Management of Chronic Conditions in the Foot and Lower Leg

267 Pages·2015·12.845 MB·English

by  Rome, Keith, Mcnair, Peter

Management of Chronic
Conditions in the Foot and
Lower Leg
Content Strategist: Rita Demetriou-Swanwick
Content Development Specialists: Catherine Jackson/Nicola Lally
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Illustrator: Antbits
Management of
Chronic Conditions
in the Foot and
Lower Leg
Edited by
Keith Rome BSc(Hons), MSc, PhD, FCPodMed, SRCh
Professor in Podiatry and Co-Director, Health and Research Rehabilitation Institute,
Department of Podiatry, School of Rehabilitation and Occupation Studies, Faculty of Health
and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
Peter McNair DipPhysEd, DipPT, MPhEd(Distn), PhD
Professor of Physiotherapy and Director, Health and Rehabilitation Research Institute,
Auckland University of Technology, Auckland, New Zealand
Foreword by
Christopher Nester BSc(Hons), PhD
Professor, Research Lead: Foot and Ankle Research Programme, School of Health Sciences,
University of Salford, Salford, UK
Edinburgh  London  New York  Oxford  Philadelphia  St Louis  Sydney  Toronto  2015
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ISBN 978 0 7020 4769 5
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
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and to take all appropriate safety precautions.
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Preface
The interpretation of the patient’s history, the extrac- predisposing factors, diagnosis, impairments, func-
tion of information from key laboratory and clinical tion, quality of life, and management strategies. We
tests, along with the decision-making process to find have asked our authors to provide not only a discus-
the best treatment solution for the patient’s predica- sion of the latest advances, but also to be thought
ment, is a challenging but enjoyable endeavour for the provoking and to consider the less straight-forward
clinician. features of each condition and provide suggestions for
Nevertheless, in the past decade, there has been new paths of research. Each chapter is further sup-
rapid growth in research activity focused upon risk ported by additional commentary from an internation-
factors, diagnosis, and treatment. In some instances, ally renowned researcher who highlights the key
the growth has been bewildering and hence particu- elements of the work and provides a supplementary
larly difficult for clinicians to stay abreast of current perspective of the particular clinical condition.
thinking in each aspect of practice, and subsequently Given the aforementioned growth in knowledge
be confident in their decisions. concerning these conditions, it seemed logical to find
The book includes the following clinical condi- a group of authors who were highly regarded for
tions: osteoarthritis, rheumatoid arthritis, gout, stress their research and or clinical contributions to their
fractures of the lower leg, Achilles tendinopathy, rear- respective professions. We are very thankful to our
foot entities, forefoot entities, and cerebral palsy. Thus authors for sharing their expertise. They have devoted
not all conditions that might be encountered are a large amount of their time, for which we are very
covered. However, we believe that the book provides appreciative and grateful. The authors represent a
a sufficiently detailed account of a set of disorders that broad spectrum of professions, and all recognize that
encompasses key changes to pathology in muscle, for the patient to receive the best possible care
tendon, and joints that might be found across the an interdisciplinary approach to their treatment is
majority of conditions affecting the lower leg, foot, required, and this attitude is apparent throughout
and ankle. Our choice of material reflects discussions the book.
with clinicians, clinical researchers, and senior stu- We wish to thank the people that we have worked
dents concerning those conditions that would be with at Elsevier for their patience, support and kind
most valuable to them. Furthermore, these enquiries attitude in all aspects of the publication process. Their
extended to the level of complexity and comprehen- advice and standards of excellence have been invalu-
sion that they wished to see in such a text. As a result, able in bringing this book to completion. Finally, we
the book is not written as an early undergraduate text thank those who read the book as it evolved for their
but rather for those close to being qualified or already critical comments and ideas for improving its content
in practice. and presentation.
Each chapter is organized into sections that are
consistent across the book, thus enhancing the ease Keith Rome
that the book can be read. These sections include Peter McNair
vi
Foreword
Anyone working in or interested in healthcare provi- it will also support those building policy and manage-
sion, health policy, or health-related research will ment strategies more broadly in the clinical areas
already understand the major factors that will shape covered.
the nature of health and wellbeing in the future. That That the editors have drawn upon an international
