Pain in the heel of children is not very common, but when it does happen, it is almost always a condition known as Severs Disease. This is thought of as being a strain of the cartilage growth plate at the back of the calcaneus. Some have even suggested that it is a stress fracture of this growth plate. The most common cause of severs disease is a combination of factors such as activity level, hard surfaces and tight calf muscles. Many consider abnormal foot biomechanics also plays a role. The typical symptoms of severs disease is pain on activity and pain at the back of the heel on medial and lateral compression. There are no typical finding of severs disease visible on x-ray. The usual treatment of severs disease is the use of activity modification, cushioning heel raises and the use of some physical therapy modalities. There are no long term consequences to severs disease as the growth plate merges with the surround bone at the mid-teen years.
September 27, 2010
August 29, 2010
Chi Running
Chi running, like the barefoot running movement is something that Podiatrists need to be familiar with. Patients will come in with injuries from one or more of the many different running technique and to be able to adequately treat patients who participant in running and use some of the many alternative techniques. Chi running is a running style that uses more of forward leaning and uses more of a midfoot strike than the traditional heel or rearfoot strike used by most runners. Like the barefoot running, there are many claims made for Chi running that are not supported by any research. That does not means that there is necessarily anything wrong with Chi running, it just means that the evidence does not support it. There are many Chi running websites, book and other resources available, but many do seem to trying to sell something.
August 26, 2010
Podiatrists and the Diabetic Foot
Two recent studies have shown just how important podiatrists are to managing the complications of the diabetic foot and in reducing the burden of lower limb amputation.
The first on one JAPMA showed:
Early identification of individuals at increased risk for lower-extremity ulceration and subsequent referral for advanced multidiscipline podiatric medical specialty care may decrease rates of ulceration and proximal amputation and improve survival in patients with diabetes mellitus who are at high risk for ulceration and limb loss.
The second one in Health Services Review showed:
Individuals with an LEC had high mortality. Visiting both a podiatrist and an LEC specialist in the year before LEC diagnosis was protective of undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care.
This is good news to have even more evidence on podiatrists role in the management of the diabetic foot. Many of the complications of diabetes put the foot at increased risk for damage to create the so-called diabetic foot, which can range from a simple need for basic nail care to foot ulcer management to Charcot’s foot to the need for an amputation. Podiatrists play a key role in the multidisciplinary management of the diabetic foot. Diabetic foot complications represent a significant burden to society and to the individual.
June 12, 2010
The Weil Osteotomy
The Weil Osteotomy is a commonly used a surgical procedure for “metatarsalgia” which shortens the metatarsal, theoretically relieving pressure to the metatarsal head. As such it can be used in a wide range of problems. However, there does seem to be a large complication rate for the Weil Osteotomy and there is quite a bit of controversy surrounding its use. Podiatry Arena has a poll on the Weil Osteotomy, which was started after a point/counterpoint debate in Podiatry Today. Opinions are clearly divided on the Weil Osteotomy.
June 8, 2010
Cuboid Syndrome
Cuboid Syndrome is a problem that develops in the joints around the cuboid bone if they are not stable when the peroneus muscle contracts. As the cuboid acts as a pulley for the change of direction of the tendon of peroneus longus, the tendon will always try and sublux the cuboid. Normally the bone is anatomically and functionally very stable in its joints and can take the load from the tendon. But if it cannot, then cuboid syndrome is one consequence. The subluxation is often easily fixed with a cuboid mobilization to ‘put it back in place’. Often low dye strapping and foot orthotics can also help cuboid syndrome.
June 4, 2010
Hallux Rigidus
What’s new in hallux rigidus? I had a look around and there is nothing. The only thing that seem to be new is some discussions around the terminology (Functional hallux rigidus), some research on how it affects gait (Gait changes following cheilectomy for hallux rigidus), and some outcome studies on surgical procedures (Surgery for hallux rigidus). This is somewhat disappointing that it is a common problem and is frequently seen in podiatric practice. The treatment options still remain pain relief, some sort of rocker in or outside the shoe to restore the pivot and surgery. As the biomechanics of hallux rigidus are far reaching up the kinetic chain would you not expect more to have been done on it.