Hallux rigidus is a big toe joint that does not move. Invariably this is due to osteoarthritis in the joint that has progressed to the stage that the joint hardly moves. Hallux rigidus makes not only the joint painful, but as the joint is not moving properly, other joints get forced to move at a time when they should not be moving. These compensation in other joints can also be painful. The big toe joint is so important for forward motion as this is the joint that the body pivots forward over the foot when the foot is in the ground. The treatment for hallux rigidus is to somehow restore that motion, which in a joint with osteoarthritis is not really possible. The only options are to add some sort of rocker to the shoe, so the foot can pivot forward over the rocker and not need to use the joint. The other option for hallux rigidus is surgical, in which the joint is either fused or replaced with a spacer so there is still some movement.
Questions keep being asked in all sorts of forums about the MBT Shoes (MBT Shoes, do they Work?; Do MBT shoes Work). MBT stands for Masai Barefoot Technology and the shoes are designed to mimic the gait of the Masai tribe from Africa, who have a very upright posture and do not develop any postural or low back problems. The shoe is designed to help people with these problem A number of studies have shown the biomechanical effects of the shoes, but very limited studies have shown the effects on outcomes. The shoes certainly do help some people with these problems and do not help others, and the evidence provide little guidance. When MBT shoes first came on the market they claimed to cure everything including cellulite. It was this cellulite claims that got them labels as ‘snake oil’. That claim has now been removed from the website. From what I have observed a key principle in using MBT shoes is the correct use of them and there are videos to aid that.
Golf is a popular sport or activity for participation and for competition. It attracts millions of dollars in sponsorship and prize money (and a few controversies!). There are a lot of golf forums on the web for discussion of golfing and related issues. Foot orthotics for golf do raise some issues when they are indicated. On the one hand you need a fairly supportive foot orthotic to control the foot over the long distances that get walking during a game of golf (and unless you are a pro, you have to carry or pull the extra weight of the golf clubs). On the other hand, the rearfoot area of an orthotic for a golfer needs to be reasonably flexible to allow for the side to side motion that happen in stance during a golf swing. Just what needs to be done to help the golf biomechanics is always going to be one of compromises between these two competing considerations.
Cyclists bring a particular challenge to podiatric practice. Running and other sports have a swing phase to gait when the foot is off the ground and not weight bearing. Cycle “gait” does not really have a swing phase and the foot is constantly “weight bearing”. This makes for an unusual injury risk profile due to the constant “stance phase”. Added to that is the relatively tight cycling shoes that cyclists tend to wear means that there is not a lot of room in the cycling shoe if foot orthotics or some sort of in-shoe modification is needed. The set up of the cycling for efficient biomechanics is the first step. Cycling foot orthotics can be challenging but when they are needed, they are needed. Given the distances and days that cyclists compete over, the risk for overuse injury is high if the mechanics are not set up properly. You often learn more about the problems of cyclists on cycling forums than cycling on podiatry forums.
Peroneal tendonitis is not a common problem that occurs on the lateral side of the ankle, usually starting with an ache above and/or below the lateral malleolus. It seems to occur in those with low supination resistance. This mean that the peroneal muscles are having to work much harder to resist that force that is easy to supinated. Combine that with some sports activity, then there is a high risk for peroneal tendonitis. This means that the treatment for peroneal tendonitis is to use some sort of lateral foot wedging to reduce the force that the peroneal muscle need to contract. There is a paranoia among some clinicians about the lateral wedging pronating the foot more and creating more problems, but those that use this do not see this problem. Peroneal tendon problems can be difficult to manage.
Asics running shoes seem to some of the more popular on the market today. They are responsible for a number of technical innovations such as the Asics space trustic system that is claimed to enhance the windlass mechanism of the foot. The Asics running shoe company has sponsorship deals with a number of sports medicine organisations around the world. Some of the popular models in the Asics running shoe range include the Asics Gel Kayano, the Asics Gel Cumulus, The Asics Gel Nimbus and the Asics Gel DS trainer. There are many shoes in the Asics running shoe range and it can be a bit hard at time to keep on top of them all, let alone the range of shoes from all the other companies.
The diabetes epidemic that is sweeping the world is being fuelled by many things. There is the obesity epidemic, the lack of traditional exercise, the westernization of traditional diets (I have even heard this called the Coca-Colonisation of traditional societies). It is all adding up to a looming health care crisis. From a podiatry perspective, this means the ‘diabetic foot’. The diabetic foot is that foot that has been placed at increased risk from damage due to the processes of diabetes. In the diabetic foot, the nerve sensation is affected, so this means that any damage that happens is not detected. In the diabetic foot, there is impaired healing due to compromised blood supply and immune responses are slower. In the diabetic foot there are biomechanical changes to the way the foot function that place it at greater risk for tissue damage. The diabetic foot presents many unique challenges to Podiatrists.
