Achilles and peroneal tendon injuries in the athlete. An expert's perspective.

Peroneal tendonopathy or injuries are not common but may be troubling to the sports enthusiast. Prompt diagnosis and treatment usually result in complete recovery with conservative measures. Biodynamic orthosis with deep heel cups and a long lateral flange extension often are required for return to activity. MR imaging is helpful in difficult, persistent cases to check for ruptures. Surgery is not commonly performed but if required is usually successful in correcting the pathology. Alternative medicine may improve treatment outcomes. Biomechanical functional analysis and attention to training errors is essential in any lower extremity injury or pathology.

Retrocalcaneal problems.

The majority of retrocalcaneal problems may be treated conservatively, using a biomechanical approach with appropriate shoe modification, padding, orthoses, and injection therapy. When appropriate indications are present, calcaneal osteotomies should be considered, despite less indication for these procedures than for simple resection of the retrocalcaneal exostoses.

New and investigative procedures for flatfoot surgery.

For those patients who need it, surgical intervention for flatfoot at an early stage affords a better chance for favorable results. Various procedures that have stood the test of time and investigative procedures are presented. It is suggested that the podiatric surgeon concentrate on tested procedures and wait for further reports on investigative procedures.

The biomechanics of running. Implications for the prevention of foot injuries.

Understanding the biomechanics of running has brought implications for the prevention of foot injuries. These biomechanical considerations, both functional and non-functional, must be evaluated by the sports medicine practitioner. Although functional biomechanical findings are more accurate predictors of injury and diagnostic tools than static findings, a correlation between the two is essential. Other important variables, e.g. training methods, athletic shoes, psychology, general health, external environment (surfaces, weather) and overuse, must be correlated with the biomechanical findings. The methodology and results of research are inconsistent with the direct predictability of various overuse injuries, based on biomechanical abnormalities and/or contributing factors. Until more research is carried out, clinical experience and the results of structured research investigations will provide the basis of treatment.

How I Manage Ingrown Toenails.

In brief: An ingrown toenail is one of the most common diseases of the nail. Initial treatment includes trimming away the ingrown area and soaking the foot in Epsom salt, or a combination of Epsom salt and pHisoHex or Betadine. If inflammation, localized cellulitis, and pain do not resolve rapidly, chemocautery with phenol or a surgical partial matricectomy can be carried out.

Foot Orthoses: An Update.

In brief: Foot orthoses can be used to correct malalignment problems that contribute to injuries to athletes. There are three basic types of orthoses: soft, semiflexible, and rigid. Soft orthoses are often temporary and are used until it can be determined whether they can alleviate pain. For some people, soft supports are all that are necessary. For others, a permanent orthosis-either semiflexible or rigid-is necessary. Athletes usually get a semiflexible orthosis, because they don't tolerate the rigid ones very well. Many sports medicine specialists can fit soft supports, but only sports podiatrists should make the permanent ones.

Medial plantar digital proper nerve syndrome (Joplin's neuroma)--typical presentation.

Joplin's neuroma, a painful pedal neuralgia, is a benign enlargement of the medial plantar digital proper nerve. The pathology is described as a degenerative process of the nerve characterized by perineural fibrosis. This clinical entity is thought to be caused by 1) trauma, 2) biomechanical imbalances, 3) entrapment, and 4) pinch callus resulting from interphalangeal joint accessory bone. This article illustrates typical presentation of the syndrome, taking into consideration the first two etiologic factors, which have not been reported in the literature.

Limb length discrepancies of the lower extremity (the short leg syndrome).

A survey of over 4,000 athletes and long distance runners, seen in my office over the past 6 years, reveals almost 40% of some form of limb length discrepancy. The limb length discrepancy is oftentimes associated with functional abnormalities, such as overpronation of one foot in contradistinction to the other or imbalances within the pelvis itself. Likewise, anatomical or true shortness may be present or a combination of anatomical and functional discrepancies. There appears to be a high correlation of injury on the short leg side and also associated weakness with the shortening. Conversely, utilizing a heel lift for a functional problem may cause contralateral symptoms. That being the case, it appears appropriate for practitioners involved in treating athletes to be aware of the various forms of limb length discrepancies that may exist, their significance, and their appropriate treatment. J Orthop Sports Phys Ther 1981;3(1):11-16.

The Flat Foot.

In brief: The flat foot ranges in severity from imbalance caused by moderate forefoot varus to a hypermobile foot with ligamentous laxity and a plantar-flexed talus. Principal causes are soft-tissue or bony abnormalities and trauma or systemic disease. Treatment includes orthotic foot control and sometimes surgery. Sport shoes for people with pronated feet should have a very firm heel counter and should be moderately stiff.

The foot and its relationship to gait: a series of articles and editorial comments.

The following series of articles by various authors is presented to inform the readers of some current concepts in biomechanics of gait and podiatric sports medicine. Better understanding of the contents should facilitate health care delivery in orthopaedic and sports physical therapy: 1) The Foot and Sports Medicine-Biomechanical Foot Faults as Related to Chondromalacia Patellae*David Ramig, DPM, Jay Shadle, DPM, C. Allen Watkins, DPM, Daniel Cavolo, DPM,Jeffrey R. Kreutzberg, DPM, PhD, RPT 2) The Foot and Chondromalacia-A Case of Biomechanical Uncertainty?Dr. J. G. P. Williams, Secretary General J Orthop Sports Phys Ther 1980;2(2):48-54.