Rearfoot Varus Research Articles

Bipedal Static Supination and Dynamic Forefoot Loading Characteristics in Taiwanese College Badminton Players: A Cross-Sectional Study.

Badminton is a unilateral sport that involves repetitive jumping, lunging and quick changes of direction with the lower limb, thus, plantar pressure profiles and foot postural profiles are critical to maintaining balance and coordination. The purpose of this study was to explore the characteristics of static and dynamic plantar pressure profiles with rearfoot posture in elite and recreational badminton players as well as assess the transitional changes of plantar loads between static and dynamic states. A cross-sectional survey was conducted among 65 college-level elite male badminton players (mean age: 20.2 ± 1.2 years; mean height: 177.4 ± 4.6 cm; mean weight: 72.6 ± 4.6 kg) and 68 recreational badminton players of the same gender (mean age: 19.9 ± 0.8 years; mean height: 170.3 ± 3.9 cm; mean weight: 67.7 ± 3.2 kg). The JC Mat was used to evaluate the arch index (AI), plantar pressure distribution (PPD), centers of gravity, and the characteristics of the footprint. Static foot posture was determined by examining the rearfoot alignment. Both groups' AI fell within the normal range. The static plantar loads of the elite group were distributed at the bipedal lateral part of longitudinal arches and heels (p < 0.01), while the right foot experienced higher centers of gravity (p < 0.05). The elite group's static rearfoot postural alignment exhibited a higher degree of rearfoot varus than the recreational group (p < 0.05). In addition, the elite group's dynamic plantar loads were mainly exerted at the medial and lateral metatarsals of both feet (p < 0.05). During the transition state, the recreational group's plantar loads were mainly shifted to the bipedal lateral part of metatarsals and heels (p < 0.05), whereas the elite group's bipedal lateral longitudinal arches as well as the medial and lateral heels experienced a reduction in plantar loads (p < 0.01). For elite badminton players, the findings revealed a possible connection among the static supinated foot, centers of gravity tending towards the right foot, and increased forefoot plantar loads in the dynamic state. The finding merits further exploration of the possible links between transitional changes in plantar pressure distribution in both states and related foot injuries resulting from intense competition and regular training in badminton.

Can orthotic wedges change the lower-extremity and multi-segment foot kinematics during gait in people with plantar fasciitis?

BackgroundOrthotic wedges with medial posting of the forefoot and rearfoot have been shown to be effective in controlling excessive foot pronation in people with plantar fasciitis (PF), however the best prescription remains unclear. Research questionThe aim of this study was to determine the biomechanical effects of two designs of orthotic wedges within a shoe on the hip, knee, rearfoot, and forefoot kinematics in individuals with PF. MethodsThirty-five participants with PF were recruited. They were asked to walk under three randomized conditions; shod, shod with orthotic wedges with foot assessment technique 1 (W1), and shod with orthotic wedges from a new assessment technique (W2). Biomechanical outcomes included lower limb and multi-segment foot kinematics in each subphase of the stance gait, including contact phase, midstance phase, and propulsive phase. ResultsCompared with shod, the W1 significantly increased rearfoot dorsiflexion, decreased peak forefoot dorsiflexion, and peak rearfoot eversion during the contact phase. In addition, W1 increased rearfoot inversion, decreased hallux dorsiflexion, and peak hallux dorsiflexion during the propulsive phase. For W2, the wedge significantly decreased peak knee internal rotation, decreased forefoot abduction, peak forefoot dorsiflexion, and peak rearfoot eversion during the contact phase. In addition, W2 increased rearfoot inversion, decreased hallux dorsiflexion, and decreased peak hallux dorsiflexion during the propulsive phase. When comparing W1 and W2, W1 showed greater rearfoot dorsiflexion during the contact phase. SignificanceThese findings suggest that the use of forefoot varus wedges, and the combination of forefoot and rearfoot varus wedges, can change the lower limb kinematics, the multi-segment foot kinematics estimated using markers fixed to the shoe, and the relative length of the plantar fascia which can be associated with a reduction in pain and symptoms during walking.

Kinematic Effect on the Navicular Bone with the Use of Rearfoot Varus Wedge.

