Defective running shoes as a contributing factor in plantar fasciitis in a triathlete.

STUDY DESIGN: Case study of a patient who developed plantar fasciitis after completing a triathlon. OBJECTIVES: To describe the factors contributing to the injury, describe the rehabilitation process, including the analysis of defective athletic shoe construction, and report the clinical outcome. BACKGROUND: Plantar fasciitis has been found to be a common overuse injury in runners. Studies that describe causative factors of this syndrome have not documented the possible influence of faulty athletic shoe construction on the symptoms of plantar fasciitis. METHODS AND MEASURES: The patient was a 40-year-old male triathlete who was followed up for an initial evaluation and at weekly intervals up to discharge 4 weeks after injury and at 1 month following discharge. Perceived heel pain, ankle strength, and range of motion were the primary outcome measures. Shoe construction was evaluated to assess the integrity of shoe manufacture and wear of materials by visual inspection of how shoe parts were glued together, if shoe parts were assembled with proper relationship to each other, if the shoe sole was level when resting on a level surface, and if the sole allowed unstable motion. RESULTS: The patient appeared to have a classic case of plantar fasciitis with a primary symptom of heel pain at the calcaneal origin of the plantar fascia. On initial evaluation, right heel pain was a 9 of 10, plantar flexion strength was a 3+/5, and ankle dorsiflexion motion was 10 degrees. One month after discharge, perceived heel pain was 0, plantar flexion strength was 5/5, and dorsiflexion motion was 15 degrees and equal to the uninvolved extremity. The right running shoe construction deficit was a heel counter that was glued into the shoe at an inward leaning angle, resulting in a greater medial tilt of the heel counter compared with the left shoe. The patient was taught how to examine the integrity of shoe manufacture and purchased a new pair of sound running shoes. CONCLUSIONS: A running shoe manufacturing defect was found that possibly contributed to the development of plantar fasciitis. Assessing athletic shoe construction may prevent lower extremity overuse injuries.

The incidence of musculoskeletal injuries in an amateur triathlete racing club.

The sport of triathlon involves three different endurance sports: swimming, biking, and running. Cross-training allows the athlete to train for one sport while resting from another. The repetitive motions required for each sport may lead to overuse and injury. The purpose of this study was to examine musculoskeletal injury incidence in amateur triathletes to determine if these injuries caused lost time from training, racing, working, or daily functioning. Seventy-two recipients responded to survey items that gathered information about demographics, sports participation, and musculoskeletal injury occurrence and interference with sports participation, work, and daily activities. Three-quarters sustained triathlon-related musculoskeletal injuries during training due to overuse. A majority experienced training interruption and interference with daily functioning and sought professional help for their injuries. Little information is available on the treatment of musculoskeletal injuries in triathletes. This survey raises important clinical implications for physical therapists. Further exploration of overuse injury incidence is warranted in this population.

Postarthroscopy physical therapy management of a patient with temporomandibular joint dysfunction.

Arthroscopy of the temporomandibular joint (TMJ) is a new, relatively noninvasive surgical procedure for treating patients with TMJ dysfunction beyond nonsurgical management. The purpose of this commentary is to introduce a four-stage rehabilitation protocol currently used by the authors in the physical therapy management of a postarthroscopy TMJ patient with a diagnosis of bilateral capsular impingement and adhesions. The patient underwent diagnostic TMJ arthroscopy and the four-stage rehabilitation protocol. Stage I exercises to maintain mandibular mobility began in the recovery room. Stage II exercises consisted of hands-on and take-home stretching exercises. Stage III and IV exercises were completed to improve muscular function. The patient was discharged from physical therapy in a month with full range of motion and diminished pain and headaches. At 1-year follow-up, the patient demonstrated full range of motion without pain, further treatment, or medications.

Rehabilitation of the temporomandibular joint after arthroscopic surgery.

Arthroscopy of the temporomandibular joint (TMJ) is a new, relatively noninvasive surgical procedure for treating patients with TMJ dysfunctions beyond management by nonsurgical means. Ninety-two patients who underwent diagnostic and operative TMJ arthroscopy completed a staged physical therapy regimen, which resulted in functional mobility and mandibular use with little or no pain at 24-month follow-up. This report introduces TMJ arthroscopic diagnostic and surgical procedures and their respective rehabilitative protocols currently used to provide beneficial outcomes in postoperative treatment.