A brief review of the literature pertaining to the strengthening of ligamentous tissue through physical activity is presented. Although literature exists supporting both sides of the question, the predominence of evidence seems to be in favor of improved ligamentous strength following physical activity. Despite the general agreement, the exact mechanism involved is unclear. It is also unclear whether the ligament or the ligament-bone interface is the site of increased strength. A review of the possible mechanisms involved, as well as a discussion of the influence of immobility on the validity of the experimental results, is presented.

J Orthop Sports Phys Ther 1984;5(5):275-277.

Torque range of motion (TROM) measurements of the metatarsophalangeal joint (MTPJ) of the great toe were made to determine the relationship of joint stiffness and plantar ulceration. Subjects included 20 patients with a history of plantar ulceration of the great toe (GTU), 20 patients with a history of ulceration on the plantar surface of the foot excluding the great toe (NGTU), and 20 normal controls. Peak MTPJ extension was significantly reduced in the GTU group compared to NGTU and control groups (p < 0.0001). The slopes of the TROM and stiffness curves were significantly steeper (p < 0.0001) in the GTU group compared to the control group (p < 0.0001). Results support the hypothesis that stiffness is a factor in plantar ulceration of the great toe.

J Orthop Sports Phys Ther 1988;10(5):172-176.

The purpose of this study was to determine if a shortened pedal shaft in comparison to a standard length pedal shaft significantly changed the amount of flexion required at the knee joint during cycling. In addition, was the phasic activity of the lower extremity musculature altered as a result of cycling under the two different conditions? Six healthy subjects pedaled at a steady rate of 75 rpm on a stationary bicycle with a standard (17.0 cm) and a shortened (8.9 cm) pedal shaft. The results of a paired t-test showed that significantly (p < 0.05) less knee flexion was needed with the shortened pedal shaft compared to the standard length shaft. Comparison of each muscle's phasic activity showed similar activity patterns between the two conditions. The onset of EMG activity, however, was found to be significantly later (p < 0.05) in the rectus femoris muscle while pedaling with the shortened shaft. In addition, the termination of EMG activity in the gastrocnemius muscle was found to occur significantly sooner (p < 0.05) during the shortened pedal shaft condition. The results of this study indicate that a shortened bicycle pedal shaft reduces the amount of knee flexion required for cycling without greatly altering the muscle contraction patterns of the muscles studied. It is the opinion of the authors that such a device will allow patients with moderately restricted ROM of the knee to utilize a stationary bicycle in their rehabilitation program.

J Orthop Sports Phys Ther 1989;11(6):259-262.

The purpose of this study was to see if mental practice (MP) would increase voluntary isometric muscle strength in normal individuals. Twenty-four female subjects were randomly assigned to either a control group or a MP group. The study was conducted over a four-day period using a pretest, posttest, and control group design. The MP group participated in four, 30-minute covert practice sessions. During these sessions, subjects were instructed to cognitively practice isometric contractions of their right quadriceps muscle. Surface electromyography was applied during each practice session to ensure that subjects were not physically contracting their muscles. The data were analyzed using a two-way analysis of variance with repeated measures on one of the factors. The results of this study showed that the MP group significantly (p < .05) increased (12.6%) their quadriceps muscle strength compared to the control group.

J Orthop Sports Phys Ther 1991;13(5):231-234.

The Heel Pain-Plantar Fasciitis Guidelines link the International Classification of Functioning, Disability, and Health (ICF) body structures (Ligaments and fascia of ankle and foot, and Neural structures of lower leg) and the ICF body functions (Pain in lower limb, and Radiating pain in a segment or region) with the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD) health condition (Plantar fascia fibromatosis/Plantar fasciitis). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) prognosis, (3) interventions provided by physical therapists, and (4) assessment of outcome for common musculoskeletal disorders.

J Orthop Sports Phys Ther. 2008;38(4):A1-A18. doi:10.2519/jospt.2008.0302

The original article was corrected in October 2008, and the amended article PDF is provided here. Please see: October 2008 Errata

KEY WORDS: APTA, clinical practice guidelines, ICD, ICF, Orthopaedic Section

Plantar fasciitis is a common pathological condition of the foot and can often be a challenge for clinicians to treat successfully. The purpose of this article is to present and discuss selected literature on the etiology and clinical outcome of treating plantar fasciitis. Surgical and nonsurgical techniques have been used in the treatment of plantar fasciitis. Nonsurgical management for the treatment of the symptoms and discomfort associated with plantar fasciitis can be classified into 3 broad categories: reducing pain and inflammation, reducing tissue stress to a tolerable level, and restoring muscle strength and flexibility of involved tissues. Each of these treatments has demonstrated some level of effectiveness in alleviating the symptoms of plantar fasciitis. Previous studies have grouped all forms of nonsurgical therapy together. It is, therefore, difficult to determine if one type of treatment is more effective compared with another. Until such research is available, the clinician would be wise to include treatments from all 3 categories.

