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This study examined the effect of customized insoles in relieving postwork discomfort in healthy individuals whose jobs require long periods of standing and walking. CompuSole insoles were worn by 122 New York City Police Department officers for up to 5 weeks for an average of 7 hours per day. The officers walked an average of 3 miles per day. Before the study, one-fifth of the police officers in this study experienced foot pain or discomfort at the end of their workday; 15% had calluses, corns, or athlete's foot; 18% had sought treatment for a foot problem in the past; and 20% had worn foot orthoses. There was a significant reduction in tiredness in the feet at the end of the day after wearing the insoles, but no improvement in back or leg discomfort. At the end of the workday, 68% had less foot discomfort and 60% were more comfortable at work when wearing the insoles.

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Orthotic management is helpful in the treatment of most orthopedic conditions involving the rearfoot, including plantar fasciitis, Achilles tendon disorders, posterior tibial tendon dysfunction, flatfoot, ankle sprains, and problems associated with diabetes, arthritis, and equinus disorders. A review of the effectiveness of orthoses in the treatment of these conditions is presented here. An in-depth analysis of the orthotic management of plantar fasciitis and a critical review of foot orthoses for the pronated foot are presented. Also discussed are the rationale and effectiveness of the tension night splint in the treatment of plantar fasciitis, orthotic devices for the different stages of posterior tibial tendon dysfunction, and the various categories of orthoses for off-loading the diabetic foot. The modern ankle brace, the effectiveness of prefabricated versus prescription foot orthoses, and recent developments in the ankle-foot orthosis are also reviewed.

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Reliability and normal values for the relaxed calcaneal stance position were determined in a nonclinic population of healthy adults and children (88 adults and 124 children) ranging in age from 5 to 36 years. The mean relaxed calcaneal stance position for adults was 6.07 degrees valgus (SD 2.71 degrees) (range, 1 degree varus to 14 degrees valgus). The mean relaxed calcaneal stance position for children was 5.6 degrees valgus (SD 2.9 degrees) (range, 6 degrees varus to 12 degrees valgus). There was no significant difference between the relaxed calcaneal stance positions of adults and children. In children the relaxed calcaneal stance position did not correlate with age, height, or weight and did not decrease with age to the theoretical normal value of 0 degree +/- 2 degrees as postulated by Root et al. The relaxed calcaneal stance position was found to be a reliable measurement; however, the theoretical normal value of 0 degree +/- 2 degrees was not found. The values reported in the present study correspond with the results of other empirical studies; thus the theoretical normal value for the relaxed calcaneal stance position of 0 degree +/- 2 degrees may be invalid.

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Musculoskeletal disease presenting in a child's foot is usually an isolated mechanical problem rather than part of a systemic disease; however, the pediatric flatfoot may be a more serious problem, caused by tarsal coalitions, congenital vertical talus, or part of a syndrome. The most common congenital pediatric foot deformities, including flatfoot, talipes equinovarus, digital anomalies, and osteochondritis, have characteristic and easily identifiable features that should be familiar to the practitioner. In this article, these deformities are described as they occur in isolation and as the result of more serious syndromes or causes.

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The major systemic musculoskeletal diseases that involve the foot include the inflammatory arthritides, gout, and diabetic osteoarthropathy. Podiatric problems are present in over one-third of patients with musculoskeletal disease and in over half of all patients with diabetes. The pedal manifestations of musculoskeletal disease are reviewed as the first indicators of systemic disorders and as they occur in established systemic diseases.

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A clinical study was performed to evaluate the efficacy of the Viscoped Insole as compared with an 1/8-inch PORON medical materials insole in the treatment of lesser submetatarsal hyperkeratotic callosities. Thirty-five patients, ranging in age from 23 through 61 years (average 42 years) were randomly divided into three groups. All three groups initially had debridement of their submetatarsal callosities. In addition to the debridement, the first group (16 patients) wore a Viscoped Insole for 4 weeks. The patients in the second group wore a PORON insole for 4 weeks. The third group did not receive an insole after their debridement and served as the control. There was a significant improvement in the Viscoped group and the PORON group versus the control group (x2 = 40; p < 0.01) as measured by the foot function index. Insole therapy combined with debridement for submetatarsal hyperkeratoses is more effective than debridement alone.

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Health care reform will have great impact on the podiatric physician as the podiatric medical profession continues to integrate into the general medical community. The role of medical education in addressing five major issues that affect health care reform is explored. These issues include specialization, economics, continuous quality improvement, ethics, and fraud.