Background: The rearfoot varus wedge (RVW) is a common treatment for foot pain and valgus deformity. There is research on its effects in the calcaneus, but there is little research on the navicular. More research is needed with the use of RVW due to the relationship that exists between the position of the navicular and the risk of suffering an injury. Objectives: this study sought to understand how RVW can influence the kinematics of the navicular bone, measuring their movement with the 6 SpaceFastrak system. Methods: a total of 60 subjects participated in the study. Two sensors were used to measure the movement of the calcaneus and navicular using RVWs as compared in the barefoot position in a static way. Results: there were statistically significant differences, the use of RVWs caused changes in the navicular bone, with subjects reaching the maximum varus movement with the use of RVW 7 mm of 1.35 ± 2.41° (p < 0.001), the maximum plantar movement flexion with the use of RVW 10 mm of 3.93 ± 4.44° (p < 0.001). Conclusions: when RVWs were placed under the calcaneus bone, the navicular bone response was in varus movement too; thus, the use of rearfoot varus wedge can influence the movement of the navicular bone.

Effects of elastic neutral ankle-foot orthoses on 3 dimensional parameters during gait training in patients with stroke: A pilot study

BackgroundGeneral ankle-foot orthosis (AFO) cannot be flexibly adjusted to volumetric change in the lower leg because the molding is custom-fit. Thus, we developed a flexible assistive device called elastic neutral AFO (EN-AFO) to help stroke patients hold a neutral ankle position. The purpose of this study was to investigate the effects of EN-AFO and improve gait patterns in stroke patients with rearfoot varus deformity. MethodsFifteen stroke patients with a varus deformity of the foot performed a walking test with and without the use of EN-AFO. Kinematic data were measured with a 3D motion analysis system with inertial measurement unit (IMU) sensors. ResultsIn the stance phase, maximal pelvic tilt and maximal ankle dorsiflexion in the affected side changed, and maximal and minimal pelvic tilts and maximal hip abduction in the less-affected limb effectively changed, as well. During the swing phase, minimal pelvic tilt and minimal ankle abduction in the affective limb greatly changed; particularly, the reduction of maximal ankle inversion was significantly cleared. ConclusionsThe EN-AFO was effective in controlling the tendency of foot inversion in patients with varus deformities. This is suitable for gait training, as it can adjust the orthosis stiffness according to the foot condition.

Soft tissue release combined with joint-sparing osteotomy for treatment of cavovarus foot deformity in older children: Analysis of 21 cases.

BACKGROUNDCavovarus foot is a common form of foot deformity in children, which is clinically characterized by an abnormal increase of the longitudinal arch of the foot, and it can be simultaneously complicated with forefoot pronation and varus, rearfoot varus, Achilles tendon contracture, or cock-up toe deformity. Muscle force imbalance is the primary cause of such deformity. Many diseases can lead to muscle force imbalance, such as tethered cord syndrome, cerebral palsy, Charcot-Marie-Tooth disease, and trauma. At present, many surgical treatments are available for cavovarus foot. For older children, priority should be given to midfoot osteotomy and fusion. Since complications such as abnormal foot length, foot stiffness, and abnormal gait tend to develop postoperatively, it is important to preserve the joints and correct the deformity as much as possible. Adequate soft tissue release and muscle balance are the keys to correcting the deformity and avoiding its postoperative recurrence.AIMTo assess the efficacy of soft tissue release combined with joint-sparing osteotomy in the treatment of cavovarus foot deformity in older children.METHODSThe clinical data of 21 older children with cavovarus foot deformity (28 feet) who were treated surgically at the Ninth Department of Orthopedics of Jizhong Energy Xingtai Mining Group General Hospital from November 2014 to July 2017 were retrospectively analyzed. The patients ranged in age from 10 to 14 years old, with an average age of 12.46 ± 1.20 years. Their main clinical manifestations were deformity, pain, and gait abnormality. The patients underwent magnetic resonance imaging of the lumbar spine, electromyographic examination, weight-bearing anteroposterior and lateral X-rays of the feet, and the Coleman block test. Surgical procedures including metatarsal fascia release, Achilles tendon or medial gastrocnemius lengthening, "V"-shaped osteotomy on the dorsal side of the metatarsal base, opening medial cuneiform wedge osteotomy, closing cuboid osteotomy, anterior transfer of the posterior tibial tendon, peroneus longus-to-brevis transfer, and calcaneal sliding osteotomy to correct hindfoot varus deformity were performed. After surgery, long leg plaster casts were applied, the plaster casts were removed 6 wk later, Kirschner wires were removed, and functional exercise was initiated. The patients began weight-bearing walk 3 mo after surgery. Therapeutic effects were evaluated using the Wicart grading system, and Meary’s angles and Hibbs’ angles were measured based on X-ray images obtained preoperatively and at last follow-up to assess their changes.RESULTSThe patients were followed for 6 to 32 mo, with an average follow-up period of 17.68 ± 6.290 mo. Bone healing at the osteotomy site was achieved at 3 mo in all cases. According to the Wicart grading system, very good results were achieved in 18 feet, good in 7, and fair in 3, with a very good/good rate of 89.3%. At last follow-up, mean Meary’s angle was 6.36° ± 1.810°, and mean Hibbs’ angle was 160.21° ± 4.167°, both of which were significantly improved compared with preoperative values (24.11° ± 2.948° and 135.86° ± 5.345°, respectively; P < 0.001 for both). No complications such as infection, skin necrosis, or bone nonunion occurred.CONCLUSIONSoft tissue release combined with joint-sparing osteotomy has appreciated efficacy in the treatment of cavovarus foot deformity in older children.

