Month: September 2015

Foot Strike Pattern and Injury Rates in Runners

Posted on by Staff

There is a lot of debate online about which is the best running technique for a runner to use. One of the more common debates is about the foot strike pattern and if it should be forefoot, midfoot or heel striking the ground first. The bulk of the evidence does not support one over the other.

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The foot strike pattern refers to the way a runner’s foot makes initial contact with the ground during each stride. There are three primary types: rearfoot strike (heel strike), midfoot strike, and forefoot strike. In rearfoot striking, the heel touches the ground first, followed by the midfoot and forefoot. Midfoot striking involves the heel and ball of the foot landing almost simultaneously, while forefoot striking means the ball of the foot contacts first, with the heel either lightly touching afterward or not at all. These patterns can influence biomechanics, efficiency, and risk of injury.

Most recreational runners naturally adopt a rearfoot strike, especially at slower paces. This pattern provides more stability and often feels comfortable because cushioned running shoes are designed to accommodate it. However, heel striking also increases impact forces transmitted up the leg, which has been associated with certain injuries like shin splints or knee pain. On the other hand, elite distance runners tend to show more variety, with some preferring midfoot or forefoot strikes, particularly at faster speeds.

A midfoot strike is often considered a balance between cushioning and efficiency. It tends to reduce the braking forces that occur with a heavy heel strike while avoiding the high calf and Achilles loading associated with forefoot striking. Many coaches recommend midfoot striking for long-distance running because it spreads out impact forces more evenly across the foot. However, adopting this pattern requires adequate ankle and calf strength, and a gradual transition to avoid overuse injuries.

The forefoot strike is commonly seen in sprinters and barefoot runners. This style allows for faster turnover and efficient energy return from the Achilles tendon, which acts like a spring. It’s beneficial for short, explosive efforts but places significant stress on the calves, Achilles tendon, and metatarsals. Without careful adaptation, runners switching suddenly to a forefoot strike can experience calf strain or plantar fascia issues. Ultimately, no single pattern is “best” for all runners—individual biomechanics, goals, and comfort largely determine the most suitable strike pattern.

Most Useful Resources:
Foot Strike Pattern and Running Injury (PodiaPaedia)
Foot Strike Pattern and Injury Rates (Running Research Junkie)
Its six of one and half a dozen of the other: Rearfoot vs Forefoot striking when running (Running Research Junkie)
Emerging Evidence on Footstrike Patterns in Running (Podiatry Arena)
Running Footstrike: Rearfoot, Midfoot or Forefoot, Which is Best? (Podiatry Arena)
New studies on injury rates between forefoot and rearfoot striking (Podiatry Arena)

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Dr Merton Root, DPM

Posted on by Staff

Dr Merton Root, DPM (1922–2002) is widely considered the ‘father’ of clinical biomechanics in podiatry and the theory (‘Root theory’) that largely underpins the use of foot orthotic is mostly based on his original concepts.

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Dr. Merton L. Root, DPM, was a pioneering podiatrist whose work had a profound and lasting impact on the field of biomechanics and podiatric medicine. Widely regarded as the “father of modern podiatric biomechanics,” he dedicated his career to understanding the structure and function of the human foot. His clinical insights and research shaped how practitioners evaluate, diagnose, and treat foot disorders, moving the profession toward a more scientific and biomechanically grounded approach.

One of Dr. Root’s most significant contributions was the development of the Root Theory of Foot Function, which emphasized the importance of foot alignment and its role in overall biomechanics. He introduced systematic methods for analyzing gait and foot posture, and he advanced the concept of orthotic therapy as a corrective tool rather than just a means of symptom relief. His theories provided a framework that continues to influence orthotic design, foot surgery, and rehabilitation programs today.

Beyond his clinical work, Dr. Root was also a teacher, author, and innovator. His seminal textbook, Normal and Abnormal Function of the Foot (co-authored with Orien and Weed), remains a cornerstone reference in podiatric education. Through teaching, writing, and mentorship, he inspired generations of podiatrists to adopt a rigorous, evidence-based approach. Although aspects of his theories have been debated and refined over time, his legacy endures in the foundational role he played in establishing podiatry as a respected medical specialty grounded in biomechanics.

Most Useful Resources:
Merton L. Root (PodiaPaedia)
Root Theory (PodiaPaedia)
Root Functional Orthotic (PodiaPaedia)
The wit and wisdom of … Merton Root (Podiatry Arena)

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Rupture the plantar fascia to treat plantar fasciitis

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This is something of a legend that happened in Australia where a footballer with a chronic plantar fasciitis allegedly jumped from a height in order to rupture his plantar fascia to facilitate healing. A surgical cutting of the plantar fascia is often used to treat chronic plantar fasciitis. It apparently worked.