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The effect of a magnetic foil placed in the PPT/Rx Firm Molded Insole on the relief of heel pain was determined using the foot function index. Nineteen patients wore the PPT/Rx Firm Molded Insoles with the magnetic foil for 4 weeks and 15 patients wore the same PPT/Rx Firm Molded Insole with no magnetic foil for the same time. Approximately 60% of patients in both groups reported improvement. There was also no significant difference in the improvement between the magnetic foil group and the PPT/Rx Firm Molded Insole group in their scores on the post-treatment foot function index. These results suggest that the PPT/Rx Firm Molded Insole alone was effective in treating heel pain after only 4 weeks. The magnetic foil offered no advantage over the plain insole.

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Sixty idiopathic toe walkers (age range 1 to 15 years) were evaluated to determine the natural history of toe-to-toe gait and the relationship between the range of ankle dorsiflexion and increasing age. The majority of toe walkers had a normal birth weight (average 7.06 pounds), walked on time (average 11.14 months), began toe walking immediately (87%), stood plantigrade (90%), were able to demonstrate a heel-toe gait (88%), and toe walked intermittently (68%). Forty-six percent of all toe walkers were found to have 0 degree or less of passive ankle dorsiflexion. Equinus toe walkers (mean dorsiflexion -5.2 degrees) had significantly less dorsiflexion than the remaining toe walkers (mean dorsiflexion 16.9 degrees; p < 0.01). An average of 12 degrees of dorsiflexion was resent in the 1-to 2-year age group, which gradually diminished to -4 degrees in the 6- to 15-year age group. It appears that there may be a relationship between persistent toe walking and the development of ankle equinus in some children and therefore interventions should be considered to inhibit the toe walking progression.

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The purpose of this study was to determine the type and frequency of lower extremity running injuries incurred by athletes participating in the New York City Marathon. A survey was conducted of 265 athletes presenting to medical stations for podiatric care during the 1994 New York City Marathon. The results of the survey indicated that the most common injuries occurring in marathon runners were corns, calluses, blisters, muscle cramps, acute knee and ankle injuries, plantar fasciitis, and metatarsalgia. An inverse relationship was observed between the number of miles trained per week and the number of injuries. These findings are consistent with long-term studies of running injuries.

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The authors offer a brief review of pedal ectrodactyly and associated conditions. Discussion of the biomechanical aspects of this abnormality are presented. A case study is also illustrated.

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The history and prosthetic difficulties of a patient with an unusual Chopart amputation variant have been presented. Although it is possible for the Chopart amputee to walk with just a shoe and filler, this patient does best with a formal prosthesis. The Chopart amputation, which has been surgically stabilized with Achilles tendon lengthening to prevent equinus contractures, can be fitted successfully with a lightweight circumferential plastic or silicone prosthesis or more traditionally with a solid ankle foot orthosis with filler. This partial foot prosthesis is worn with a sturdy shoe with a rocker and solid ankle cushion heel or a well constructed running shoe. The Chopart amputee with equinus contractures must be fitted with a Chopart clamshell prosthesis or solid ankle patellar tendon bearing orthosis with filler and the above shoe prescription. Recent variants of the partial foot prosthesis including the Imler partial foot prosthesis, the Lange silicone prosthesis, and the ankle corset prosthesis were described.

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The authors describe the podiatric biomechanical management of the child and adolescent with Down syndrome. They also present an overview of the genetics, general characteristics, orthopedic problems, and gait of these patients. They discuss the various approaches to the biomechanical problems associated with the syndrome, and present two case histories that demonstrate common considerations in the treatment of the patient with Down syndrome.

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From a comparative biomechanical standpoint, it would appear that modern man's ancestors have possessed upright posture and bipedalism for 12 to 14 million years. More recent hominid comparisons would show that Australopithecines, hominids dating from about 3 to 4 million years ago, had almost indistinguishable foot structure from that of modern Homo sapiens. Yet man's environment and activities have changed dramatically over this period of time. Perhaps man's foot and his entire ambulatory structure has not evolved sufficiently to meet his needs, and perhaps this has led to the reason why man has a multitude of foot and gait problems, and therefore the need for the study of these problems.

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Habitual toe-walking has been presented as a prolongation of a normal stage of development that requires conservative treatment to prevent or ameliorate associated gait abnormalities such as tripping and falling. An approach to the evaluation of a child with toe-walking should include (1) medical history (prenatal, intrapartum, and postnatal), (2) gait evaluation, (3) musculoskeletal examination, and (4) neurologic examination. Pathologic entities producing toe-walking have been explored in order to differentiate those conditions from idiopathic (habitual) toe-walking. The most common etiologies of toe-walking (nonhabitual) would include gastrosoleus equinus, clubfoot, or cerebral palsy. Treatment of habitual toe-walkers might include shoe therapy, orthosis therapy, auditory feedback, and surgery.

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A method for the orthopedic evaluation of a child during the neonatal period of life has been discussed. Emphasis has been placed on conditions affecting the lower extremities such as spinal anomalies, congenitally dislocated hip, and congenital foot disorders. Early detection and medical intervention can play an important role in lower extremity function.

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