Changes in gait and plantar foot loading upon using vibrotactile wearable biofeedback system in patients with stroke

Background: Patients with stroke walk with excessive foot inversion at the affected side, which may disturb their balance and gait.Objectives: This study aimed to investigate the effects of instant biofeedback of plantar force at the medial and lateral forefoot regions on gait and plantar foot loading in patients with stroke.Methods: A total of eight patients with hemiplegic stroke, who had flexible rearfoot varus deformity at the affected side, participated in this study. A vibrotactile biofeedback system was developed and evaluated. It analyzed forces at the medial and lateral forefeet, and instantly provided vibration clues when the plantar force at medial forefoot was less than a threshold. Each subject’s three-dimensional gait parameters and plantar-pressure distribution during walking were measured under two experimental conditions (sequence randomized): with and without the device turned on (Trial-registration number: ChiCTR-IPB-15006530 and HKCTR-1853).Results: Providing biofeedback significantly reduced the foot inversion and increased the mid-stance foot–floor contact area and medial midfoot plantar pressure of the affected limb, bringing the values of these parameters closer to those of the unaffected side. The biofeedback also significantly reduced the unaffected side’s excessive knee flexion and hip abduction.Conclusions: There were signs of improved foot loading characteristics and gait upon provision of instant vibrotactile biofeedback of plantar force. The positive results of this study further support the development of wearable biofeedback devices for improving gait of patients with stroke.

Correlation of rearfoot angle to Q-angle in patellofemoral pain syndrome: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Objective of the study was to evaluate the correlation between rearfoot posture to Q-angle in patients with patellofemoral pain syndrome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a two-year prospective observational study in which all patients with patellofemoral pain syndrome in the age group of 20-30 years were included in the study. The static Q-angle and the rearfoot angles of these subjects were measured and analyzed statistically for their correlation.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were sixty patients who fulfilled the inclusion criteria of the study. Pearson product moment correlation showed 27% subjects having rearfoot valgus and 73% having rearfoot varus angle. T test showed statistically significant Q-angle for rearfoot varus compared to rearfoot valgus.&lt;/p&gt;&lt;p class="western"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Rearfoot varus is more commonly associated with patellofemoral pain syndrome. The Q-angle increases in both rearfoot varus and valgus but is significantly more in patients with rearfoot varus. &lt;/p&gt;

Biomechanical podiatric evaluation in an Italian cohort of patients with systemic sclerosis: A pilot study.

