 24.6% to 44.6% (p= 0.0310)
We also noted that St Helens Hospital (SHH- the dedicated day case surgery unit) had a significant increased rate of same day discharge than Whiston Hospital (WH- the main hospital) at 87.5% and 28.89% respectively (p= 0.0002).
Conclusion: Preoperative physiotherapy assessment is an important tool in reducing length of stay for first ray surgery. The use ward analgesia packs seems to be have added efficacy. We therefore commend its use to other centres. Additionally, we have shown dedicated day case surgery units are more effective at achieving same day discharge than are general hospitals.

The following 4 points were delineated and clarified in my response to Dr Craig's challanges:
(1)  Retention of talar supinatus is the embryological cause of a structurally elevated first metatarsal
(2)  The elevated first metatarsal is a common cause of foot hyperpronation
(3)  A structurally elevated first metatarsal can be stabilized using medial column support
(4)  Prior research projects presented (clinical outcomes) that validate the efficacy of the medial column support insoles

Chronic mid-foot pain have several etiological factors and related treatment protocols. Most of the times, the treatment is limited to supportive and symptomatic therapy. Physical therapy measures are ancillary modalities along with activity modifications. A very localized chronic pain refractory to conservative treatment options warrants imaging studies to delineate underlying pathology. On rare instances very interesting underlying lesions are encountered. We present a case report of recalcitrant pain over medial aspect of foot diagnosed radiologically and managed accordingly.

Background: The purpose of our study was to compare ankle range of motion and stiffness in individuals with and without diabetes mellitus using a reliable and valid technique and to document the effect of knee flexion and severity of pathology on ankle range of motion and stiffness. Methods: Twenty-five individuals with diabetes mellitus and 64 nondiabetic individuals, similar in age and gender profile, participated in this study. Results: Results revealed that individuals with diabetes mellitus had both significantly lower peak dorsiflexion range of motion (5.1 and 11.5 degrees, p < 0.001) and higher passive ankle stiffness (0.016 and 0.008 Nm/kg/degree, p < 0.01) than non-diabetic individuals. In individuals with diabetes mellitus, a positive relationship between glycemic control and duration of diabetes mellitus and ankle stiffness ((r 2 = 0.48 and 0.24 respectively, p < 0.01 for both) was found. Conclusion: While decreased range of motion and increased stiffness in the diabetes mellitus population seem clinically intuitive, as far as we know this is the first study to confirm the concurrent existence of both these findings in the plantarflexors in individuals with diabetes mellitus. We applied a reliable and valid technique, one that allowed control of confounding factors such as knee flexion position and differences in determination of end range of motion, and documented a mean 41% loss in dorsiflexion excursion. Changes in the muscle, stemming from underlying pathology, are hypothesized to account for a significant part of the lost range of motion. Changes in ankle range of motion and stiffness may have important implications in plantar loading and ulcer formation.

A previous study highlighted the importance of footwear to individuals&#39; sense of their identity, demonstrating that shoes must &#39;fit&#39; someone socially, as well as functionally. However, unhealthy shoes can have a detrimental effect on both foot health and mobility. This project utilises qualitative social science methods to enable podiatrists to understand the broader contribution of footwear to patients&#39; sense of themselves and from this an online toolkit was developed to aid footwear education. Semi-structured interviews were conducted with six podiatrists/shoe-fitters and 13 people with foot pathologies, some of whom also completed shoe diaries. These were supplemented with some follow-up interviews and photographs of participants&#39; own shoes were taken to allow in-depth discussions. Four areas related to &#39;fit&#39; were identified; practicalities, personal, purpose and pressures, all of which need to be considered when discussing changes in footwear. These w...