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Most Useful Resources:
Deliberate Rupture of Plantar Fascia to Treat Plantar Fasciitis (PodiaPaedia)
Rupture the plantar fascitis to help? (Podiatry Experts)
Deliberate rupture of plantar fasica to treat plantar fasciitis (Podiatry Arena)

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Treatment for a plantar fascia rupture typically involves a combination of conservative measures and, in some cases, surgical intervention:

Rest and immobilization: Initially, it’s important to rest the affected foot and avoid activities that worsen the pain. Immobilization through the use of a walking boot, cast, or crutches may be necessary to allow the plantar fascia to heal.

Ice therapy: Applying ice to the affected area as soon as it happend can help reduce pain and inflammation. Ice packs or frozen water bottles can be used for 15-20 minutes several times a day.

Pain management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help alleviate pain and reduce inflammation. Always consult a healthcare professional before taking any medication.

Physical therapy: A physical therapist may provide specific exercises to stretch and strengthen the muscles and tissues surrounding the foot and ankle. These exercises can help improve mobility, reduce pain, and promote healing.

Orthotic devices: Wearing orthotic devices, such as arch supports or custom-made shoe inserts, can help alleviate stress on the plantar fascia and provide support during the healing process.

Night splints: Night splints are devices worn while sleeping to keep the foot and ankle in a stretched position, which can help prevent the plantar fascia from tightening and promote healing.

Extracorporeal shock wave therapy (ESWT): In some cases, ESWT may be recommended. This treatment involves using shock waves to stimulate healing and reduce pain.

Surgical: If thee above conservative measure do not help, then surgery is an option.

Corticosteroid injections: Corticosteroid injections may be considered if conservative treatments are not effective. However, these injections are generally used sparingly due to potential risks.

Surgical intervention: Surgery is typically considered only when conservative treatments fail to provide relief. Surgical options may include plantar fascia release, where the tight or damaged portion of the plantar fascia is surgically cut or detached to relieve tension.

Gabapentin

Posted on by Staff

Gabapentin’s connection to podiatry is that it can be used to treat chronic regional pain syndrome and restless leg syndrome which is common among patients seen in podiatry clinical practice. It is mainly used to treat epilepsy, but its use in conditions such as restless leg syndrome and other has increased over time due to clinical experience in its use.

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Gabapentin is a prescription medication originally developed to treat epilepsy, but it has since become more widely used for managing neuropathic (nerve-related) pain and certain mood disorders. It works by affecting the way nerves send signals to the brain, calming overactive electrical activity. While not chemically related to benzodiazepines or opioids, gabapentin influences neurotransmitters in a way that can help stabilize nerve firing and reduce sensations of pain, burning, or tingling often caused by conditions like diabetic neuropathy, postherpetic neuralgia (nerve pain after shingles), and fibromyalgia.

In clinical practice, gabapentin is valued for its versatility. Beyond its primary role in seizure control and nerve pain relief, it is sometimes prescribed off-label for conditions like anxiety, restless legs syndrome, or migraine prevention. Dosing typically starts low and is gradually increased, since the body needs time to adjust and the drug’s effectiveness depends on steady levels in the bloodstream. Unlike some stronger pain medications, gabapentin does not carry the same high risk of addiction, though misuse and dependence have been reported, especially when combined with other sedatives.

Like most medications, gabapentin comes with potential side effects. Common ones include dizziness, drowsiness, fatigue, and coordination problems, which can make activities like driving more hazardous until the body adapts. Some people also experience swelling in the extremities or mood changes. Serious side effects are less common but may involve severe allergic reactions or suicidal thoughts, which require immediate medical attention. Because gabapentin is processed by the kidneys, people with impaired kidney function usually need adjusted doses. Overall, gabapentin can be very effective when used appropriately under medical supervision, but careful monitoring is important to balance its benefits with its risks.

Most Useful Resources:
Gabapentin (PodiaPaedia)
NEURONTIN Prescribing Information (Pfizer)
Gabapentin (Wikipedia)

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Restiffic Foot Wrap for Restless Legs Syndrome

Posted on by Staff

Restless legs syndrome is a common and extremely annoying problem. No one treatment works for each person, so often it is a trial and error to find the most useful treatment. There are many different drug options, including gabapentin, but each drug only seems to a small percentage of those with restless legs syndrome. There has been some recent discussion on the use of the Restiffic foot wrap, but it has not yet come to market. It appears to be a wrap that tight binds the foot. Those with Restless legs syndrome are always searching for cures as it has a significant affect on sleep quality and on their quality of life.

