Research Articles

Plantar and Medial Heel Pain – Diagnosis and Management

Common Causes and Treatment of Heel PainHeel pain is a common ailment that is frequently misdiagnosed because there can be a lot going on in a small space. A review article recently looked at the most common diagnoses and their causes. The authors challenge that a thorough exam should result in a correct diagnosis, which usually can be treated conservatively with over the counter anti-inflammatory medication (NSAIDs), rest, shoe modification, or physical therapy. Corticosteroid injections sho…Read more

Metatarsal Joint Instability – Lesser Toes and Plantar Plate Deficiency

Toes are like teeth, you take them for granted until they hurt and then you realize how much you rely on them and are amazed at how much pain they can cause. Toe instability resulting in a rigid deformity is a common foot problem. A recent review article speaks to new knowledge of toe instability and a surgical technique that should be utilized—specifically, repairing the plantar plate.In a healthy foot the tiny muscles of the feet and toes along with ligaments on the sides of your toe j…Read more

The Advantage of Conservative Care for Achilles Tendon Rupture

For a long time now, studies have repeatedly shown that surgery is the better way to treat Achilles tendon ruptures. Patients got better faster and returned to work and play sooner. And there were fewer cases of tendon rerupture after surgery compared with conservative care. But surgery always comes with some risks of its own. So there have been continued efforts to compare different types of conservative care against surgical repair.In this meta-analysis, the authors combined the results of 10 …Read more

Evidence to Support Shock Wave Therapy for Plantar Fasciitis

Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis is usually just on one side. In about 30 per cent of all cases, both feet are affected.Treatment is usually with conservative (no…Read more

What To Do About Hallux Rigidus

Hallux rigidus is a degenerative type of arthritis that affects the large joint at the base of the big toe. Degenerative arthritis can result from wear and tear on the joint surface over time. The condition may follow an injury to the joint or, in some cases, may develop with no known cause.In this review article, an orthopedic surgeon from the Hospital for Special Surgery in New York presents ways to treat this condition based on classification (severity). Nonsurgical management is always advis…Read more

Review and Update on Tarsal Coalition of the Foot

The causes and effects of tarsal coalition are presented in this article from The Children’s University Hospital in Dublin, Ireland. Some of the information comes from CT scans of patients being treated for this condition. Other insights come from cadaver studies (after death).What exactly is tarsal coalition? It is the failure of the developing bones in the foot to properly form all the distinct, individual bones in the midfoot (between the ankles and toes). Instead, two or more bones can form …Read more

Extra Bone in Feet Cause Problems for Dancers

Many people are born with oddly shaped bones, extra bones, or fused bones and never know about it. In fact, studies show up to one-third of the general population have what is called an accessory (extra) bone. Sometimes these extra bones are in the joint and sometimes they occur embedded in a tendon or muscle.Most of the time, unless the bone is prominent, no one knows about them. But dancers and other athletes are often the first to notice problems. The strain and stress on the feet from repeti…Read more

Changes in Treatment for Achilles Tendon Rupture

Research continues in the area of treatment for Achilles tendon ruptures. The last 10 years has brought a change from placing patients in a nonweight-bearing cast to using an ankle-foot orthosis (AFO) instead. An AFO is a brace usually made from plastic or light metal (carbon fiber). It allows for early weight-bearing. The question now is what’s the best AFO design for this problem?The Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. The calf is actually forme…Read more

Results of Surgery to Correct Tailor’s Bunions

Most people are familiar with bunions of the big toe but have you ever heard of a bunionette on the little toe side of the foot? With a bunion of the big toe, a large bump seems to grow out of the side of the great toe. But in fact what is happening is that the two bones that meet to form the big toe joint angle away from each other. A bump we call a bunion forms at the end of the metatarsal (long bone of the toes).The bunion that develops is actually a response to the pressure from the shoe on …Read more

What Is Cuboid Syndrome

In this review article, a Physical Therapist from the University of Wisconsin – La Crosse explains what a cuboid syndrome is, causes, effects, diagnosis, and treatment. A complete review of the anatomy, mechanics during standing and walking, and clinical presentation are also included. Other names for this condition are cuboid fault syndrome, dropped cuboid, subluxed cuboid, locked cuboid, peroneal cuboid syndrome, and lateral plantar neuritis.The first thing to know about cuboid syndrome is tha…Read more

Unraveling the Mysteries of the Bunion

In many ways, hallux valgus more commonly known as “bunions” remains a mystery. What causes it? Why does it seem to run in some families but not others? Is it caused by wearing pointy shoes? If it is caused by shoe wear, why doesn’t everyone who wears those shoes develop bunions? These and other questions are investigated in this review of the problem.Here’s what we know so far. Studies have been done that show shoe wear is a factor. But it isn’t the only factor because some people who don’t wea…Read more

Part Two Study on Platelet Rich Plasma for the Achilles Tendon

You may have heard the expression, What you see is what you get. Well, in medical research that isn’t always the case. Time can be an important factor. For example, treatment results using platelet-rich plasma for tennis elbow were better than results with steroid injections when measured a year after the injections. Three months after the treatments, there was no difference between the two groups.In this study, orthopedic surgeons from The Netherlands used platelet-rich plasma (PRP) to treat ch…Read more

