Monthly Archives: October 2014

The Six Determinants of Gait

I need to remember this to remember these for the boards!
1. Pelvic rotation
2. Pelvic tilt
3. Knee flexion in stance phase
4. Foot mechanisms
5. Knee mechanisms
6. Lateral displacement of the pelvis


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Cuboid Syndrome

Cuboid syndrome is a reasonably common problem on the outside of the foot commonly seen in athletes. The cuboid bone is a small bone just in front of the heel bone and behind the base of the fifth metatarsal. It acts as a pulley for the tendon of the peroneus longus muscle  which is a very strong muscle. As this is a strong muscle it does require that the cuboid bone be very stable to act as a pulley for the tendon. If the bone is not stable it will tend to move when this muscle contracts straining the joints around the bone. This is what cuboid syndrome is. The treatment for cuboid syndrome is generally in the short term to mobilise the bone and treat the symptoms and in the long term is to use interventions to increase the stability of the cuboid bone so the strain does not happen to the joints around the bone.

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Charcots Foot

Charcots foot is a particularly complex complication of diabetes in those who have developed the peripheral neuropathy or nerve damage. One of the functions of nerves is to tell us when something hurts and when the neuropathy develops and diabetes they lose that extraordinarily important signal. This means that when something goes wrong with the foot that hurts they do not know it is hurt. So just imagine what happens if, for example, you sprain your ankle. It hurts. You stop walking on it. You seek treatment for it. Now imagine what would happen if you did not feel the pain from that. It will not hurt. You will not stop walking on it. You will not seek treatment for it. It should be not too difficult to imagine the consequences of that. The damage will be substantially worse. Often the first time that someone with Charcots foot knows they have this problem is that they just notice the swelling, in that one foot is bigger than the other. Those with diabetes really do need to normally take good care of their feet but really keep a close eye on them to make sure there is nothing like this Charcots foot that will develop

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Barefoot Science Insoles

I have caught these insoles being advertised on late-night TV, which should be an alarm bell to anyone. However I was intrigued by them and exactly what was behind them until I read this. There is actually nothing barefoot about them and they are really just foot supports with a really big but more proximal metatarsal dome. They claim that typical foot orthotics weaken muscles and provide no evidence for that and we know from the evidence that typical foot orthotics do not weaken muscles. They claim that the barefoot file science insoles strengthen the muscles, but then fail to provide any evidence for that. It all looks like pseudoscientific nonsense to me. One commentator has even come up with a hypothetical mechanism in which these insoles would actually weaken the muscles that they claim they are strengthening. That does not mean that they do or do not help some people who might have pain in their feet. From what I can gather the bulk of the complaints about these insoles are not really about the insoles themselves but about the unsubstantiated claims that get made for the product.

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Metastasis from a distant cancer to the foot

I am in awe of this thread on Podiatry Arena. It lists all the cases of a metastasis from a distance tumor that was causing pain in the foot. In many of those cases the initial symptoms of that distant tumor was the pain in the foot. That thread on Podiatry Arena started in 2005 and has over 60 cases reported. Obviously this is very rare and many podiatrists will probably go their entire career and never see one of these. But it does emphasize just how extremely important it is to get the diagnosis of the cause of pain in the foot, or anywhere else for that matter, as on those very rare occasions there is a potential life-threatening cancer that underpins the symptoms. This is what podiatrists train for, to get that differential diagnosis right and not to find these sorts of problems but to rule them out. That is why we train for as many years as what we do.

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Calcaneal Apophysitis

Calcaneal Apophysitis is the technical name for a common cause of heel pain in kids, that is more commonly known as Severs disease. The problem affects the apophysis at the back of the heel bone or calcaneus hence its name. It is assumed to be a stress reaction in the cartilage that is part of the growing area of the heel bone. It is more common in kids that are overweight or play a lot of sporting activity, especially on hard sports surfaces. The most common symptom of this is pain at the back of the heel and pain on squeezing the sides of the heel bone. The most common treatment that I have been taught to use is just to use a heel raise that relieves the pool from the Achilles tendon and give some shock absorption. This does help the vast majority of cases of Calcaneal Apophysitis but a few will need total abstinence from sporting activity and even a walking brace to further restrict activity.

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Why Have Bunion Surgery?

There are two reasons to have bunion surgery. 1) bunions hurt and (2) its the only way to make them go away.

Bunions are an enlargement of the big toe joint generally caused by a genetic predisposition, biomechanics and poor fitting footwear. There are a number of conservative treatments that can be used to deal with the symptoms of bunions, but the problem will always remain as long as the bunion is there. The choice is simple: continue with the conservative treatments to manage the symptoms or have surgery to make it go away.

However, if what caused the bunion in the first place is still there after the surgery there is a possibility that the bunion will come back again, so it is important that the surgeon addresses the cause of the bunion.

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