Podiatry Update

Overpronation in Runners

2011-12-29T10:52:00.002+11:00

“Overpronation” has been some sort of buzz word in the running community for a long time, but is generally a meaningless term. It is widely used to wrongly prescribe a specific running shoe (ie motion control). The real problem with the term is that it is a substantial oversimplification of what is actually happening to the foot and the use of the term seems to have made experts in it by some

Navicular Stress Fracture

2011-12-21T17:20:00.001+11:00

Navicular stress fractures are a diagnostic challenge and the existence of the so called “N spot” over the navicular is an important diagnostic suspicion. X-rays are not always helpful with a significant number of false positives. There are no short cuts with a navicular stress fracture, the time non-weightbearing away from sport is a minimum of 5-6 weeks. There is no way around this. I have

Running With a Cadence of 180 Steps a Minute

2011-12-13T19:40:00.002+11:00

The concept of runners shortening the stride length and increasing the cadence to 180 steps a minute has been coming up as a concept a lot me recently. I am not sure what to make of it. Some prominent coaches and running form experts are advocating it to reduce the risk of injury. At the same time a number of sports scientists are dismissing it as not valid. Most runners tend to naturally adopt a

Does the Circulation Booster Work at Improving Circulation?

2011-09-14T19:13:00.003+10:00

We have all seen the adverts for the Circulation Booster, but can it really boost the circulation? Surely the claims “as seen on TV” and the reliance on testimonials in the marketing should be enough to set off the ‘snake oil’ alarm bells. There is certainly no good scientific data to support its use at improving circulation to the lower limb and the Therapeutic Products Advertising authority in

'Top of Foot Pain' Management in Barefoot Runners

2011-09-01T18:17:00.007+10:00

Despite all the propaganda that barefoot or minimalist running is better due to less injuries occurring, it is now becoming increasingly clear that it is not the way to get less running overuse injuries. Just check any barefoot/minimalist website and look at all those looking for advice on their injuries! Just ask any of the health professionals who treat a lot of running injuries. Most will tell

Do shoes cause flat foot in children?

2011-08-10T11:44:00.003+10:00

There have been a number of previous studies in children in African countries that have shown a high correlation between flat foot and the wearing of shoes. This often gets touted as the shoes caused the flat foot and is used by those with an agenda to promote barefoot. However, that is not what those studies showed. All they showed was a correlation. Correlation does not mean causation The

Growing Pains in Children

2011-05-29T14:56:00.000+10:00

Just have been having to deal with the issue of growing pains in the children. Growing pains in children have a very specific definition – its unexplained pain usually at the back of the knee and upper calf muscles that occurs at night. The cause is thought to be fatigue and sleep related, so is probably a biochemical problem. The real problem with the term growing pains is that any leg pain can

Manipulation for Cuboid Syndrome

2011-05-01T17:41:00.003+10:00

Cuboid syndrome is an interesting condition with many different understanding about what exactly it is; what causes it; and how to treat it. Everyone seems to have an opinion on cuboid syndrome. Is it a subluxed cuboid? Or is it just a strain of the ligaments about the joints the cuboid is involved in. Opinions are also divided on the value of cuboid manipulation. For some it’s the only treatment

Is Forefoot Varus Posting Bad?

2010-12-07T12:45:00.002+11:00

internal rotation moment to leg; the opposite leg is

Recomended Running Shoes

2008-10-21T23:01:00.003+11:00

Advising runners what shoe to use is always difficult. Shoes change frequently and what suits one runners does not necessarily suit another, even if they appear to have similar needs. Keeping on top of who needs what and what company makes what is always difficult. This grid is a good step in the right direction to pick up what shoes models fit into what category of running shoe.Back to home page

Gout

2008-09-22T17:37:00.005+10:00

I use this quote (not sure where I got it from) during lectures to students to suggest just how painful gout is: “Screw up the vise as tightly as possible - you have rheumatism; give it another turn, and it is gout” - AnonymousHere are a couple of good threads at Podiatry Arena on Gout:The latest on gout (this one has all the very latest news)Reason for gout in more peripheral joints (this one

Running Shoe Forum

2008-09-08T16:11:00.005+10:00

I have been asked to do some work on a Running Shoe forum. Here are some links to the section that need some work: Running shoes Nike Brooks Best running shoes New balance Adidas Asics Mizuno Spira Saucony Newton Kids Running Shoe Reviews . The forum has not been officially launched yet, but they are looking for people to help out to get the content developed before the official launch.Back to

