Kohler’s Disease in Kids

The navicular bone in the foot is just in front of the ankle joint and forms what is the apex of the arch of the foot. As it is at the apex of the arch it is subjected to substantial pressure and load when walking and in other activities. In adults if the load on that bone is too much for it to take, a stress fracture can result. In younger children a particular condition known as Kohler’s disease can affect the navicular bone. This is an osteochondritis or ischaemic reaction within the bone due to the loads on the bone affecting the blood supply. This generally presents as a limp in the child typically around the age of five with vague pain over the navicular. On x-ray the navicular is much thinner compared to the other side. Generally the treatment for this is to put the child into a cast or walking brace to limit weight-bearing and to limit load on the bone so it can heal up. This is generally needed for six or so weeks and is extremely important as that ischaemic area in the bone needs to be reversed.

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Newtons for Christmas!

For a Christmas present this year I was given a pair of the Newton running shoes. These running shoes have what are called lugs under the forefoot that are claimed to help improve the running technique or running form. Not quite sure what to think about them yet, I went for one short run today and I wouldn’t say I like them but I also would not say that I did not like them. I will say they are unusual. There have been done some research on these lugs which is what picked up my interest. I guess I will just add the shoes into my running shoe rotation and do a few more shorter runs on them before trying anything longer.

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My new fav running shoe: New Balance Minimus

Just started doing some of my shorter runs in the NB Minimus running shoe. It was a shoe that was born out of the recent barefoot and minimalism running fad. I really do kike this shoe, mostly as it does fit my foot almost perfectly as far as the shape goes.

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The Navicular Drop Test

I seem to be posting a lot about different clinical tests that I knew nothing about when I was a student (for example the lunge test). The navicular drop test is also a test I knew very little about when I was a student. This video explains what it is

Like the lunge test it appears the navicular drop test is used a lot by podiatrists outside the USA and by physical therapists worldwide. It is just a measure of of how much the arch collapses when the foot pronates or supinate so it certainly can be seen how useful it is.

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The Lunge Test

This is not a test that I got taught about as a student, but it does seem to be popular among podiatrists outside the USA and by physical therapists worldwide. The lunge test is a weight bearing test for the ankle joint range of motion. This video desrcbes it:

Normally you would want to see the knee go past the foot around at least 4 inches in an average height person. If not, then stretching and a heel raise may be indicated. I also like to do this test with the shoes on and the orthotics in the shoe. The lunge test is useful, especially in athletes.

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The ‘Best Running Shoe’?

I get tired of that question. Yes I know a lot about feet, running and running shoes. That does not mean that I know what is the best running shoe. The reason for that is there is no such thing as the best running shoe. What works for one runner will not work for the next runner. There are over 100 different running shoe brands and each brand has a number of different models, so there are almost a 1000 different running shoes. The best one will be the one that suit the characteristics of the individual runner. Each runner is unique with different foot types (eg overpronation), running techniques and running experiences. Each running shoe model is unique. The challenge to get the best set of features in a running shoe that match the best set of characteristics – get the match right and you have eh best; get the match wrong and you have the worst. The problem is that it is not entirely clear how to work all this out and often it can be a matter of trial and error.

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The Hubscher maneuver or Jacks test?

When I was a student we were taught about the Hubscher maneuver. This is a test of the windlass mechanism of the foot in which when the patient is standing, you grab the biog toe and lift it up. When this happens, the arch of the foot should raise. I have always called this the Hubscher maneuver. I learnt today that this is a US term and the rest of the world calls it Jacks test.

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