Background: Tendon transfers are commonly used for correction of pathology or deformity of the foot and ankle. Bioabsorbable implants have been developed as an alternative to metal interference screws. The purpose of this study was to document complications following tendon transfers of the foot and ankle using bioabsorbable poly-L-lactide interference screws. Methods: A retrospective chart review was used to identify patients in whom either of the 2 senior authors had performed a tendon transfer of the foot and ankle using a bioabsorbable interference screw between 1999 and 2005. A minimum of 6 months of follow-up was required for inclusion in the study. In all, 31 patients were identified who met the inclusion criteria with an average follow-up of 75 weeks. All screws were made of poly-L-lactide (PLLA). Results: Complications were identified in 12 (39%) of patients. All of the complications reported were known complications of the tendon transfer procedure itself, and were not directly related to the bioabsorbable screw. Conclusions: Based on these early results, PLLA implants appear safe and effective for tendon transfers of the foot and ankle. However, until long-term outcomes are available, judicious use of these implants is recommended. Level of Evidence: Level IV, retrospective case series.

Distal tibianın dev hücreli tümörü: Nadir bir olgu sunumu Georgi P. Georgiev, Svetoslav A. Slavchev ÖZET Kemiğin dev hücreli tümörleri iyi huylu olmalarına rağmen agresif lezyonlardır. Ayak ve ayak bileği tutulumu ise nadirdir. Biz burada, sol ayakta şişlik ve ağrı artışı şikâyeti nedeniyle eklem hareketi kısıtlanan 26 yaşında bayan hastayı sunduk. Görüntüleme yöntemleri kemikte dev hücreli tumor tanısı koydurdu ve bu tanı açık biyopsi ile doğrulandı. Lezyon segmental en-blok rezeksiyon ve bilek artrodezi yapılarak tedavi edildi ve iyi fonksiyonel sonuç alındı. Biz aynı zamanda yazımızda bu patolojinin klinik, radyolojik ve tedavi karakteristiklerini literatür bilgileri ışığında tartıştık.

Background 13 Patient education supports general disease self-management and in relation to foot 14 problems, it is recommended as a key intervention for people with rheumatoid arthritis (RA). 15 Further, it is known what the foot health educational (FHE) needs are in relation to their 16 experiences of foot problems. Podiatrists are the key health professionals who provide the 17

BackgroundNon-medical prescribing is one healthcare reform strategy that has the potential to create savings in the health system as well as offer equitable and timely access to scheduled medicines. Currently there is a lack of information about prescribing practices of Australian podiatrists, making it difficult to assess if endorsement for scheduled medicines (endorsement) for podiatrists provides health system efficiencies or improved patient access and outcomes. Further, the uptake for endorsement remains low among Australian podiatrists. The aim of this research was to investigate the prescribing practices among Australian podiatrists as well as to explore barriers and facilitators that influence participation in endorsement. MethodsParticipants in this quantitative, cross-sectional study were registered and practicing Australian podiatrists and podiatric surgeons who were recruited through a combination of professional networks, social media, and personal contacts. Respondents...

A prospective, open study in patients with symptomatic (≥50 mm and ≤90 mm on a 100 mm VAS) ankle osteoarthritis. Patients received 1 ml × 2 ml intra-articular injection of hylan GF 20, plus an optional, second injection if pain remained at baseline levels after 1, 2 or 3 ...

Background: The effect of footwear on the gait of children is poorly understood. This systematic review synthesises the evidence of the biomechanical effects of shoes on children during walking and running. Methods: Study inclusion criteria were: barefoot and shod conditions; healthy children aged ≤ 16 years; sample size of n > 1. Novelty footwear was excluded. Studies were located by online database-searching, hand-searching and contact with experts. Two authors selected studies and assessed study methodology using the Quality Index. Meta-analysis of continuous variables for homogeneous studies was undertaken using the inverse variance approach. Significance level was set at P < 0.05. Heterogeneity was measured by I 2. Where I 2 > 25%, a randomeffects model analysis was used and where I 2 < 25%, a fixed-effects model was used. Results: Eleven studies were included. Sample size ranged from 4-898. Median Quality Index was 20/32 (range 11-27). Five studies randomised shoe order, six studies standardised footwear. Shod walking increased: velocity, step length, step time, base of support, double-support time, stance time, time to toe-off, sagittal tibia-rearfoot range of motion (ROM), sagittal tibia-foot ROM, ankle max-plantarflexion, Ankle ROM, foot lift to max-plantarflexion, 'subtalar' rotation ROM, knee sagittal ROM and tibialis anterior activity. Shod walking decreased: cadence, singlesupport time, ankle max-dorsiflexion, ankle at foot-lift, hallux ROM, arch length change, foot torsion, forefoot supination, forefoot width and midfoot ROM in all planes. Shod running decreased: long axis maximum tibialacceleration, shock-wave transmission as a ratio of maximum tibial-acceleration, ankle plantarflexion at foot strike, knee angular velocity and tibial swing velocity. No variables increased during shod running. Conclusions: Shoes affect the gait of children. With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern. The long-term effect of these changes on growth and development are currently unknown. The impact of footwear on gait should be considered when assessing the paediatric patient and evaluating the effect of shoe or in-shoe interventions.