Leg Length differences

2008-08-28T15:47:00.004+10:00

This can sometime be a hot topic. In orthopaedic circles, what is considered a significant difference between the two legs can be quite large and in chiropractic circles what is considered significant can be quite small. Both sides of the argument can be quite passionate about this.Reminds me of Payne's Law: "The amount of passion involved in defending a theory and the amount of emotional

Functional hallux limitus

2008-08-11T12:46:00.005+10:00

I am privileged with the honour of being invited to speak at many conferences. Most recently was at the Podiatric Surgeons conference. When I agreed to speak, I did not think to much about about the topic until I was back from another conference, then I had a OMG why did I agree to talk about that moment ? What the hell am I going to say?One reason I enjoy speaking at conferences is that it

Chi Running

2008-07-31T03:07:00.014+10:00

Chi running is a "movement" within the running community based a particular running technique based mostly on being more efficient, relaxed and having a midfoot strike. I initially dismissed it as just another one of those fads until I noticed that one of the key Chi running websites had an alliance with New Balance running shoes and they have a shoe that is specific for Chi Running. I wonder

Research on one foot, two feet, or one person

2008-07-16T00:17:00.004+10:00

I have recently reviewed several manuscripts that I recommended that editors not publish due to a fundamental flaw in the methodology. It concerned me enough to post a thread here about it (and will freely admit that I have been guilty of this in the past, but times change as we learn more).One potentially appealing thing about doing foot or podiatry research is that each subject has two feet,

Hubscher manoeuvre

2008-07-14T15:49:00.005+10:00

There has been some good discussion at Podiatry Arena on the Hubscher maneuver (terminology primarily used in the USA) or Jacks Test (used by the rest of the world!). A poll in that thread showed that 82% of those that responded to the poll used it as a clinical test.A lot of the discussion focused on it value as a static clinical test used to predict dynamic function and, more important, as a

This is a fun read

2008-06-10T18:30:00.004+10:00

At Podiatry Arena, a post was made about some research that should have never been published in the Journal of the American Podiatric Medical Association. It was an appalling piece of research. The inclusion criteria was biased toward getting the result that the researcher wanted. No means or standard deviations of the data was presented, yet the author managed to do a t-test on the data! The

The researcher vs the clincian

2007-08-26T06:59:00.001+10:00

This dichotomy keeps coming up.Most recently in this Podiatry Arena thread:No evidence for foot orthoses in children (notice the questions by clinicians directed at the researchers about the type of foot orthotics used)Previously it came up in this thread:Effectiveness of Foot Orthoses to Treat Plantar Fasciitis (notice the really poor understanding by clinicians of just what is a randomised

The 5 great FALLACIES of podiatric biomechanics

2007-07-11T22:32:00.003+10:00

Adam asks:"I've been refreshing my comprehension of pedal biomechanics of late and wondered if you had an opinion on what the 5 greatest mis-truths of this discipline are.In other words what concepts most people think/ assume are correct, that haven't yet been tested by science or are likely to be."Read the responses.Back to home page

Gangastapod

2007-02-11T09:56:00.002+11:00

For a different view of evidence based practice, check GangstapodBack to home page

2006-09-24T11:11:00.003+10:00

This study has generated a lot of good discussion:Effectiveness of Foot Orthoses to Treat Plantar Fasciitis A Randomized TrialKarl B. Landorf, PhD; Anne-Maree Keenan, MAppSc; Robert D. Herbert, PhDArchives of Internal Medicine 2006;166(12), June 26:1305-1310."Background Plantar fasciitis is one of the most common foot complaints. It is often treated with foot orthoses; however, studies of the

How important is debridement in onychomycosis?

2006-01-29T07:13:00.003+11:00

This paper has generated some good discussion:Study to determine the efficacy of Clotrimazole 1% cream for the treatment of onychomycosis in association with the mechanical reduction of the nail plate"Onychomycosis is invasion of the nail by dermatophytes yeasts and moulds [Calderon RA, Hay RJ. Fungicidal activity of human neutrophils and monocytes on dermatophyte fungi Tri. Quinckeanum and Tri.

