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

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

STUDY DESIGN: Descriptive and reliability study. OBJECTIVES: To evaluate the interrater reliability of the FABER test, flexion-internal rotation-adduction impingement test, log roll test, and the palpation of the greater trochanter for tenderness. BACKGROUND: Clinical examination for individuals with musculoskeletal hip pain is believed to provide critical diagnostic information. However, there is very limited information in the literature on the reproducibility of examination techniques for the hip region. METHODS AND MEASURES: Seventy subjects were evaluated prospectively by an orthopaedic surgeon and physical therapist. Subjects had a mean age of 42 years (range 18-76 years; SD 15.4) and included 32 (46%) females and 38 (54%) males.  Subject diagnoses were as follows: degenerative joint disease (n=27 [39% of subjects]), labral tear (n=35 [50% of subjects]), femoroacetabular impingement (n=48 [69% of subjects]), capsular laxity (n=28 [40% of subjects]), trochanteric bursitis (n=29 [41% of subjects]), iliopsoas tendonitis (n=10 [14% of subjects]), and adductor strain (n=2 [3% of subjects)]. Subjects could have more than 1 diagnosis. Kappa, prevalence indexes, bias indexes, and maximal attainable kappa were calculated. RESULTS: Kappa (κ) coefficients with 95% confidence intervals (CI) were as follows: FABER test κ was 0.63 (95% CI: 0.43-0.83); flexion-internal rotation-adduction impingement test κ was 0.58 (95% CI: 0.29-0.87); log roll test κ was 0.61 (95% CI: 0.41-0.81); and greater trochanteric tenderness κ was 0.66 (95% CI: 0.48-0.84). Bias indexes were low (0.06-0.08) for all 4 tests while prevalence indexes were low (0.03-0.37) for 3 of the 4 tests. The flexion-internal rotation-adduction impingement test had a high prevalence index (0.76), with a higher proportion of positive tests. CONCLUSION: The kappa values for the FABER test, log roll test, and assessment of greater trochanteric tenderness were greater than 0.40 (fair level of agreement) at a 95% confidence level. The low reliability obtained for the flexion-internal rotation-adduction impingement test may be related to a prevalence concern.

J Orthop Sports Phys Ther. 2008;38(2):71-77, published online 21 September 2007. doi:10.2519/jospt.2008.2677

KEY WORDS: agreement, examination, kappa, reproducibility

When choos­ing between conservative/nonoperative versus surgical intervention, the extent of subchondral bone exposed and the time over which the arthritis has developed are factors that should be consid­ered. The role and effectiveness of conservative treatment, such as medication, patient education, shoe modification, bracing, stretching, mobiliza­tion, strengthening, and symptom management, need to be further determined. Surgical proce­dures for posttraumatic ankle arthritis can include distraction arthroplasty, arthrodesis, or total ankle arthroplasty.

Unlike the relatively new procedure of distraction arthroplasty, the outcomes for arthrod­esis have been well defined. Arthrodesis generally has a good outcome, but its limitations have been recognized. These limitations include the extended time required to achieve fusion, potential for non­union, arthritis developing in adjacent joints, leg length discrepancy, malalignment, chronic edema, symptoms due to the hardware, stress fractures, and continued pain. While first generation total an­kle arthroplasty led to poor results, advancements in prosthetic design and surgical technique have revived optimism regarding total ankle arthroplasty as an alternative to arthrodesis. The key for the fu­ture of total ankle arthroplasty may not be related to the development of newer ankle components but rather in refining the criteria to determine who would best benefit from joint replacement versus fusion.

J Orthop Sports Phys Ther. 2007;37(5):253-259. doi:10.2519/jospt.2007.2404

KEY WORDS: arthrodesis, arthroplasty, joint fusion, joint replacement

The information acquired from self-reported outcome instruments is useful only if there is evidence to support the interpretation of obtained scores. To properly interpret scores, there should be evidence for content validity, construct validity, reliability, and responsive­ness. Evidence regarding score interpretation must also contain a description of the applica­ble test conditions, including information about the characteristics of subjects, timing of data collection, and construct of change. The objec­tive of this review was to identify self-reported outcome instruments that have evidence to support their usefulness for assessing the ef­fect of treatment directed at individuals with foot and ankle-related pathologic conditions in an orthopaedic physical therapy setting. In ad­dition, we provide specific information that will allow clinicians and researchers to select an appropriate instrument and properly interpret the obtained scores. Fourteen self-reported outcome instruments that met the objective of this review were identified. Five instruments, the Foot and Ankle Ability Measure, Foot Func­tion Index, Foot Health Status Questionnaire, Lower Extremity Function Scale, and Sports Ankle Rating System quality of life measure, satisfied all 4 categories of evidence (content validity, construct validity, reliability, and re­sponsiveness) outlined herein. 

J Orthop Sports Phys Ther. 2007;37(2):72-84. doi:10.2519/jospt.2007.2403

KEY WORDS: ankle, foot, outcome instru­ments, reliability, responsiveness, validity

The purpose of this clinical commentary is to provide an evidence-based review of the examination process and diagnostic challenges associated with acetabular labral tears of the hip. Once considered an uncommon entity, labral tears have recently received wider recognition as a source of symptoms and functional limitation. Information regarding acetabular labral tears and their association to capsular laxity, femoral acetabular impingement (FAI), dysplasia of the acetabulum, and chondral lesions is emerging.

Physical therapists should understand the anatomical structures of the hip and recognize how the clinical presentation of labral tears is difficult to view isolated from other hip articular pathologies. Clinical examination should consider lumbopelvic and extra-articular pathologies in addition to intra-articular pathologies when assessing for the source of symptoms and functional limitation. If a labral tear is suspected, further diagnostic testing may be indicated. Although up-and-coming evidence suggests that information obtained from patient history and clinical examination can be useful, continued research is warranted to determine the diagnostic accuracy of our examination techniques.

J Orthop Sports Phys Ther. 2006:36(7):503-515. doi:10.2519/jospt.2006.2135

Key Words: diagnosis, labrum, MRI

Recent technological improvements have resulted in a greater number of surgical options available for individuals with hip joint pathology. These options are particularly pertinent to the relatively younger and more active population.

The diagnosis and treatment of acetabular labral tears have become topics of particular interest. Improvements in diagnostic capability and surgical technology have resulted in an increased number of arthroscopic procedures being performed to address acetabular labral tears and associated pathology. Associated conditions include capsular laxity, femoral-acetabular impingement, and chondral lesions. Arthroscopic techniques include labral tear resection, labral repair, capsular modification, osteoplasty, and microfracture procedures.

Postoperative rehabilitation following arthroscopic procedures of the hip joint carries particular concerns regarding range of motion, weight-bearing precautions, and initiation of strength activities. Postoperative rehabilitation protocols that have been typically used for surgeries such as total hip arthroplasty are often not sufficient for the population of patients undergoing arthroscopic procedures of the hip joint. Postoperative rehabilitation should be based upon the principles of tissue healing as well as individual patient characteristics. As arthroscopic procedures to address acetabular labral tears and associated pathology evolve, physical therapists have the opportunity to play a significant role through the development of corresponding rehabilitation protocols.

J Orthop Sports Phys Ther. 2006;36(7):516-525. doi:10.2519/jospt.2006.2138

Key Words: clinical research, hip, labrum, lower extremity