Background: Intrinsic foot muscle weakness has been implicated in a range of foot deformities and disorders. However, to establish a relationship between intrinsic muscle weakness and foot pathology, an objective measure of intrinsic muscle strength is needed. The aim of this review was to provide an overview of the anatomy and role of intrinsic foot muscles, implications of intrinsic weakness and evaluate the different methods used to measure intrinsic foot muscle strength. Method: Literature was sourced from database searches of MEDLINE, PubMed, SCOPUS, Cochrane Library, PEDro and CINAHL up to June 2012. Results: There is no widely accepted method of measuring intrinsic foot muscle strength. Methods to estimate toe flexor muscle strength include the paper grip test, plantar pressure, toe dynamometry, and the intrinsic positive test. Hand-held dynamometry has excellent interrater and intrarater reliability and limits toe curling, which is an action hypothesised to activate extrinsic toe flexor muscles. However, it is unclear whether any method can actually isolate intrinsic muscle strength. Also most methods measure only toe flexor strength and other actions such as toe extension and abduction have not been adequately assessed. Indirect methods to investigate intrinsic muscle structure and performance include CT, ultrasonography, MRI, EMG, and muscle biopsy. Indirect methods often discriminate between intrinsic and extrinsic muscles, but lack the ability to measure muscle force. Conclusions: There are many challenges to accurately measure intrinsic muscle strength in isolation. Most studies have measured toe flexor strength as a surrogate measure of intrinsic muscle strength. Hand-held dynamometry appears to be a promising method of estimating intrinsic muscle strength. However, the contribution of extrinsic muscles cannot be excluded from toe flexor strength measurement. Future research should clarify the relative contribution of intrinsic and extrinsic muscles during intrinsic foot muscle strength testing.

Background: Randomised controlled trials are widely accepted as the gold standard method to evaluate medical interventions, but they are still open to bias. One such bias is the effect of patient's preference on outcome measures. The aims of this study were to examine whether patients' treatment preference affected clearance of plantar warts and explore whether there were any associations between patients' treatment preference and baseline variables in the EverT trial. Methods: Two hundred and forty patients were recruited from University podiatry schools, NHS podiatry clinics and primary care. Patients were aged 12 years and over and had at least one plantar wart which was suitable for treatment with salicylic acid and cryotherapy. Patients were asked their treatment preference prior to randomisation. The Kruskal-Wallis test was performed to test the association between preference group and continuous baseline variables. The Fisher's exact test was performed to test the association between preference group and categorical baseline variables. A logistic regression analysis was undertaken with verruca clearance (yes or no) as the dependent variable and treatment, age, type of verruca, previous treatment, treatment preference as independent variables. Two analyses were undertaken, one using the health professional reported outcome and one using the patient's self reported outcomes. Data on whether the patient found it necessary to stop the treatment to which they had been allocated and whether they started another treatment were summarised by treatment group. Results: Pre-randomisation preferences were: 10% for salicylic acid; 42% for cryotherapy and 48% no treatment preference. There was no evidence of an association between treatment preference group and either patient (p=0.95) or healthcare professional (p=0.46) reported verruca clearance rates. There was no evidence of an association between preference group and any of the baseline variables except gender, with more females expressing a preference for salicylic acid (p=0.004). There was no evidence that the number of times salicylic acid was applied was different between the preference groups at one week (p=0.89) or at three weeks (p=0.24). Similarly, for the number of clinic visits for cryotherapy (p=0.71) Conclusions: This secondary analysis showed no evidence to suggest that patients' baseline preferences affected verruca clearance rates or adherence with the treatment. Trial registration: Current Controlled Trials ISRCTN18994246 and National Research Register N0484189151