What Treatment Works Best for Plantar Fasciitis

The search for pain relief from plantar fasciitis continues. In this study, a podiatrist reports on the results of comparing four different treatments for plantar fasciitis. One hundred patients received either ultrasound, orthotics (shoe inserts), injections, or arch supports.Plantar fasciitis is a painful condition affecting the bottom of the foot. The plantar fascia (also known as the plantar aponeurosis) is a thick band of connective tissue. It runs from the front of the heel bone (calcaneus…Read more

Three Questions and Answer) About Navicular Fractures of the Foot

In this study, orthopedic surgeons from The OrthoCarolina Foot and Ankle Institute in North Carolina asked three questions about navicular stress fractures. Let’s orient ourselves to the navicular bone, to stress fractures, and then we can tell you the three questions (and answers to the questions).The navicular bone of the foot is one of the small bones on the mid-foot. The bone is located at the instep, the arch at the middle of the foot. One of the larger tendons of the foot, called the poste…Read more

Role of the Biceps Pulley in Shoulder Pain

New Information on the Role of the Biceps Pulley in Shoulder Pain You’ve probably never heard of the biceps pulley system. But anyone who has had a rotator cuff tear or who has pain along the front of the shoulder may, in fact, have a lesion (tear or damage) of the biceps pulley.What is this biceps pulley? The full name of the pulley mechanism is biceps reflection pulley. It is a sling of soft tissue fibers made from surrounding shoulder ligaments and tendons of the shoulder rotator cuff. The s…Read more

Effects of a Custom-Fit Orthosis for Plantar Fasciitis

Physical Therapists are front and center in the nonsurgical treatment of plantar fasciitis, a painful foot condition that affects 10 per cent of all Americans at some time in their lives. With an estimated one million patient visits to physicians each year in the United States for this painful condition, finding effective treatment strategies has become an important research goal.One of those treatments is the use of a custom made foot orthosis. That’s the focus of this study. An orthosis is a m…Read more

Review of Heel Fractures That Heal Wrong or Don’t Heal

Falls from a height or car accidents that cause fractures of the heel change a person’s life forever. The impact often causes more than one fracture of the calcaneus (heel bone). The injury can also affect the bone above (the talus) and the supportive soft tissue structures. Recovery is very slow and many times the bone just doesn’t heal.With malunion the calcaneus fractures separate, the bone widens, and deformity results. The fracture heals but the bone is not knitted back together properly. T…Read more

New Study Challenges Surgery for Achilles Tendon Ruptures

The debate continues among surgeons about the best way to treat Achilles tendon ruptures early on after they have happened. The first question is whether to operate and repair the torn tendon or treat it conservatively (without surgery). It would seem that whichever way gives the best outcomes is the way to go. But the problem is that different studies come up with different results. There just don’t seem to be consistent results to support one approach over the other.In a recent study by this a…Read more

Step-By-Step Evaluation of Midfoot Fractures

In this review article, orthopedic surgeons remind us how midfoot injuries called Lisfranc injuries come about, why they are called by that funny name, how the physician makes the diagnosis, and what type of treatment is called for.Most people have a general idea of what is meant by the midfoot — that area between the base of the toes and the ankle/heel complex. The proper anatomical term is the tarsometatarsal (TMT) joint. Metatarsals are the long bones of the forefoot. These are the bones of …Read more

Rare Ankle Fracture in Children

It can be difficult to advise parents or caretakers of children with traumatic fractures of the talus because this type of fracture is rare. We know how these fractures develop (the mechanism of injury). But other information on talus fractures in children is limited. Who gets these (risk factors), what’s going to happen (natural history), and what can go wrong (complications)?The talus is located just above the calcaneus (heel bone). The talus has a bit of an odd shape with a main square-shaped…Read more

More Good News From the Operating Room

The ankle is a very complex joint and a bad break affecting the joint itself can lead to considerable pain and disability. Older age and certain health factors can add misery to an already difficult situation. That’s been the case with intraarticular (inside the joint) calcaneal fractures.The calcaneal bone is your heel bone. It sits right under the tibia (lower leg bone) and right above the talus and forms part of the ankle joint. In the past, surgery to fix a fracture affecting this area in an…Read more

Stretching or Shock-Wave Therapy for Plantar Fasciopathy?

Many people suffer from foot pain attributed to plantar fasciitis. But when the pain becomes chronic and lasts months to years, the problem isn’t one of inflammation but rather a failure to heal. The condition is referred to as plantar fasciopathy. What can be done to help?The plantar fascia is a thick band of connective tissue along the bottom of the foot. It goes from the calcaneus (heel bone) to the metatarsal bones (toes). It supports the arch of the foot and helps carry the load of body wei…Read more

Report on Turf Toe in Athletes

If you pay attention to any sports news, then you know how sports radio and TV hosts talk endlessly about athletes’ injuries. With more and more focus on sports, even the tiniest scratch or dent is headline news. One of the more unusual injuries reported in football players is called Turf Toe.Turf toe describes damage to the base of the big toe. The medical term for this problem is hyperextension injury to the hallux metatarsophalangeal (MTP) joint. Hyperextension means the toe is bent way back …Read more

Achilles Tendon Rupture: Surgery or No Surgery?

