Achilles and peroneal tendon injuries in the athlete. An expert's perspective.

Peroneal tendonopathy or injuries are not common but may be troubling to the sports enthusiast. Prompt diagnosis and treatment usually result in complete recovery with conservative measures. Biodynamic orthosis with deep heel cups and a long lateral flange extension often are required for return to activity.

Retrocalcaneal problems.

The majority of retrocalcaneal problems may be treated conservatively, using a biomechanical approach with appropriate shoe modification, padding, orthoses, and injection therapy. When appropriate indications are present, calcaneal osteotomies should be considered, despite less indication for these procedures than for simple resection of the retrocalcaneal exostoses.

New and investigative procedures for flatfoot surgery.

For those patients who need it, surgical intervention for flatfoot at an early stage affords a better chance for favorable results. Various procedures that have stood the test of time and investigative procedures are presented. It is suggested that the podiatric surgeon concentrate on tested procedures and wait for further reports on investigative procedures.

The biomechanics of running. Implications for the prevention of foot injuries.

Understanding the biomechanics of running has brought implications for the prevention of foot injuries. These biomechanical considerations, both functional and non-functional, must be evaluated by the sports medicine practitioner. Although functional biomechanical findings are more accurate predictors of injury and diagnostic tools than static findings, a correlation between the two is essential.

How I Manage Ingrown Toenails.

In brief: An ingrown toenail is one of the most common diseases of the nail. Initial treatment includes trimming away the ingrown area and soaking the foot in Epsom salt, or a combination of Epsom salt and pHisoHex or Betadine. If inflammation, localized cellulitis, and pain do not resolve rapidly, chemocautery with phenol or a surgical partial matricectomy can be carried out.

Foot Orthoses: An Update.

In brief: Foot orthoses can be used to correct malalignment problems that contribute to injuries to athletes. There are three basic types of orthoses: soft, semiflexible, and rigid. Soft orthoses are often temporary and are used until it can be determined whether they can alleviate pain.

Foot Orthoses in Ski Boots.

In brief: Orthoses can be used inside downhill ski boots to aid in parallel skiing. Small degrees of imbalance become significant when they affect the skier's posture and ability to turn. The author explains how orthoses, cants between the boot and the ski, and posts correct biomechanical deformities including tibial varus and valgus, subtalar varus, forefoot varus and valgus, and leg-length discrepancies.

Medial plantar digital proper nerve syndrome (Joplin's neuroma)--typical presentation.

Joplin's neuroma, a painful pedal neuralgia, is a benign enlargement of the medial plantar digital proper nerve. The pathology is described as a degenerative process of the nerve characterized by perineural fibrosis. This clinical entity is thought to be caused by 1) trauma, 2) biomechanical imbalances, 3) entrapment, and 4) pinch callus resulting from interphalangeal joint accessory bone.

The Flat Foot.

In brief: The flat foot ranges in severity from imbalance caused by moderate forefoot varus to a hypermobile foot with ligamentous laxity and a plantar-flexed talus. Principal causes are soft-tissue or bony abnormalities and trauma or systemic disease. Treatment includes orthotic foot control and sometimes surgery.

Limb length discrepancies of the lower extremity (the short leg syndrome).

A survey of over 4,000 athletes and long distance runners, seen in my office over the past 6 years, reveals almost 40% of some form of limb length discrepancy. The limb length discrepancy is oftentimes associated with functional abnormalities, such as overpronation of one foot in contradistinction to the other or imbalances within the pelvis itself. Likewise, anatomical or true shortness may be present or a combination of anatomical and functional discrepancies.

The Cavus Foot.

About one third of Dr. Subotnick's patients have high-arched feet. He describes the problems they encounter and how to treat them.