Background: Women, as compared with men, have a higher proportion of injuries in the ankle/foot region. However, the reason for this sex-related difference in foot injuries remains unclear. Recently, joint coordination and variability of coordination have been suggested to be a critical index for defining both the state of injury and the potential risk of injury. The purpose of this study was to investigate sex-related differences in coordination and variability among the foot joints during running. Methods: Twelve healthy men and 12 healthy women ran on a treadmill. A modified vector coding technique was used to identify coordination and variability among foot joints involving the shank, rearfoot, midfoot, and forefoot segments, and categorized into the following four coordination patterns: in-phase with proximal dominancy, in-phase with distal dominancy, anti-phase with proximal dominancy, and anti-phase with distal dominancy. Results: There were no differences in all spatiotemporal parameters and in the foot strike angle between men and women. Coordination of variability of the foot joints during running was similar between men and women, but the anti-phase with proximal dominancy in proportion of frontal rearfoot-shank vs. midfoot-rearfoot couple (men; 7.2%, women; 13.9%) and midfoot-rearfoot vs. forefoot-midfoot couple (men; 18.6%, women; 39.8%) in women was significantly increased compared to that in men. Other all coordination of the foot joints during running differed between men and women, and effect sizes of these parameters were all large. Conclusion: The results may be useful for understanding the underlying mechanism contributing to differences in injury risk in men and women, and may provide novel data on foot joint coordination and variability that could be used as reference data for both biomechanical and clinical running studies.

The development of repetitive ankle sprains and persistent symptoms after initial ankle sprain has been termed chronic ankle instability (CAI). Two contributing factors to CAI are functional ankle instability and mechanical ankle instability. Although the two may occur in isolation, it may be a combination of the two that causes CAI. There have been relatively few studies that have examined the two in combination. Additionally, the relationship of the specific insufficiencies to each other, or how they individually contribute to ankle instability, has not been examined. There is not a clear indication of what measures are most important in discriminating between individuals with and without CAI. Therefore, the purposes of this study were to 1) examine group comparisons of the involved ankle of the CAI group and the matched ankle of the control group for ankle laxity and hypomobility, static and dynamic balance, ankle and hip strength, selected lower extremity malalignments, and ITB flexibility in subjects with unilateral CAI, 2) examine group comparisons of the symmetry indices of side-to-side differences for the same variables, and 3) examine the bivariate correlations between the

Background: Diabetic foot ulcers are frequently related to elevated pressure under a bony prominence. Conservative treatment includes offloading with orthopaedic shoes and custom made orthotics or plaster casts. While casting in plaster is usually effective in achieving primary closure of foot ulcers, recurrence rates are high. Minimally invasive surgical offloading that includes correction of foot deformities has good short and long term results. The surgery alleviates the pressure under the bony prominence, thus enabling prompt ulcer healing, negating the patient's dependence on expensive shoes and orthotics, with a lower chance of recurrence. The purpose of this protocol is to compare offloading surgery (percutaneous flexor tenotomy, mini-invasive floating metatarsal osteotomy or Keller arthroplasty) to non-surgical treatment for patients with diabetic foot ulcers in a semi-crossover designed RCT. Methods: One hundred patients with diabetic neuropathy related foot ulcers (tip of toe ulcers, ulcers under metatarsal heads and ulcers under the hallux interphalangeal joint) will be randomized (2:3) to a surgical offloading procedure or best available non-surgical treatment. Group 1 (surgery) will have surgery within 1 week. Group 2 (controls) will be prescribed an offloading cast applied for up to 12 weeks (based on clinical considerations). Following successful offloading treatment (ulcer closure with complete epithelization) patients will be prescribed orthopaedic shoes and custom made orthotics. If offloading by cast for at least 6 weeks fails, or the ulcer recurs, patients will be offered surgical offloading. Follow-up will take place till 2 years following randomization. Outcome criteria will be time to healing of the primary ulcer (complete epithelization), time to healing of surgical wound, recurrence of ulcer, time to recurrence and complications.