Sinus tarsi syndrome can be a tricky problem. It usually presents with pain on the outside of the ankle joint. Sinus tarsi syndrome can be due to two quite distinct causes. It can follow a lateral ankle sprain in which the structures in the sinus tarsi are damaged as part of the ankle sprain. This usually presents as a chronic problem following the ankle sprain. The other cause of an sinus tarsi syndrome is a chronic pronated subtalar joint in which the joint functions at its end range of motion. If the forces driving the joint into its pronated position are great enough, sinus tarsi syndrome can result. Treatment of the post-ankle sprain sinus tarsi syndrome is best managed with physical therapy and mobilisation. The chronic sinus tarsi syndrome from a pronated foot is best managed with a foot orthotics. In either case, if they are resistant to treatment, they can be helped with a sinus tarsi injection.
The Cluffy Wedge is an extension for a foot orthotic that has been getting some attention lately. All it is aimed at doing is slightly dorsiflexing the hallux, which many call preloading the hallux. The effect of this is to bring the windlass mechanism into effect earlier, which is really helpful for those with a delay in windlass action (they require more dorsiflexion before the resistance of the windlass is felt). It is also use for functional hallux limitus. The Cluffy Wedge was developed by Dr James Clough who published a paper on it in JAPMA and has lectured on it. There are a number of You Tube Videos on the Cluffy Wedge.
Chilblains are a common skin condition in the colder climates that occur on the toes. Chilblains, however, are NOT caused by the cold and they are NOT caused by poor circulation. The cause of a chilblain is a too rapid warming of the foot or toe after it has got cold and the circulation not responding quick enough to that warming. It is not the cold that is a probem in chilblains, it is the rewarming that the problem. It’s not the quantity of circulation that is the problem, it how the circulation responds. The best way to prevent chilblains is not get cold in the first place and if you do, make sure any warming of the foot happens very slowly.
Severs disease is a relatively common problem in youngsters aged 10-15 years. The pain is felt at the back and sides of the heel. This is where there is a thin cartilage growth plate that allows the heel bone to grow. This growth plate merges with bone by age 15, so it’s no longer a problem after that. Severs Disease tends to be much more common in those who are more active, particularly on the harder sports fields. The Achilles tendon also attaches to the back of this growth area, so that increases the pull on it. It has been suggested that severs disease be thought of as a stress fracture and should be treated like a stress fracture (but there is no evidence if it is or not actually a stress fracture). The best initial treatment of severs disease is a reduction in sports activity to tolerable levels and the use of a cushioned heel raise. Sometime foot orthotics are used to correct foot alignment and calf muscle stretches are also considered important. Ice is often helpful when the severs disease is painful.
I just came across this new site, Podiatry Tradeshow. It’s got a listings of things like all the podiatry suppliers and all the foot orthotic labs from around the world. It’s a good resource.
Plantar fasciitis has got to be by far the most common musculoskeletal problems of the foot. It also gets commonly mislabelled as a heel spur which are not a problem. The problem is the plantar fascia inserting into the heel bone. The key symptom of plantar fasciitis is plantar heel pain after arising from rest, especially getting out of bed in the morning. This pain after rest for the first few steps is almost diagnostic of the problem. Plantar fasciitis is due to too much load in the long ligaments that supports the arch of the foot (the plantar fascia). This load can come from higher levels of activity, being overweight and having tight alf muscles. As this is a load issue, then the only proper way to manage plantar fasciitis over the long term is to reduce the load in the plantar fascia. This can only be done with low dye strapping and certain foot orthotic design parameters. All other treatment modalities (eg shockwave, ultrasound, accupuncture, etc) are really aimed at helping the tissue heal that are damaged as part of the plantar fasciitis. They are not going to be very helpful if the load going through the plantar fascia is not addressed.
There are many ways to measure or determine the posture or alignment of the foot. The problem with any one method is that the foot may be normal or abnormal on that measure (eg arch height) and yet be the oposite in another measure (eg heel alignment). So the foot may be classified as being normal or abnormal depending on the measure used. Tony Redmond developed the Foot Posture Index to overcome this problem. The foot posture index is a composite measure of 6 factors that get added together to give an index of foot posture or alignment. The Foot Posture Index has been shown in most studies to be reliable and also having some validity.
