The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain.

People with early stages of tibialis posterior tendinopathy benefited from a program of orthoses wear and stretching. Eccentric and concentric progressive resistive exercises further reduced pain and improved perceptions of function.

To study the incidence of fibulocollateral ligament ankle sprains in the young male athlete, a survey of 84 varsity basketball players was done. Seventy percent of the players had a history of an ankle sprain. Eighty percent of those with a positive history had multiple sprains. Most of the injuries were mild, but in 32% of the injuries, the athlete missed more than 2 weeks of play. No medical attention was sought in 55% of the cases. About 50% of the athletes with a sprain had residual symptoms from their injuries; 15% of the injured athletes felt that their residual symptoms compromised their playing performance. This article emphasizes the potential seriousness of the ankle sprain in the young athlete and presents a recommended method of management, including assessment of severity, treatment, and rehabilitation.

As an integral part of any rehabilitative, preventive, or maintenance program, proper exercise prescription can facilitate improvements in musculoskeletal function by addressing the specific needs of an individual. To this end, functional weight-bearing exercises have received a significant amount of attention as the preferred mode of exercise for lower extremity strengthening. 8,10,28 The popularity of weight-bearing

Abnormal foot pronation and subsequent rotation of the lower extremity has been hypothesized as being contributory to patellofemoral pain (PFP). The purpose of this study was to test the hypothesis that subjects with PFP would exhibit larger degrees of foot pronation, tibia internal rotation, and femoral internal rotation compared to individuals without PFP. Twenty-four female subjects with a diagnosis of PFP and 17 female subjects without PFP participated. Three-dimensional kinematics of the foot, tibia, and femur segments were recorded during self-selected free-walking trials using a six-camera motion analysis system (VICON). No group differences were found with respect to the magnitude and timing of peak foot pronation and tibia rotation. However, the PFP group demonstrated significantly less femur internal rotation compared the comparison group. These results do not support the hypothesis that individuals with PFP demonstrate excessive foot pronation or tibial internal rotation compared to nonpainful individuals. The finding of decreased internal rotation in the PFP group suggests that this motion may be a compensatory strategy to reduce the quadriceps angle.

Appropriate management of patellar tendinopathy requires distinguishing between inflammatory and degenerative conditions, often difficult because tendon thickening can be a normal or pathological adaptation, and micromorphology is not observable on clinical imaging. The purpose of this study was to quantitatively examine patellar tendon micro- and macromorphology in volleyball athletes and relate those findings to reported symptoms. Longitudinal ultrasound images of proximal and distal patellar tendons were acquired from 84 male elite volleyball athletes (44 symptomatic, 40 asymptomatic) and 10 asymptomatic nonathlete controls. Micromorphology was determined using two-dimensional Fast Fourier Transform analysis providing a discriminating peak spatial frequency parameter (PSF). Macromorphology (patellar tendon thickness) was measured using Image J software. All athletes regardless of symptoms had thicker proximal tendons compared to nonathletes, suggesting a normal adaptation to training loads. However, symptomatic athletes demonstrated lower PSF than asymptomatic athletes and nonathletes at the proximal tendon, suggesting greater collagen disorganization, and tendon degeneration rather than inflammation. Only symptomatic athletes had thicker distal tendons than nonathletes, but there was no difference in PSF distally. Diagnostic ultrasound enhances the understanding of the micromorphology of patellar tendons, supporting the rationale for management that remodels the degenerated tendon instead of treating inflammation.

Persons with acquired flatfoot deformity demonstrate impaired walking performance, as indicated by slower walking speed and frequent reports of foot pain during activity and at rest. 25,29 There is no doubt that acquired flatfoot deformity is accompanied by some level of tibialis posterior tendon dysfunction. The tibialis posterior functions to create a rigid foot segment by stabilizing the midfoot 37 and assists in generating energy, by the plantar flexors in terminal stance, to produce successful propulsion. 41 Laboratory studies confirm that persons with acquired flatfoot deformity demonstrate T T STUDY DESIGN: Controlled laboratory study using a cross-sectional design. T T OBJECTIVES:To characterize ankle and hip muscle performance in women with posterior tibial tendon dysfunction (PTTD) and compare them to matched controls. We hypothesized that ankle plantar flexor strength, and hip extensor and abductor strength and endurance, would be diminished in women with PTTD and this impairment would be on the side of dysfunction. T T BACKGROUND:Individuals with PTTD demonstrate impaired walking abilities. Walking gait is strongly dependent on the performance of calf and hip musculature. T T METHODS:Thirty-four middle-aged women (17 with PTTD) participated. Ankle plantar flexor strength was assessed with the single-leg heel raise test. Hip muscle performance, including strength and endurance, were dynamometrically measured. Differences between groups and sides were assessed with a mixed-model analysis of variance. T T RESULTS:Females with PTTD performed significantly fewer single-leg heel raises and repeated sagittal and frontal plane non-weight-bearing leg lifts, and also had lower hip extensor and abductor torques than age-matched controls. There were no differences between sides for hip strength and endurance measures for either group, but differences between sides in ankle strength measures were noted in both groups. T T CONCLUSION:Women with PTTD demonstrated decreased ankle and hip muscle performance bilaterally.

The purpose of this study was to test the hypothesis that the magnitude and timing of peak foot pronation would be predictive of the magnitude and timing of peak rotation of tibia and femur. Thirty subjects who demonstrated a wide range of pronation participated. Three-dimensional kinematics of the foot, tibia, and femur segments were recorded during self-selected free walking trials using a six-camera VICON motion analysis system. Regression analysis demonstrated that the magnitude and timing of peak pronation was not predictive of the magnitude and timing of tibial and femoral rotation. The lack of a relationship between peak foot pronation and the rotation of the tibia and femur is contrary to the clinical hypothesis that increased pronation results in greater lower extremity rotation. It would seem, therefore, that the relationship between foot pronation and rotation of the lower extremity segments should be assessed on a patient-by-patient basis.