If we told you the rate of re-rupture after surgery for acute Achilles tendon injuries is four per cent (compared with 12 per cent for patients treated nonsurgically), would you have the surgery? At first glance, the numbers seem to speak for themselves. But listen to what surgeons and physical therapists have to say about these results.The large Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. Along with other tendons, it supports, stabilizes, and helps move …Read more

Foot Pain: Causes and Treatment

Foot Pain: Causes and Treatment In this review article, orthopedic surgeons specializing in foot care bring us up-to-date on a type of foot pain called metatarsalgia. Metatarsals refer to the long bones of the toe. The term -algia always indicates pain. So in metatarsalgia, the pain occurs at the base of the toes where the metatarsals join the phalanges (end of the toes). You might recognize this area as the “ball” of the foot.If you look up the treatment for metatarsalgia, you won’t find a “on…Read more

Results of Foot Injuries — Airbags

You probably won’t be surprised to know that front-end collisions resulting in airbag release cause significant physical injuries. The force of the bag inflating against the body protects the person from smashing into the dashboard or going out the front window.But as Newton’s third law of motion states, For every action, there is an equal and opposite reaction. This means that for every force there is a reaction force that is equal in size but in the opposite direction. The transfer of force du…Read more

Joint Replacement For the Big Toe

Joint replacements are widely used for the hip, knee, and shoulder. Ankle, elbow, and finger joint replacements are available but are less common. Now on the cutting edge are toe replacements — specifically the first metatarsophalangeal joint (MTP) or base of the big toe.Companies that make joint implants are working with surgeons to find the right materials and design for the first ever successful metatarsophalangeal (MTP) joint replacement. Actually, the first MTP joint implant was tried back…Read more

Using Ultrasound Can Help Diagnose Stress Fracture in Foot

A stress fracture is a broken bone, an overuse injury. It can happen in just about any bone, but is most common in the feet or the tibia, the shin bone. Diagnosing stress fractures can be difficult because early fractures don’t always show up on regular x-rays. In fact, it can take up to 10 weeks from the initial injury and beginning of the symptoms to when the fracture is visible. The problem is the delay in diagnosis may lead to other problems, such as chronic pain.Read more

Encouraging Results Seen with Early Ambulation After First Metatarsophalangeal Joint Fusion with Locking Plate

Pain and stiffness of the first metatarsophalangeal joint (the “big toe” joint where it meets the foot) is fairly common and can be caused my any number of conditions, such as rheumatoid arthritis, failed bunion surgery, or cerebral palsy, to name a few. To reduce the pain and disability, surgeons fuse the joint with a procedure called arthodesis. They can do this procedure with a variety of tools. They can use wires, pins, screws, even metal plates to stabilize the bones. Whatever technique the…Read more

Is There a Link Between Tight Calf Muscles and Foot Pain?

Serendipity is a fancy word for the idea that sometimes things happen unexpectedly. And the results of the event have a positive effect on us or benefit us in some special way. Sometimes surgeons discover things serendipitously.Read more

Bunions: Can Anything Really Be Done for Them?

The “what,when, and why” of bunions explained. If you have a family history, or personal experience with bunions this article explains the rationale for orthotics in the prevention of bunions. Talk to your Physical Therapist at Synergy Therapeutic Group to determine if orthotics would be appropriate for you.Bunions can get pretty ugly — and not just because they look funny. But because with the big toe angled so oddly, the foot loses the normal function of that joint and changes how a person w…Read more

PT Restores Function After Bunionectomy

Sometimes evidence-based medicine reveals some surprising findings. You may find this article interesting. Take for example, surgery for bunions, a condition referred to in medical terms as hallux valgus. The surgeon removes a pie-shaped piece of bone from one side of the big toe and wedges it on the other side of the joint to restore a more normal alignment of the toe. The idea is to restore function in weight-bearing for walking.But new studies using plantar pressure analyses have shown that a…Read more

Review of Causes and Treatment in the Athlete with Heel Pain

Most athletes really depend on their feet and ankles to propel them during sports activities. Running and jumping can become huge problems when the athlete experiences heel pain of any kind. The two most common heel problems affect the plantar heel (underneath) and the posterior heel (back of heel). In this review article, the diagnosis and treatment of four specific problems are addressed. These include 1) insertional Achilles tendon disorders, 2) plantar fasciitis, 3) plantar fascia rupture, a…Read more

No Consensus on Optimal Treatment for Achilles Tendon Disorders

Despite the fact that every year, many people (athletes and nonathletes alike) injure their Achilles tendons, the best way to treat these injuries is still up in the air. Should you use ice? Are steroid injections helpful? Wear a cast? Have surgery? If surgery is needed, the questions start over. What kind of surgery? How invasive? Would a tendon transfer help?