Foot and Ankle Curricular Guidelines in Entry-Level Physical Therapist Education: How Are We Doing?

Introduction: The Foot and Ankle Curricular Guidelines for Physical Therapist Professional Degree Programs (FACG) provided recommendations regarding essential entry-level content and skills. Eight years later, the extent of its implementation is unknown. This study characterizes entry-level Doctor of Physical Therapy (DPT) programs' foot and ankle curriculum with reference to the FACG.

When, where, and why should we look for vestibular dysfunction in people with diabetes mellitus?

The biochemistry of diabetes mellitus results in multi-system tissue compromise that reduces functional mobility and interferes with disease management. Sensory system compromise, such as peripheral neuropathy and retinopathy, are specific examples of tissue compromise detrimental to functional mobility. There is lack of clarity regarding if, when, and where parallel changes in the peripheral vestibular system, an additional essential sensory system for functional mobility, occur as a result of diabetes.

Musculoskeletal Injuries in Elite Collegiate Tenpin Bowling Athletes.

Context: Collegiate tenpin bowling participation is increasing. Accordingly, the experience level of athletes participating, factors related to performance, as well as training workload and sport specialization are likely evolving. However, literature regarding injury rates remains extremely limited.

Ankle plantar flexor muscle performance and patient reported outcomes in people following total ankle arthroplasty.

Background: The purpose of this study was to prospectively evaluate ankle power generation during gait in people with total ankle arthroplasty, and examine the relationships between postoperative plantar flexor strength, ankle power, and patient outcomes.

Methods: Nineteen people with end-stage ankle arthritis who received a total ankle arthroplasty and 19 healthy matched controls participated in this case-control study. Patient reported outcomes included a region specific measure of foot function and a generic measure of physical function.

The Enduring Controversy of Cervicogenic Vertigo, and Its Place among Positional Vertigo Syndromes.

The idea of cervicogenic vertigo (CV) was proposed nearly a century ago, yet despite considerable scrutiny and research, little progress has been made in clarifying the underlying mechanism of the disease, developing a confirmatory diagnostic test, or devising an appropriately targeted treatment. Given the history of this idea, we offer a review geared towards understanding why so many attempts at clarifying it have failed, with specific comments regarding how CV fits into the broader landscape of positional vertigo syndromes, what a successful diagnostic test might require, and some practical advice on how to approach this in the absence of a diagnostic test.

Total ankle arthroplasty: Strength, pain, and motion.

Background: While outcomes such as pain and ankle motion are well researched, information regarding the effect of total ankle arthroplasty on ankle plantarflexion strength is extraordinarily limited. The purpose of this study was to evaluate ankle plantarflexion strength before and after total ankle arthroplasty, and examine the interplay of pain, motion, and strength.

Methods: This prospective case-control study included 19 patients with end-stage ankle arthritis who received a total ankle arthroplasty and 19 healthy control participants matched for age, sex, and body mass index.

Midfoot Function Before and After Total Ankle Arthroplasty.

Background: Information regarding the effect of total ankle arthroplasty (TAA) on midfoot function is extremely limited. The purpose of this study was to characterize midfoot region motion and power during walking in people before and after TAA.

Methods: This was a prospective cohort study of 19 patients with end-stage ankle arthritis who received a TAA and 19 healthy control group participants.

Use of time-to-boundary to assess postural instability and predict functional mobility in people with diabetes mellitus and peripheral neuropathy.

Background: People with diabetes mellitus and peripheral neuropathy (DMPN) often have balance and mobility deficits. Time-to-boundary (TTB) is a parameter of postural control that combines position and velocity center of pressure data. While not previously investigated, assessment of TTB may provide new insight regarding postural control in people with DMPN.

Patient reported outcomes and ankle plantarflexor muscle performance following gastrocnemius recession for Achilles tendinopathy: A prospective case-control study.

Background: Prospective studies to guide the application of a gastrocnemius recession for Achilles tendinopathy are limited. Our aim was to prospectively evaluate patient reported outcomes and muscle performance.

Methods: Patients with unilateral recalcitrant Achilles tendinopathy who received an isolated gastrocnemius recession (n=8) and a healthy control group (n=8) were included.

Ankle and Midfoot Power During Single-Limb Heel Rise in Healthy Adults.

Although the midfoot is recognized to have an important role in the successful performance of a single-limb heel rise, healthy heel rise performance remains primarily characterized by ankle function. The purpose of this study was to examine the contribution of midfoot region power to single-limb heel rise in healthy adults. Participants (N = 12) performed 20 single-limb heel rises.

Changes in Muscle Morphology Following Gastrocnemius Recession for Achilles Tendinopathy: A Prospective Cohort Imaging Study.

The purpose of this study was to evaluate changes in posterior compartment muscle volume and intramuscular fat content following gastrocnemius recession in people with Achilles tendinopathy (AT). Eight patients diagnosed with unilateral recalcitrant AT and an isolated gastrocnemius contracture participated in this prospective cohort study. Magnetic resonance imaging was performed on both limbs of each participant before and 6 months following an isolated gastrocnemius recession.

Ankle and Midfoot Power During Walking and Stair Ascent in Healthy Adults.

Ankle power dominates forward propulsion of gait, but midfoot power generation is also important for successful push-off. However, it is unclear if midfoot power generation increases or stays the same in response to propulsive activities that induce larger external loads and require greater ankle power. The purpose of this study was to examine ankle and midfoot power in healthy adults during progressively more demanding functional tasks.

The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice.

Background: Implementation of interprofessional clinical guidelines for the prevention of neuropathic diabetic foot ulceration has demonstrated positive effects regarding ulceration and amputation rates. Current foot care recommendations are primarily based on research regarding the prevention of ulcer recurrence and focused on reducing the magnitude of plantar stress (pressure overload). Yet, foot ulceration remains to be a prevalent and debilitating consequence of Diabetes Mellitus.

Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for Achilles Tendinopathy.

Background: Studies have demonstrated improved ankle dorsiflexion and pain reduction following a gastrocnemius recession (GR) procedure. However, changes in muscle performance during functional activities are not known. The purpose of this study was to determine the effect of an isolated GR on ankle power and endurance in patients with Achilles tendinopathy.

Multi-joint foot kinetics during walking in people with Diabetes Mellitus and peripheral neuropathy.

Neuropathic tissue changes can alter muscle function and are a primary reason for foot pathologies in people with Diabetes Mellitus and peripheral neuropathy (DMPN). Understanding of foot kinetics in people with DMPN is derived from single-segment foot modeling approaches. This approach, however, does not provide insight into midfoot power and work.

Individual metatarsal and forefoot kinematics during walking in people with diabetes mellitus and peripheral neuropathy.

The purpose of this study was to compare in-vivo kinematic angular excursions of individual metatarsal segments and a unified forefoot segment in people with Diabetes Mellitus and peripheral neuropathy (DMPN) without deformity or ulceration to a healthy matched control group. Thirty subjects were recruited. A five- segment foot model (1st, 3rd, and 5th metatarsals, calcaneus, tibia) was used to examine relative 3D angular excursions during the terminal stance phase of walking.

Alterations in plantar pressure with different walking boot designs.

Background: Specialized walking devices, such as total contact casts and removable walking boots, have been shown to be effective noninvasive treatment options for plantar ulcers. Attempts at improving patient compliance frequently lead to new boot designs; however, the effect of the design modifications on plantar pressures or on the contralateral limb often is unknown. The purpose of this study was to determine the effect of different walking-boot calf heights and rocker sole designs on regional plantar pressures, as well as, on contralateral limb loading during walking.