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The Restiffic Foot Wrap is a medical device designed to provide relief for individuals suffering from Restless Legs Syndrome (RLS), a condition characterized by uncomfortable sensations in the legs and an uncontrollable urge to move them, particularly at night. The wrap works by applying targeted pressure to specific points on the foot, which stimulates the peripheral nerves and helps reduce the neurological triggers that contribute to RLS symptoms. This pressure-based approach is non-invasive and drug-free, making it an appealing option for those seeking alternatives to medication.

One of the key benefits of the Restiffic Foot Wrap is its potential to improve sleep quality. Since RLS often disrupts rest due to constant leg movement and discomfort, alleviating these symptoms can lead to more restorative sleep. Better sleep not only enhances daily energy levels but also supports overall health, including cardiovascular and cognitive function. For many patients, consistent use of the foot wrap can help break the cycle of fatigue and nighttime restlessness, which are some of the most frustrating aspects of living with RLS.

Additionally, the wrap’s design prioritizes ease of use and comfort. It resembles a soft foot strap, adjustable to different sizes, and can be worn while lying in bed. Unlike pharmaceutical treatments, which may cause side effects or diminish in effectiveness over time, the Restiffic Foot Wrap offers a mechanical, low-risk solution. While results vary from person to person, clinical studies and user testimonials suggest that it can significantly reduce the severity of RLS symptoms, making it a valuable option for long-term management of this challenging condition.

Most Useful Resources:
RESTIFFIC™ Foot Wrap (PodiaPaedia)
The Restiffic Foot Wrap for Restless Legs Syndrome (Podiatry Arena)
Restiffic Foot Wrap for Restless Legs Syndrome (Its a Foot)

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The Mueller TPD Foot Orthotic

Posted on by Staff

The Mueller TPD Foot Orthotic is a particular foot orthotic design originally developed by Terrance J Mueller DPM to specifically treaty posterior tibial tendon dysfunction. This foot orthotic typically has a deep heel cup and medial and lateral flanges to limit transverse plane motion.

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Most Useful Resources:
Mueller TPD Foot Orthoses (PodiaPaedia)
Mueller TPD Orthotic info (Podiatry Arena)

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Gowers Sign

Posted on by Staff

Gowers Sign is an indicator of several neurological problems such as Duchennes Muscular Dystrophy. It is due to the weakness of the proximal muscles. The child as to raise from the ground from a supine position and use the hands to climb up the legs.

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Gowers’ sign is a classic clinical indicator of proximal muscle weakness, particularly involving the muscles of the pelvic girdle and lower limbs. It is named after Sir William Richard Gowers, a 19th-century British neurologist, who first described the maneuver in patients with muscular dystrophy. The sign is observed when a patient, asked to rise from a sitting or lying position on the floor, cannot do so directly. Instead, the individual uses their hands and arms to “walk” up their own body — pushing on the thighs and knees to achieve an upright stance. This compensatory motion reflects the weakness of the hip and thigh muscles that normally extend the trunk and hips.

The underlying mechanism behind Gowers’ sign lies in weakness of the proximal muscles, especially the gluteus maximus, quadriceps femoris, and hip extensors. In healthy individuals, these muscles provide sufficient power to raise the body smoothly. However, when they are weakened, as in conditions like Duchenne muscular dystrophy (DMD), the child cannot generate enough strength from the lower limbs alone. To compensate, they use their upper limbs to support and lift the trunk — a process often described as “climbing up the body.” This movement pattern is not only diagnostic but also provides insight into the severity and distribution of muscle involvement.

Clinically, Gowers’ sign is most commonly associated with Duchenne muscular dystrophy, but it may also appear in other disorders causing proximal weakness, such as Becker muscular dystrophy, limb-girdle muscular dystrophies, polymyositis, and spinal muscular atrophy. The presence of Gowers’ sign in a pediatric examination often prompts further diagnostic evaluation, including serum creatine kinase (CK) testing, genetic studies, and electromyography (EMG) to identify the underlying cause. Recognizing the sign early is critical because it may be one of the first observable manifestations of progressive muscle disease.

From a diagnostic standpoint, observing Gowers’ sign provides a simple yet powerful clue in neuromuscular assessment. It underscores the importance of functional testing in neurological examination, where careful observation of movement can reveal the nature of underlying pathology. In modern practice, though advanced imaging and genetic tools are available, bedside signs like Gowers’ remain invaluable in guiding clinical suspicion. Thus, Gowers’ sign not only serves as a window into muscle physiology but also as a testament to the enduring relevance of classical clinical observation in medicine.

Most Useful Resources:
Gowers’ Sign (PodiaPaedia)
Gower Sign (Podiatry FAQ)
Gowers Sign (Podiatry TV)

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