Rigid carbon fibre orthoses for Idiopathic Toe Walkers?
“Foot orthoses and high-top boots reduce the immediate occurrence of toe walking” according to Australian research published in Gait and Posture.
In this study the authors highlight that one of the primary treatment goals for idiopathic toe walkers (ITW) is encouraging heel contact. To date there is a lack of research to ascertain whether orthoses can effectively achieve this. 15 children with ITW were recruited for this RCT. They were “fitted with bilateral custom made rigid contoured carbon fibre foot orthoses placed inside high-top boots” which was then compared to barefoot walking.
Results indicated that the orthoses and boots increased heel contact time, altered stance and swing phases, and increased stride time and double support time in children with ITW. This research initially suggests that “the hardness and thickness of the shoe and stiffness of the orthosis midsole may lead to improved local dynamic stability and foot position awareness with increased sensory feedback provided through the entire length of the foot”.
Management of acute Achilles tendon rupture.
A paper published in Orthopaedics and Trauma has suggested guidelines for the Management of acute Achilles tendon rupture.
The authors note the paradigm shift for management or acute Achilles rupture with the introduction of functional rehabilitation and early weight bearing following rupture. They go on to discuss the benefits of non-operative care noting that re-rupture rates for non-surgical treatment are similar to those for surgical treatment but with less complications. Surgery should be considered for very active individuals and athletes because non-operative treatment could lead to statistically significant deficits in high-speed plantar flexion strength and hopping ability. Most patients, however, can be treated with early functional rehab, and if surgery is necessary, minimal invasive techniques should be used to reduce the risk of wound complications
Most importantly, “treatment should be tailored to each individual patient with a shared decision-making process between the surgeon and patient, taking into consideration their occupation, lifestyle, sporting aspirations and expectations”.
Equinus Casts for Conservative Management of Achilles Rupture?
Wedged boots and equinus casts may have different effects on the Achilles following acute rupture according to new research published in The Foot.
In the study, 29 patients with acute Achilles rupture were randomised to a rigid boot with heel wedge group or an equinus cast group. Tibiotalar angle (TTA), tibio-1st metatarsal angle (TMA) and posterior malleolar to calcaneal tip height (PCH) were all measured from X-rays.
Results showed that the rigid boots with heel wedges produced significantly less equinus than an equinus cast. The authors suggest that while the clinical relevance of this is unclear, clinicians should be aware that the different methods produce different degrees of Achilles shortening.