13 Sep 2016

Autumn 2016 - Foot & Ankle

In this edition our clinical authors explore and explain the issues of gait analysis, foot and ankle rehabilitiation, aspects of tibial tendon dysfunction and the latest in ankle surgery.

4. Gait analysis in a clinical musculoskeletal setting

Clinical examination of gait in relation to injury is a common occurrence in physiotherapy, podiatric, orthopaedic and general musculoskeletal clinics. The vast majority of these assessments are conducted by practitioners without immediate access to gait analysis equipment. Methodology remains vague and varied, with no systematic or standardised process available to observe adult patients gait. Often with only a small clinical space, plinth and short walkway we are expected to take a history, and then diagnose not only the current injury, but also the aetiological factors linking to this injury. A simple inversion sprain may be straightforward, but a lateral ankle pain after 3 miles walking with no history of trauma is less so.

This article introduces normal and abnormal foot function in gait, highlighting areas that may be more valid for assessment. It appears that further research and development of gait analysis methodology is required

Paul Harradine, Lucy Gates and Caroline Bowen


10. The "Surrey Stages" award system

In order to help our patients understand the healing and rehabilitation process involved following surgery, or injury to the foot and ankle, we have developed an awards system that encourages progress at a rate that aims to recognise the patient’s goals but prevents the occurrence of re-injury that often results from an attempt to return to activity too quickly 

Julie Kohls-Gatzoulis and Iwona Kolodziejczyk


14. Medial ankle pain: how well do you know Tom?

This article explores posterior tibialis tendon dysfunction (PTTD), an often overlooked tendinopathy that causes medial ankle that can progress to adult acquired flat foot deformity (AAFF). The epidemiology and pathophysiology of the disease will be briefly discussed, but the main focus of this article is to review the assessment skills needed to identify and subsequently classify this disease as the staging determines the management plan. When conservative rehabilitation is indicated the physiotherapist will find that interesting, creative and varied treatment strategies are needed

Noelene Davey


22 - Posterior tibial tendon dystfunction: the highlights of current thinking

Posterior tibial tendon dysfunction (PTTD) is a progressive deformity which can result in the development of a pathological flat foot deformity. Clear evidence exists that suggests that the quality of life for patients with PTTD is significantly and adversely affected. Furthermore, evidence suggests that early conservative intervention can significantly improve the quality of life regarding disability, function and pain. Despite a plethora of studies detailing the benefits of conservative intervention, PTTD remains poorly diagnosed. The aim of this article is to provide an overview of the current position on assessment and diagnosis of PTTD, highlighting differences in interdisciplinary assessment of the condition and providing some clinical data on specific assessment tests, where the evidence base may be limited

Beverley Durrant


30. Recent advances in foot and ankle surgery

Orthopaedic surgery is one of the most innovative of the surgical specialities, the sub-speciality of foot and ankle surgery particlulary so. This article brings together three topics which are new but are all beginning to make a significant impact on the day-to-day care of patients and offer opportunities for orthopaedic surgeons and physiotherapists to work together

Stephen Bendall


36 - Looks aren't everything branding and culture

As Physio First launches their new brand, logo and website, and we have recently been discussing branding with delegates on our Ethical and Effective Marketing module as part of the partnership between Painless Practice and Physio First, it seems timely to explore the issues of brand within the world of private physio, and to provide pointers to what you need to consider before, during and after any re-brand in your own clinic, to make the most of the opportunity and avoid the many potential pitfalls

James Butler


41 - Education calendar

42 - Conference 2016 survey results

44 - Round-up