Foot problems are often present in Systemic Sclerosis (SSc) patients, however studies regarding podiatric problems related to SSc are lacking and there are no data evaluating the foot biomechanical changes. The aim of the present pilot study was to evaluate podiatric problems in an Italian cohort of SSc patients by assessing received podiatric services, foot pain and disability and biomechanical foot deformity. 25 consecutive SSc patients were enrolled from the Division of Rheumatology, University of Florence. All SSc patients were assessed by: Standards of Care for People with Foot Musculoskeletal Health problems: Audit Tool, Foot Function Index (FFI), Weight and non-weight bearing foot joint assessment, (Foot Posture Index (FPI) and Gait Cycle), Health Assessment Questionnaire (HAQ) and Medical Outcomes Survey Short Form 36 (SF-36). Audit Tool - Only 7 (28%) out of the 25 patients with SSc had a specific podiatric assessment and treatment: no patient received a foot health assessment within the first 6 months of disease diagnosis and no patient received information about foot involvement. 1 patient (4%) received foot assessment every year; 1 patient (4%) received specific information about the disease and 5 patients (20%) received information about the benefits of using adapted footwear and insoles. FFI - Values of pain, disability and activity limitations, reported in FFI, are 4.7±5.1, 5.1±3.2 and 3.2±3.1 (M±DS), respectively. Non-weight bearing foot joint assessment shows a rearfoot varus deformity in 64% of patients, forefoot varus deformity in 42% and 6% forefoot valgus deformity. Weight bearing foot joint assessment, through FPI shows a pronated foot 20% of patients with and 34% with highly pronated overall foot posture. Gait analysis shows that 64% of patients has a contact of the calcaneus in invertion while 36% in eversion. In the midstance, 78% have the foot in pronation and 22% in supination, while in propulsion 12% presents a takeoff of the foot in supination and 88% in the pronation. HAQ result is 1.13±0.80, SFI and SMI scales of SF-36 have scores of 32.38±10.65 and 38.67±11.40, respectively. Our results shows that podiatric problems in SSc patients are common, serious but foot assessment and health care are inadequate. Thus, foot health information should be improved in order to better empower patients to self-manage low risk problems and help identify high-risk problems, which require specialist care.

Functional clinical typology of the foot and kinematic gait parameters

Background: The foot plays a key role in a standing posture, walking and running performance. Changes in its structure or function may alter upper segments of kinematic chain which can lead to formation of musculoskeletal disorders. Although functional clinical typology provides a complex view of foot kinesiology there is a lack of knowledge and evidence about influences of different foot types on human gait. Objective: The aim of the study was to analyse differences of kinematic gait parameters of lower extremity joints and pelvis between functional clinical foot types in healthy young men. Methods: Three-dimensional kinematic analysis by the Vicon Motion Capture MX System device in synchronization with 2 Kistler force platforms was used to obtain kinematic data from 18 healthy men (mean age 23.2 ± 1.9 years). The functional clinical foot type was clinically examined and sorted into 3 basic foot type groups - forefoot varus (FFvar), rearfoot varus (RFvar) and forefoot valgus (FFvalg). Peak angular values and range of an angular displacement in all of three movement planes were analysed for pelvis, hip, knee and ankle joint. For statistical analysis of kinematic gait parameters differences between foot types Mann Whitney U test at a statistical significance level p < .05 and Cohen's coefficient d for effect size were used. Results: This study showed that functional clinical foot type can affect kinematic parameters of gait in the joints of the lower limb and pelvis. Significant differences were presented in the FFvar in comparison with other two foot type groups with middle and high size of effect. The most alterations were observed in pelvis area and in a sagittal plane of movement. Nevertheless, significant differences between FFvalg and RFvar foot types were not noticed. Conclusions: Functional clinical foot typology provides one of the possible methods to describe foot structure and function. Our results showed that foot type could alter gait. Forefoot varus foot type has more significant influence on kinematic gait parameters then other foot types. These effects should be considered by clinicians during examination of musculoskeletal system disorders especially in lower extremities.