Feds accuse foot doctor of massive Medi-fraud

2006-01-14T20:51:00.002+11:00

This not good:"Federal prosecutors say a Middlesex County podiatrist bilked the government of hundreds of thousands of Medicare dollars by submitting claims for treatments that were little more than massaging feet and clipping toenails. A civil complaint filed in federal court in Newark said Ming Tung, who lives in East Brunswick and has offices there and in Jersey City, ignored warnings about

The Mid Tarsal Joint

2006-01-14T20:47:00.002+11:00

The midtarsal joints is one of those joints that is subject to so much ongoing debate, discussion, scientific and theoretical modeling. Chris Nester has attempted to, at least, get everyone speaking the same language with this new publication: Clinical and Experimental Models of the Midtarsal Joint Proposed Terms of Reference and Associated Terminology Journal of the American Podiatric Medical

Comparison of foot orthoses made by podiatrists, pedorthists and orthotists

2005-12-22T16:34:00.003+11:00

"Within each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p< .001). This was also true for the effect in the regions with the highest baseline peak pressures and

What defines podiatry as a profession

2005-12-17T23:11:00.002+11:00

In this discussion on Who Treats Feet?, I posted this message:That is an issue - what defines "podiatry" as "podiatry" so that it is different from other professions --- in the USA, podiatry is clearly part of the medical model - in the rest of the world it is not, where it is a discipline similar to physiotherapy etc (that is despite limited numbers with surgical qualifications in places like

Plantar fasciitis discussions

2005-12-16T00:15:00.002+11:00

Podiatry Arena has had a lot of good topics and discussions on plantar fasciitis:Orthoses vs plantar fasciitisIs a calcaneal spur in the plantar fascia?Extracorporeal Shock Wave Therapy:Ultrasound therapy for plantar fasciitisPlantar fasciitis and dorsal painNutrition and plantar fasciitisBotulinum toxin and plantar fasciitisFirst-Step PainPlantar fasciitis is associated with functional

The common cold and cold feet.

2005-12-04T19:18:00.002+11:00

The common cold is a viral infection .... being exposed to the cold does not cause a cold.... at least that is what I have always been led to believe - but is it so? This recent study has shown that cold symptoms develope in some when the feet are exposed to the cold:Acute cooling of the feet and the onset of common cold symptoms.Back to home page

Does genu valgum cause the foot to pronate?

2005-11-17T05:03:00.003+11:00

This one has troubled me for a while.When teaching the pediatrics part of the course here, especially the genu varum and genu valgum, it always comes up about the effect they have on foot function. Genu vaurm affects the foot as it has to pronate to get the foot flat on the ground. According to so many podiatric texts, genu valgum also causes the foot to pronate as the center of body weight is

Foot Outcomes measures

2005-10-02T15:37:00.002+10:00

I let my frustration show a bit here:Another bl....y outcome measure for the foot"Does anyone share my frustration at the plethora of outcome tools that have been developed for the foot . When will it stop? When will people actually stop developing them and start doing research that actually uses them."" It just seems as though people are more keen to develop yet another outcome tool, rather than

Good Feet Stores

2005-09-18T10:56:00.001+10:00

There has been an exposure on this franchised chain of stores using hidden video camera's:Good Feet StoresBack to home page

Mythbusting

2005-09-18T10:53:00.002+10:00

Along the theme of the Discovery Channel's Mythbusters - Podiatry Arena has been doing some mythbusting:The foot on the long side does not pronate more in LLDForefoot Varus is rare"First Ray Hypermobility" is really bad terminologyRunning shoe technology does not reduce injuries Do foot orthoses weaken "arch" muscles?Flat-footed 'are high achievers' Is a calcaneal spur in the plantar fascia?The

Lots of fun

2005-09-04T13:46:00.001+10:00

Lots of fun and content at the Australasian Podiatry Council Conference in Christchurch, New Zealand. A couple of pictures and some reports here.Back to home page

Foot pronation and leg length differences

2005-08-21T12:50:00.002+10:00

I recently posted this message at Podiatry ArenaAsymmetrical foot pronation has the potential to create a LLD of up to 1cm (based on Bill Sanner's work), so obviously this will have consequences further up the chain (esp as the pronation is also associated with internal limb rotation).What I am talking about is a foot pronately excessively as a compensation for a STRUCTURAL LLD - something that

The placebo effect of foot orthoses

2005-08-13T20:35:00.002+10:00

We all know about the possible placebo effect of our treatments etc etc, but tend not to pay a great deal of attention to it...We have a plantar fasciitis RCT in press at the moment - subjects randomised to one of 3 "inserts" (all of which can be purchased from a retail pharmacy) - these are devices that I would never consider using clinically (they are that bad) ..... to our dismay all but 3 of

Is the calcaneal spur in the plantar fascia?