J Orthop Sports Phys Ther. 1999;29(12):756-760.

Key Words: foot pathology, injury overuse, treatment

Measurement of calcaneal inversion and eversion during walking is limited when subjects wear shoes. The authors of this study propose the use of transverse tibial rotation as a viable alternative measurement when barefoot assessment is not possible. The purpose of this study, therefore, was to: 1) determine the relationship between transverse tibial rotation and rearfoot motion during the stance phase of normal walking and 2) demonstrate the usefulness of measuring transverse tibial rotation when evaluating the effect of footwear and insole foot orthotic devices. Part 1 consisted of 8 volunteers (5 women, 3 men) whose rearfoot and transverse tibial motion was videotaped while they walked along a 12-m walkway. The results of this study showed that although absolute values were not comparable, the 2 motion patterns are related to each other. The correlation between the mean rearfoot and tibial motion patterns of all 16 feet was r = .953. Part 2 investigated the effect of footwear and orthotics on transverse tibial rotation using 2 case presentations. A video camera was positioned in front of each subject as they walked at a self-selected speed under various footwear or orthotic conditions. The results of the case studies revealed that footwear or foot orthotics decrease maximum tibial internal rotation compared with barefoot walking. In addition, internal tibial rotation velocity and acceleration were decreased by the use of shoes, an accommodative orthosis, and an inflatable medial longitudinal arch support. A rigid orthotic produced a slight increase in transverse tibial rotation and a dramatic increase in transverse tibial acceleration. It is felt that measurement of transverse tibial rotation may prove useful in evaluating footwear and orthotic effectiveness.

J Orthop Sports Phys Ther. 1995;21(6):337-344.

Key Words: walking, orthotics, tibial rotation

The purpose of this study was to determine the relationship of the static angle of the rearfoot during single leg standing, relaxed standing foot posture, and subtalar joint neutral position with the pattern of rearfoot motion during walking. The authors felt that this study was important to gain a better understanding of the relationship between dynamic rearfoot motion and 3 static rearfoot angles, which are often included in foot examination procedures. The pattern of rearfoot motion was assessed using 2-dimensional video recordings for each lower extremity of 31 healthy young adult subjects with a mean age of 25.2 years. The mean path of rearfoot motion during walking crossed relaxed standing foot posture but did not cross single leg standing or subtalar neutral position. These findings suggest that the mean path of rearfoot motion during the first 60% of the walking cycle occurs between the static angles of relaxed standing foot posture and single leg standing. In addition, the static angle of the rearfoot in single leg standing may serve as a clinical indicator of the degree of maximum rearfoot eversion occurring during the walking cycle.

J Orthop Sports Phys Ther. 1996;23(6):370-375.

Key Words: walking, rearfoot, eversion, subtalar joint

Despite the fact that clinicians regularly perform static lower extremity measurements on their patients, to date, little research has been published supporting their ability to predict dynamic rearfoot motion. The abilities of static measurements to predict dynamic foot motion could have important implications considering the fact that excessive rearfoot motion has been associated with various injuries of the lower extremity. The purpose of this study, therefore, was to determine if static lower extremity measurements could be used to predict the magnitude of rearfoot motion during walking. Rearfoot motion of each lower extremity was measured from videotape of 27 healthy young adult subjects with a mean age of 26.1 years. In addition, 17 static measurements were measured and recorded bilaterally for each subject. The results of a multiple regression analysis indicated that the only variable that was able to predict maximum rearfoot pronation was the "difference in navicular height" (r2 = .17). None of the 17 measurements were found to predict time to maximum pronation. These results indicate that static measurements of the lower extremity and foot are poor predictors of dynamic rearfoot motion as measured by maximum pronation or time to maximum pronation in healthy individuals without severe foot deformities.

J Orthop Sports Phys Ther. 1996;24(5):309-314.

Key Words: lower extremity, physical examination, rearfoot motion, foot

Whether application of a cold modality following soft tissue trauma causes reactive vasodilation is an important clinical question since one goal of using a cold modality is to limit edema formation. The purpose of this study was to measure change in local blood volume during application of a cold gel pack following inversion sprain of the ankle. Fifteen volunteers participated as subjects (age range: 18-46 years, mean age: 22.2 years). A bilateral tetrapolar impedance plethysmograph was used with venous occlusion to measure the change in local limb volume at the ankle over a 20-minute period during 2 conditions: at rest and with cold gel pack application. A significant reduction in local blood volume occurred during cold gel pack application compared with rest. A significant vasodilation response was not observed. The lack of vasodilation response lends support to the clinical use of a cold gel pack following soft tissue trauma when applied to the ankle for a period of up to 20 minutes.

J Orthop Sports Phys Ther. 1994;19(4):197-199.

Key Words: plethysmography, reactive vasodilation, cold treatment