Pronação excessiva e varismos de pé e perna: relação com o desenvolvimento de patologias músculo-esqueléticas - revisão de literatura

A literatura propõe mecanismos biomecânicos que relacionam a pronação subtalar excessiva ao desenvolvimento de diversas patologias músculo-esqueléticas. A presença dos desalinhamentos anatômicos antepé varo, retropé varo e tíbia vara pode levar à ocorrência da pronação subtalar excessiva. Entretanto, não existe um consenso sobre a contribuição do padrão de movimento e da presença desses desalinhamentos para o desenvolvimento de patologias. O objetivo deste estudo foi realizar uma revisão da literatura para investigar a influência de varismos aumentados de antepé, retropé e tíbia e da pronação subtalar excessiva no surgimento de patologias músculo-esqueléticas. Foi realizada uma pesquisa bibliográfica sistematizada nas bases Medline, ISI - Web of Science, Lilacs e Scielo, tendo sido selecionados 13 estudos analíticos. Do total de 13 estudos, 10 encontraram associação de patologias no membro inferior com um ou mais dos desalinhamentos anatômicos analisados ou com um ou mais parâmetros cinemáticos relacionadas à pronação subtalar excessiva. A análise dos estudos sugere que a pronação subtalar excessiva e/ou a presença de desalinhamentos que podem levar a esse padrão de movimento são possíveis fatores de risco para o desenvolvimento de patologias músculo-esqueléticas no membro inferior.

Radiographic Analysis of Haglund’s Deformity: An Evaluation of NCSP and RCSP

Biomechanics is an important topic in considering podiatric foot and ankle pathology. It is the root of all underlying factors during the diagnosis of a structural foot deformity. One such deformity is an enlargement of the posterosuperior aspect of the calcaneus, called a Haglund’s deformity. Structural malposition of the foot, including rearfoot equinus, compensated rearfoot varus, compensated forefoot valgus, plantarflexed first ray, and a cavus foot have all been associated with producing retrocalcaneal discomfort.1 These biomechanical conditions have been well documented, with lateral x-ray evaluation in the sagittal plane, of producing a Haglund’s deformity.1 However, additional areas in biomechanics can still be investigated to understand the development of a Haglund’s deformity.

Postura do pé e classificação do arco plantar de adolescentes usuárias e não usuárias de calçados de salto alto

OBJECTIVES: To investigate the relationship between foot posture and plantar arch among adolescent wearers and non-wearers of high-heeled shoes. METHODS: Thirty-six female adolescents aged 13 to 20 years were selected and grouped as 16 high-heel non-wearers and 20 high-heel wearers. Foot posture was analyzed using photos, firstly barefoot and, secondly, after wearing previously standardized high-heeled platform shoes for an hour. The analysis was performed using the software SAPo. Barefoot impressions were taken, and the Chipaux-Smirak Index was calculated to classify the plantar arch of the foot. For statistical analyses, the paired t test was used to investigate equality between the right and left sides. The Shapiro-Wilk adherence test was performed, followed by inferential analysis using the non-parametric Wilcoxon test, the Mann-Whitney test and Spearman's correlation coefficient. The significance level used was 0.05. RESULTS: There was no correlation between the type of plantar arch and foot posture among the female adolescents studied. However, the rearfoot angle was significantly different, with rearfoot varus after wearing the shoes in both groups. The plantar arch in the wearers group presented smaller values for the Chipaux-Smirak Index. CONCLUSIONS: There is no correlation between foot posture and the type of plantar arch, although these variables are influenced by high-heeled shoes. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN12608000300370.

Effect of 7-Degree Rearfoot Varus and Valgus Wedging on Rearfoot Kinematics and Kinetics During the Stance Phase of Walking

The scientific evidence behind the mechanical function of foot orthoses is still controversial. Research studies that have investigated the kinematic effect of foot orthoses on the lower extremity have shown variable results, with orthoses causing either no significant change or a small significant change in foot kinematics. The right limbs of 12 healthy asymptomatic individuals were studied in three walking conditions: barefoot, with a 7 degrees rearfoot varus wedge, and with a 7 degrees rearfoot valgus wedge. Kinematic and kinetic variables measured were the foot progression angle, the peak internal tibial rotation angle, and net ankle inversion moments during the stance phase in the three conditions. There were statistically significant differences in the foot progression angle between the barefoot and varus wedge conditions and between the varus and valgus wedge conditions. There were no significant changes in peak internal tibial rotation among the three conditions tested. However, rearfoot varus wedges significantly reduced net ankle inversion moments compared with barefoot and rearfoot valgus wedges. These results support the idea that foot orthoses work by methods other than by changing kinematic parameters. The present study supports the concept that foot orthoses work primarily by altering kinetics, with their effects on kinematics being secondary.