2005-07-17T17:45:00.003+10:00

In a Yahoo Groups Discussion on manipulation, a question was asked:"What is the best treatment for plantar fascitis induced heel spurs... " to which I replied:"Since when did heel spurs have anything to do with the plantar fascia?"Needless to say there was some interesting comments that followed, mostly based on what people were taught as students, and NOT on a reading of the research

Foot Health Status Measures

2005-05-29T14:56:00.002+10:00

There are a number of tools for measuring outcomes and foot health status. Some of the tools include, the Foot Health Status Questionnaire, the Foot Function Index and now there is the Bristol Foot ScoreBack to home page

Podiatrist gets death penalty

2005-05-25T16:51:00.002+10:00

From LA TimesA federal jury decided that a Chicago podiatrist should get the death penalty for killing a disabled patient to keep her from testifying against him in a Medicare fraud case. Ronald Mikos, 56, was convicted earlier this month of murder, and was also found guilty of defrauding Medicare out of more than $1 million by billing it for thousands of operations that he never performed.

Podiatrist facing death penalty.

2005-05-15T19:26:00.001+10:00

This has been an interesting story to follow:"A Chicago podiatrist murdered a former patient just days before she was to testify against him in a fraud probe because the doctor believed she would be the lone witness against him, a prosecutor said Tuesday...""Joyce Brannon had reportedly undergone 72 foot surgeries at the hands of Chicago podiatrist Ronald Mikos, the man she was set to testify

Custom vs prefabricated fot orthoses

2005-05-08T21:21:00.002+10:00

This debate has been going on for years and will continue. All research to date has shown no differences in outcomes between the two. The exception is this recent publication on foot pain in those with juvenile chronic athritis:Efficacy of Custom Foot Orthotics in Improving Pain and Functional Status in Children with Juvenile Idiopathic Arthritis: A Randomized Trial MARY POWELL, MICHAEL SEID, and

Nurses providing footcare

2005-05-01T17:53:00.002+10:00

Nurses providing foot care is proving to be somewhat controversial:Nurses Administering FootHealthCare in UK? Nurses Entrepreneurial Foot Care Association of Canada The New Foot Care Nurse... COMMENTS! Add your comments...Back to home page

Cancer Metatasis to the Foot

2005-03-25T13:56:00.002+11:00

Every few years, there is a case report in the literature of foot pain being either the presenting feature of cancer or occuring in those with known cancer somewhere else in the body (due to a metastasis). Recently, there have been two ..... providing a timely reminder of our importance in arriving at a correct diagnosis:From: International Urology & Nephrology. 2004;36(3):329-30.Renal cell

Qualitative research on diabetic foot ulcers

2005-03-14T21:20:00.002+11:00

Medscape have a full text article on this (free registration required to access)A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist PerspectiveAbstract The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are

New research should have impact on clinical practice

2005-02-27T00:35:00.001+11:00

The latest Diabetes Care has two important papers:Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trialDavid G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. BoultonOBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in

RCT on Foot orthoses and low back pain

2005-02-06T13:55:00.002+11:00

A Controlled Randomized Study of the Effect of Training With Orthoses on the Incidence of Weight Bearing Induced Back Pain Among Infantry Recruits. Spine. 2005 Feb 1;30(3):272-275.Milgrom C, Finestone A, Lubovsky O, Zin D, Lahad A.Quote:STUDY DESIGN.: Randomized controlled trial. OBJECTIVES.: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back

Ischemic diabetic foot ulcers do respond to total contact casting

2005-01-28T09:15:00.001+11:00

There has always been a reluctance to use total contact cats on diabetic ischemic ulcers. This latest study in Diabetes Care has shown that moderate ischaemic ulcers do respond:Total Contact Casting of the Diabetic Foot in Daily Practice A prospective follow-up study Marrigje H. Nabuurs-Franssen, Ron Sleegers, Maya SP Huijberts, Wiel Wijnen, Antal P. Sanders, Geert Walenkamp and Nicolaas C.

Interclinician variation in diabetes foot assessment- a national lottery?

2005-01-21T19:12:00.001+11:00

From the latest Diabetic Medicine:Interclinician variation in diabetes foot assessment- a national lottery?L. Thompson, C. Nester, L. Stuart and P. WilesAim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.Methods Seventeen clinicians assessed three patients with diabetes using a standardized

Asymptomatic pediatric flatfoot

2004-12-30T20:00:00.001+11:00

This is another one of those perennial issues that keep coming up. Discussing it with some people is like arguing a religion (and because of the $$$ involved). Views are varied from one extreme of leaving them all alone to the other extreme of using expensive custom made orthoses every 6 months in them all. There are divergent views within the podiatric profession and divergent views within the

