Monthly Archives: September 2014

Autism and Podiatry

What does autism have to do with podiatry.? Surprisingly it actually has quite a bit. Firstly those who have kids who are somewhere on the autistic spectrum are no different to other kids when it comes to developing foot problems. They still need to have their foot problems treated and those foot problems may or may not have anything to do with the autism. This means that podiatrists do need to be very familiar with the autistic spectrum, the behaviours that this creates in children, and have the skills and tactics to interact with these children. It is challenging but they do need to have their foot problems managed.

Autism is also commonly associated with toe walking, so a child who presents for assessment of a toe walking problem needs to have this considered in the differential diagnosis. It is not the most common reason but the podiatrist does not necessarily need to have the skills to diagnose autism but does need to have the skills to recognize the red flags associated with it that may need to be investigated further. See this collection of discussions of autism on a podiatry forum.

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100 miles per week

That used to be the gold standard for the best runners. It can be traced back to the New Zealand coach Arthur Lydiard who coached many Olympic gold medalists and world record holder back in the 60 and 70’s. He was a strong advocate of a big aerobic base from running 100 miles a week. This is then followed by periods of hill work and speed work on the track prior to the racing season. My impression is that most elite runners today do not run that far.

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Forefoot Striking for Anterior Compartment Syndrome

Anterior compartment syndrome is a overuse problem that is reasonably common in runners and I know that because several of my friends have had it. It occurs when the muscle expands in a fascial compartment that is too tight and this causes a type of compression ischaemia that becomes painful. The treatment of this has largely been unsatisfactory and more often than not ended up in surgery to have that fascial compartment split to accommodate the expanding muscle. Of most interest to me has been the recent discussions surrounding the use of forefoot striking versus rear foot striking when running to manage this problem. One small study with no control group had some very dramatic results in doing just that. Changing the running pattern from heel striking to forefoot striking saved all the participants in the study from needing surgery but, alas there was no control group in the study. So there has been a lot of discussion about is this enough to change clinical practice. Some people have argued that it is because of the potential to avoid the need for surgery. Others have argued that we really do need to wait for a properly controlled study before the widespread implementation of that. I’m on the side that we need to change the way people run now and we really don’t have time to wait for the proper controlled study.

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Knee OA Treated by APOS Therapy

APOS thearpy is a device or what the company calls a ‘biomechanical system’ which sound a bit more sexy. It consists of two individually calibrated thingys (don’t know what else to call them!) that are attached to the rearfoot and forefoot regions of a shoe. They are adjusted so that the direction of load going through the knee can be changed. This has been shown in some limited studies to help knee osteoarthritis. It is an interesting concept.

http://www.podiatryabc.com/a-is-for-apos-therapy/

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The Airia One Running Shoe

There is a new running shoe that has recently came on the market, the Airia running shoe, that is causing quite a bit of buzz in social media. The buzz is around the shoe claiming that it can improve running performance by 7%. The company has data that says the shoe can do this, but it has not been independently verified. Some people who have tried the shoes love them, other people hate them. They claim to enhance performance by having an elevated lateral column under the forefoot and a large toe spring, and a zero drop. Theoretically this will help some people with their running and not help others which might explain the mixed response that they getting in social media. In other words they will not suit everyone.

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Classification of the Accessory Navicular

The Geist classification divides the accessory navicular into three types:
Type 1 accessory navicular bone:
Commonly called as os tibiale externum; 30% o accesory navicualr; it is a 2-3mm sesamoid bone embedded within the distal portion of the tendon with no connection to the navicular tuberosity and may be separated from it by up to 5mm

Type 2 accessory navicular bone:
About ~55% of accessory navicular bones; triangular or heart-shaped; it is connected to the navicular tuberosity fibrocartilage or hyaline cartilage; may eventually fuse to the navicular tuberosity may take place

Type 3 accessory navicular bone:
Prominent navicular tuberosity; may have been a Type 2

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Abebe Bikila as a poster boy

I find this one really interesting. You often see Abebe Bikila held up as a poster boy by those who like to promote barefoot running. They point out that he won the 1960 Rome Olympic Games Marathon and the gold medal and he did this running barefoot. What they don’t often mention is that four years later he again won the 1964 Tokyo Olympic Games Marathon and the gold medal and this time he ran faster breaking the world record, but he did it in shoes. I would have thought that that is evidence that running in shoes is better than running barefoot, yet you see him widely held up as the poster boy for the barefoot running movement. I just can’t figure that one out

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