Varus foot alignment and hip conditions in older adults

Mechanical strain on the hip can result from varus malalignment of the foot. This study was undertaken to explore the cross-sectional relationship between varus foot alignment and hip conditions in a population of older adults. The Framingham Osteoarthritis Study cohort consists of a population-based sample of older adults. Within this sample, we measured forefoot and rearfoot frontal plane alignment using photographs of a non-weight-bearing view of both feet of 385 men and women (mean age 63.1 years). Each foot segment was categorized according to the distribution of forefoot and rearfoot alignment among cases of ipsilateral hip pain, trochanter tenderness, hip pain or tenderness, and total hip replacement (THR). The relationship of foot alignment to these conditions was examined using logistic regression and generalized estimating equations, adjusting for age, body mass index, sex, and physical activity. The mean +/- SD rearfoot varus alignment was 0.7 +/- 5.5 degrees, and the mean +/- SD forefoot varus alignment was 9.9 +/- 9.9 degrees. Subjects in the highest category of forefoot varus alignment had 1.8 times the odds of having ipsilateral hip pain (P for trend = 0.06), 1.9 times the odds of having hip pain or tenderness (P for trend < 0.01), and 5.1 times the odds of having undergone THR (P for trend = 0.04) compared with those in the lowest category. No significant associations were found between rearfoot varus alignment and any hip conditions. Forefoot varus malalignment may be associated with ipsilateral hip pain or tenderness and THR in older adults. These findings have implications for treatment, since this risk factor is potentially modifiable with foot orthoses.

The Effect of 5-Degree Valgus and Varus Rearfoot Wedging on Peak Hallux Dorsiflexion During Gait

The dynamic effects of 5 degrees varus and valgus rearfoot wedging on peak hallux dorsiflexion were investigated in 30 asymptomatic subjects (5 males and 25 females). Statistically significant reductions in peak hallux dorsiflexion were found with rearfoot varus wedging and rearfoot valgus wedging. Furthermore, the reduction in peak hallux dorsiflexion occurring with rearfoot varus wedging was statistically significant compared with that associated with rearfoot valgus wedging. These findings have implications for the orthotic management of a variety of lower-limb pathologies.

The effect of foot orthoses on patellofemoral pain syndrome.

In a retrospective review of 102 patients treated for chondromalacia pa-tellae and patellofemoral pain syndrome/retropatellar dysplasia (PFPS/RPD), the effectiveness of semiflexible foot orthoses was investigated. The combined disorders were diagnosed in 89.3% of the patients. Subjects were 46 women and 54 men, aged 12 to 87 years (mean, 37.9 years; SD, 15.9), who exhibited excessive forefoot varus or rearfoot varus. The initial screening and clinical diagnosis were based on an examination by an orthopedist. Particular attention was directed to patellar crepitation, patellofemoral malalignment, Q-angle measurements, limitation of range of motion, and knee effusion. Patients were evaluated for the onset and duration of patellofemoral pain and degree of knee joint disease. Semiflexible orthoses for each subject were fabricated, based on a clinical lower extremity biomechanical examination. At their follow-up visit, 76.5% were improved and 2% were asymptomatic, showing a significant decrease in the level of pain with orthoses intervention (chi-square P <.001). Although multiple treatment modalities are used for these patients, the results suggest that the use of semiflexible orthoses is significant in reducing symptoms of PFPS/RPD.