Diabetic Foot Natural History

2004-12-25T16:48:00.001+11:00

Some pretty bold claims were made on altering the natural history of the diabetic foot in this paper: Changing the Natural History of Diabetic Neuropathy: Incidence of Ulcer/Amputation in the Contralateral Limb of Patients With a Unilateral Nerve Decompression Procedure (Ann Plast Surg. 2004 Dec;53(6):517-522 Aszmann O, Tassler PL, Dellon AL.). The authors claims that "decompression of lower

2004-12-11T15:07:00.001+11:00

Good friend of mine, Cameron Kippen has now ended his time at Curtin University to move on to other things. Read comments here. Cameron is well know for his sex and footwear work :-)Back to home page

Foot orthoses outcomes and kinematic changes

2004-12-11T15:01:00.001+11:00

To get some debate going, I just posted this at Podiatry Arena:"Foot orthoses outcomes and kinematic changes1. We use various types of foot orthoses in clinical practice in an attempt to alter the pattern of rearfoot motion to "improve" biomechanics and make patients better.2. Numerous outcomes studies, patient satisfaction surveys (many with methodological flaws) and RCT's show patient do get

2004-12-07T18:27:00.001+11:00

The latest British Medical Journal has a full text article on Tibialis posterior dysfunction. Its a good review and has a podiatrist as co-authorThere is some interesting speculation from the Journal of Pediatric Orthopedics on the causes of growing pains. ... problem is when someone talks or writes about growing pains, its not clear that we are talkng about the same thing.....and a bit of fun in

2004-11-26T10:15:00.001+11:00

ABC News are reporting on concerned expressed by the Australian Podiatry Assciation (WA) about the impact of the closure of the course at Curtin University. MorePodiatry Management have the full text of The Comprehensive Diabetic Foot Exam (CDFE) - A Win-Win For Doctor and Patient available from their Nov 04 issuePodiatry Today have the full text of A Closer Look At Deep Vein Thrombosis

Burnout High Among Podiatrists, but Not Inevitable

2004-11-23T20:54:00.001+11:00

Burnout High Among Podiatrists, but Not InevitableFrom Podiatry Online:"Burnout among podiatrists doesn't have to be inevitable. Many podiatrists view it as a job hazard, something that they believe goes along with the stress of dealing with people and their problems day in and day out, but that's not so.Research about burnout and occupational stress relating to podiatry is lacking, although a

Podiatrist Sentenced for Medicaid Fraud

2004-11-21T10:32:00.001+11:00

Podiatrist Sentenced for Medicaid Fraud "A podiatrist is going to jail for playing footsie with Medicaid."Some interesting threads at Podiatry Arena:Serial casting for internal tibial torsion Vioxx The Pros and Cons of Computerized Foot Orthotic Technology Prefabricated vs custom made foot orthoses Decompression drilling for heel pain Congratulations to Mike Edmonds, Ali Foster and Lee Sanders

This is getting exasperating!!!! - here is anthor:

2004-11-12T08:27:00.001+11:00

This is getting exasperating!!!! - here is anthor:Unclipped nails: Symptom of patients getting clipped"A Las Vegas podiatrist allegedly seeking reimbursements for ingrown toenails that were never clipped is one of the growing number of cases across the nation involving health care fraud, authorities noted at a national conference Tuesday."I think I need to go and find a good news story.... anyone

Doc indicted in thefts from widow

2004-11-11T22:39:00.001+11:00

Another one!!! ---really on a roll here:Doc indicted in thefts from widow" A Spring Lake podiatrist who lost a court battle over his elderly neighbor's fortune was indicted in Monmouth County yesterday for allegedly duping the eccentric widow out of her home and wealth"Back to home

Leg Length Differences and Quality of Life

2004-11-10T09:34:00.001+11:00

In the lastest Journal of Vertebral Subluxation Research, there is a paper on leg length differences affecting quality of life .... it was only a small pilot study, but results are interesting.AbstractDiscuss this at Podiatry ArenaBack to home

What is it with Podiatrists at the moment

2004-11-08T05:13:00.001+11:00

ANOTHER ONE - What is it with Podiatrists at the moment!!! :-)Doctor charged in arson of homeBack to home

Another naughty podiatrist!!!!

2004-11-06T08:30:00.001+11:00

ANOTHER ONE!!!!Mississippi high court to hear medical malpractice caseBack to home

Another naughty podiatrist

2004-11-05T18:22:00.001+11:00

Another one !!!Salem podiatrist guilty of Medicaid fraudBack to home

More Naughty Podiatrists

2004-11-05T07:37:00.001+11:00

More naughty Podiatrists:Podiatrist free on promise not to leave United StatesDrugs given by podiatrist allegedly out-of-dateBack to home