Posterior tibial tendon dysfunction

This is the primary cause of acquired flat foot in adults. Essentially the underlying pathomechanics is that the posterior tibial tendon and muscle just give up - they can no longer do their job. Why do they give up? My understanding and experience is that all that all those with posterior tibial tendon dysfunction have a medially located subtalar joint axis. If this is the case, then it means that the posterior tibial tendon will have a much shorter lever arm to the joint axis. This would mean that in these people the muscle would have to work substantially harder than if the tendon had a longer lever arm if the subtalar joint axis was closer to a more normal or average position. After a life time of having to work so much harder, no wonder the tendon and muscle complex just give up. This is becoming more common in runners who start forefoot striking.

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How common is heel pain caused by gout?

This is something that I almost never see, but I have seen others claim that it is common. I recently did a liteature search on 'gout heel pain' and found next to nothing. The best I could find being to use colchicine for a few days as a diagnostic aid.

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Are MBT Shoes Helpful?

Masai Barefoot Technology or MBT shoes are shoes that have been on the market for a while now and have a rocker bottom that is supposed to simulate the natural gait of walking barefoot that is modeled on the Masai people from Africa. The MBT company do make a lot of claims for the benefits of the shoes. They even used to make cliams about treating cellulite (but recently stopped that one). There is some limited evidence to support the claims about helping some people with postural porbalme, but there is not enough to support the wide range of claims made. Do MBT shoes work? Based on what i have read and what I understand, I think the shoes are beneficial in certain subpopulations, I would just prefer to see some better clinical trials to guide us as to how to better identify these people.

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Podiatry and Twitter

Do you even know what Twitter is? Have you caught up on all the fuss and what its about. There are many podiatrists and Podiatry related organisations on Twitter. See this search for podiatry. For example, Podiatry Arena has its twitter page. For those who have no idea what this is all about there is some good information I found on Twitter.

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iPhone tool for biomechanical measurements

For those who still do measurements as part of your biomechanical assessment (I stopped doing this a long time ago, except for measuring the tibial angle for the lunge test) and you have an iPhone, have you seen the iHandy Carpenter Tool (search for it at iTunes). It’s a cool way to do your measurements. It works really well for the Lunge Test.

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Jones fracture

I came across this little gem from 1902:

"SOME months ago, whilst dancing, I trod on the outer sideof my foot, my heel at the moment being off the ground. Some-thing gave way midway down my foot, and I at once suspected arupture of the peroneus longus tendon. By the help of a friend I managed to walk to my cab, a distance of over 300 or 400 yards.The following morning I carefully examined my foot and dis-covered that my tendon was intact. There was a slight swelling over the base of the fifth metatarsal bone. I endeavored to obtainc repitus and failed. A finger on the spot gave exquisite pain. Body pressure on the toes, even the slightest, was painful; butwhen the pressure was deviated to the outer side the pain wasstill greater. Extension of the ankle and flexion of the toes wereimmediately felt at the base of the fifth metatarsal."

This was Sir Robert Jones talking about his fracture that became known as a Jones fracture.

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Barefoot Running

I am not opposed to the barefoot running movement. It just some of the promoters of barefoot running that I have a problem with. They are like religious zealots that are fanatical about the whole concept of barefoot running. They use nonsensical non-scientific mumbo jumbo to support what they do. They twist research to make it sound like it supports their cause. They dismiss research that is anti-barefoot. They take any research that is anti-running shoe as evidence that proves running barefoot is better (huh?).

At the end of the day, there is no evidence that running barefoot is even ideal, let alone beneficial. There is also no evidence that its not. I blogged about this here and see Podiatry Arena: Barefoot Running for a balanced discussion on the pros and cons of barefoot running. For a bit a fun check out the zealotry on some of the running forums when it comes to discussing this. Trying to be rational with these people is like trying to argue a religion - not going to win that one.

I have no doubt that the research will show that there will be some benefits to running barefoot; I have no doubt it will also show that there will also have some risks. What we need is better evidence of who and when it should be used. I have no doubt that barefoot running should be a part of a balanced running program for all those who can tolerate it, but it should be used in moderation.

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