HEEL PAIN IN A RUNNER

HISTORY - A 40-year old female collegiate softball coach initially developed lateral pain of the left heel after landing hard on her heel while playing softball. She continued her normal running routine as she was at the time training for a marathon and the heel pain subsided over 2–3 weeks. The heel recieved a second blow approximately 2 months later and the subsequent pain did not resolve despite a short period of rest from running. The patient resumed her running program despite the heel pain. The pain was located at the inferior-lateral aspect of the heel and was worse when rising in the morning and at the initiation of a run. She was able to continue her training despite increasing pain and participated in the marathon 5 months after the initial occurence. She was initially treated for peroneal tendonitis and plantar fascitis unsuccessfully during this period leading up to the marathon. PHYSICAL EXAMINATION - Examination at the initial office visit approximately one month prior to the marathon revealed tenderness at the distal peroneal tendon inferior to the lateral malleolus and at the inferior-lateral aspect of the calcaneus. The foot and ankle had full range of motion and strength with pain produced in passive inversion only. There was a palpable click noted along the peroneal tendons with active eversion and full weight-bearing produced lateral heel pain. At a subsequent office visit one month after the marathon, the pain and click along the peroneal tendon had resolved. The pain at the inferior-lateral aspect of the calcaneus remained and medial/lateral compression of the calcaneus produced pain. DIFFERENTIAL DIAGNOSIS Plantar fascitis Fat pad syndrome Calcaneal contusion Calcaneal stress fracture Peroneal tendonitis TEST AND RESULTS Inital Office Radiographs:- No bony pathology.Bone scan of lower extremities one month after marathon:- focus of moderately intense increased radiotracer uptake seen in posterior aspect of left calcaneus.Gait analysis done during rehabilitation process:- Pattern of rearfoot varus with lateral heel strike and forefoot valgus with mild pronation. FINAL/WORKING DIAGNOSIS Stress fracture of posterior aspect of left calcaneus TREATMENT Full non-weight bearing with Aircast walking boot and crutches for 3 weeks. Partial weight bearing for additional 3 weeks Physical therapy after return to weight bearing with iontophoresis, gastroc and plantar fascia stretching and progressive strengthening. Gait analysis and custom orthotics Return to activities as dictated by pain and return to full running in 4–6 months.

Surgical correction of adult neglected clubfoot: Three case histories

Surgical correction of the neglected, and severely deformed clubfoot in the adult is necessary to achieve plantigrade, pain free, and cosmetically acceptable feet. Also, it is important that the patient is able to wear shoes and participate in a more active and normal life. Three adult immigrants with neglected clubfoot underwent surgical correction for the first time. Posterior medial plantar soft tissue release and a double arthrodesis involving calcaneal cuboid wedge resection with talonavicular fusion have been effective in removing rearfoot varus, providing minimal shortening, and restoring the foot to a normal plantigrade position.

Rearfoot Posture in Subjects With Patellofemoral Pain

The relationship between structural foot deformities and excessive subtalar joint pronation as being contributory to patellofemoral pain has not been well documented. It was the purpose of this study to assess the rearfoot posture in patients diagnosed with patellofemoral pain compared with a normal population. In addition, the intratester reliability in obtaining rearfoot measurements was assessed for right and left sides in 21 normal subjects. A goniometer was used to measure rearfoot posture in 30 female subjects (15 with patellofemoral pain and 15 controls). Measurements were taken with the subjects prone and the subtalar joint in neutral. Intraclass correlation coefficients were good for both the right and left measurements (.87 and .86, respectively). A small but significant increase in rearfoot varus was found in the patellofemoral pain group compared with the control group (8.9 vs. 6.8 degrees; p = .0002). These results suggest that increased rearfoot varus may be a contributing factor in patellofemoral pain and should be assessed when evaluating the events at the subtalar joint and the lower extremity. In addition, it has been demonstrated that consistent rearfoot measurements can be obtained by an individual clinician.

Foot types and lower limb injuries in elite netball players.

In assessing the foot types and lower limb injuries of elite netball players, the following summary seems warranted. Ninety percent of elite female netball players had symmetrical foot types for both feet and these players had experienced at least one lower limb injury. Only 7.6% players (N = 16) of the 204 players surveyed had never sustained a lower limb injury during their netball careers. Regardless of foot type, the injury history of these elite netball players presented with a total number of 449 injuries that occurred to both ankle joints (36%), one ankle joint (16%), both knee joints (6%), one knee joint (13%), shin soreness (18%), and retropatellar pain problems (11%). On further inspection, 55% of players experienced one to two lower limb injuries throughout their netball careers. Injured players showed that players with the pronating foot types with rearfoot abnormalities (57%) were the most commonly injured and that compensated rearfoot varus foot type presented the most lower limb injuries for all body sites.