Runners are paying more attention to their running form in an attempt to reduce the risk for injury. There are many different techniques being promoted with all making a number of claims about their “form” being better than others. One of these is Pose Running. Pose running uses more of a forefoot strike rather than a heel strike; a shorter stride length and faster cadence; and more of a forward lean to allow gravity to do more work. Pose running advocates make a number of claims regarding the reduction in injury with this technique, but there is no data to support the claims. One study has shown that it is more energy inefficient to run using the Pose method. Those promoting the Pose method are very sensitive to criticism and some have gone to extraordinary length to try and discredit that study. Pose running is something that Podiatrists need to be aware of as they will have runners as patients who use the method.
Overpronation is a term that gets used and misused a lot. The term is widely used in lay circles, especially the running community, to label a foot that pronates too much at the rearfoot and is usually associated with arch this term flattening. Anyone with more than the most basic understanding of foot biomechanics know what an unhelpful and misused term that overpronation is. Pronation is a motion and motion is not necessarily painful. What is more important is the force of that motion. Traditionally, running shoes have been prescribed based on the amounts of overpronation that a runner demonstrates. However, the evidence for the use of running shoes in that way is not good. Overpronation as a term probably needs to be dropped and replaced with terms that more accurately define foot function and the risk for injury in runners. For a more detailed look at pronation in runners, have a look as Running Research Junkie.
Forensic podiatry could be considered as the application of sound podiatric knowledge, research and experience in forensic or criminal investigations This can be to show the association of a particular individual with a scene of crime of interest, or to investigate other legal questions concerning the foot or footwear that requires knowledge of the functioning foot such as what a podiatrist would have.
Forensic podiatry assists in the identification of those who commit crimes where barefoot prints, footwear and CCTV evidence can be analysed. This expertise is necessary in the identification and the assessment of the effects of foot and lower limb function, how that affects the matching of wear associated with the shoe interface and in the actual comparisons of shoe size. Using CCTV work, forensic podiatry can compare the gait patterns of individuals captured on CCTV with those of the suspects. Forensic podiatrists can also be involved in the identification of human remains from comparison of the feet of the deceased with detail listed in the podiatry records of the people reported missing
Minimalist running or minimalist running shoes is running in shoes that do nothing more than protect the foot from the environment. Running in minimalist running shoes is the next thing to running barefoot. Minimalist running shoes are shoe that are so minimal in their design and construction that do not interfere in any way with the motion of the foot and they mimic how the foot would function barefoot. The shoes have no support and no cushioning. They are meant for those who want to do barefoot running but do not actually want to be barefoot.
Foot orthotics work. Every single patient and clinical outcome study that has looked at the type of foot orthotics commonly used by Podiatrists has shown they work. Not one study has shown that they don’t. The results are unequivocal. Yet people still make all sorts of extraordinary claims that they don’t. Most of those who make those claims usually have another type of foot orthotic to sell, like Barefoot Science. They sell that product by making things up about foot orthotics lie about the research and then make claims for their product that is totally unsupported by any research. It’s a common marketing practice. Barefoot Science is largely promoted via testimonials.
The Austin Bunionectomy is probably the common bunion procedure used for bunions. The Austin bunionectomy is generally used for mild to moderate bunion deformities and is a combination procedure. Initially the ‘bump’ of the bunion is shaved off. Secondly, a wedge of bone is removed from the metatarsal to correct the alignment of the bone. Screws are usually needed to hold the bones that are cut in the Austin Bunionectomy in place. Following that the balance of the tendons and ligaments that pull around the joint are altered. All reports on the Austin bunionectomy are favourable and it is a popular technique with surgeons.
There are a number of overuse injuries that can happen from running. One that is starting to be seen more often is posterior tibial tendonitis. The reason that it is being seen more often is that with the trend towards barefoot or minimalist running, the posterior tibial muscle has to work harder leading to the posterior tibial tendonitis. With heel striking that particular muscle does not have to work so hard. The symptoms of posterior tibial tendonitis is usually just above or below the medial malleolus. Initially the pain is only present during activity and not at rest. Usually there is also no swelling initially, but later of the tendon sheath becomes inflamed there may be some swelling. The treatment of posterior tibial tendonitis is to use foot orthoses to decrease the load in the tendon by altering how hard the muscle has to work. Ice and anti-inflammatory medication helps in the early stages.
A child is toe walking should be of concern and thoroughly investigated. Most cases of toe walking are habitual and of no real concern and the child will grow out of it with no problems. The reason for the concern is that some of those toe walking cases are due to potentially serious neurological or behavioral problems. They need to be checked for to rule them. Provided the range of motion of the ankle joint is adequate, and there are no adverse neurological signs, and there are no indications of behavioral problems such as autism then the chances of toe walking being a problem are low.
Peripheral vascular disease is a common problem in those with and without diabetes. It is certainly more of a problem in diabetes. The issue with the poor circulation I those without diabetes is that those that have it do not get the public attention and public health interventions that diabetes receives. This means that not as many resources are devoted to the poor circulation that probably should be. Poor circulation complicates a lot of problems in podiatry practice and a thorough vascular history and assessment is needed prior to any podiatric procedure.
Plantar plate dysfunction is a common problem that used to be embraced by the umbrella term, metatarsalgia and more recently, capsulitis. The plantar plate is a thickening of the plantar fascia and joint capsule plantar to the lessor metatarsophalangeal joint, so plays an important role in the function of the toes. It’s not uncommon for there to be plantar plate tear causing pain around the joint, usually the second metatarsophalangeal joint. Often the toe is in a slightly dorsiflexion position. Usually the treatment is to use padding and strapping to hold the toe in a plantarflexed position. Sometime the plantar plate dysfunction needs surgery to repair the tear.