you will have heard a great deal about ‘the aging and multiprofessional authorship in each of the areas
population’, the increase in ‘long-term conditions’, applauds the clear commitment to quality and trust-
and the ‘obesity epidemic’ and so on should not blunt worthy information. The inclusion of reviewer com-
the very real impact that these issues will have on the mentaries is a useful change in style and assists further
lives of everyone. Much of future healthcare need will in the reader contextualizing the information pro-
be shaped by these issues, but also by some of the vided. It also builds trust in the information in each
activities that healthy people choose to engage in: chapter.
running and triathlons remain the fastest growing That the editors used their relationships with clini-
sports in the world, and so we look set to challenge cal colleagues to shape the focus and style of the book
our musculoskeletal systems to the maximum whether reflects their commitment to meeting the real needs
we are healthy or live with the daily challenges of of people working in practice, and their commitment
a chronic condition. Understanding the underlying to research knowledge informing the care patients
causative mechanisms, the identification of and man- receive. A broad view of the needs of patients is offered
agement of chronic conditions is already an imperative throughout, a welcome departure from traditional
in practice, but it is an area that, given the issues texts that narrowly define objectives in too-clinical
above, will only grow. terms. Inclusion of specific sections on impairments,
Thankfully, researchers and clinicians have been function, and quality of life reflect this ethos, since it
busy on these topics for a considerable time. More seeks to connect clinical realities to real-world patient
fortunately still for you, the need for research-led experiences. Furthermore, patient-reported outcome
information and data to support management of measures and health behaviour strategies are a consist-
chronic conditions has clearly energized the editors ent feature of this text.
and authors of this book. This book is therefore timely Through this text, therefore, the authors are seeking
but has also saved any reader a huge amount of time to support clinicians and researchers in doing their
and resource that would otherwise be required to current roles to the highest standards and shape
access such a diverse range of clinical conditions in knowledge in the musculoskeletal community that
such depth, and selecting so appropriately only the best prepares it for the future. Indeed, statements on
most pertinent and quality literature. ‘future directions’ are a key feature of this text and will
This book is also of the highest standard and makes help you seek further niche information from the
a welcome addition to the current texts on chronic related literature. As such, this book can strongly
conditions of the lower limb and foot. It is research support your current professional development and
and scholarship led throughout but bridges under- underpin the quality and relevance of future service
graduate and postgraduate knowledge and experience and policy developments too.
in a very accessible way. Whilst it can be a practical
tool that can inform daily decision making in practice, Professor Christopher Nester
vii
List of Contributors
Kim Bennell BAppSc, PhD Shannon E. Munteanu BPod(Hons), PhD
Professor and Director, Centre for Health Exercise Senior Lecturer, Department of Podiatry, Faculty of
and Sports Medicine, Department of Physiotherapy, Health Sciences, School of Allied Health, LaTrobe
University of Melbourne, Melbourne, Australia University, Bundoora, Victoria, Australia
Peter Brukner MBBS, FACSP David Rice BHSc, PhD
Sports Physician, Olympic Park Sports Medicine Lecturer and Senior Research Officer, Health and
Centre, Melbourne; Associate Professor in Sports Rehabilitation Research Institute, Auckland
Medicine, Department of Physiotherapy, University University of Technology, Auckland; Audit,
of Melbourne, Melbourne, Victoria, Australia Quality and Research Officer, Waitemata Pain
Services, Department of Anaesthesiology and
Vivienne Chuter BPod(Hons), PhD
Perioperative Medicine, North Shore Hospital,
Senior Lecturer, Podiatry, School of Health Sciences, Auckland, New Zealand
Faculty of Health and Medicine, The University of
Newcastle, Callaghan, NSW, Australia Keith Rome BSc(Hons), MSc, PhD, FCPodMed, SRCh
Professor in Podiatry and Co-Director Health and
Michael Corkill MBChB, FRACP
Research Rehabilitation Institute, Department of
Rheumatologist, Clinical Director, Waitemata DHB Podiatry, School of Rehabilitation and Occupation
Rheumatology Services, North Shore Hospital, Studies, Faculty of Health and Environmental
Takapuna, North Shore City, Auckland, New Sciences, Auckland University of Technology,
Zealand Auckland, New Zealand
Mark W. Creaby BSc(Hons), PhD N. Susan Stott MBChB, PhD, FRACS
School of Exercise Science, Australian Catholic Professor of Paediatric Orthopaedic Surgery,
University, Australia; and Centre for Health, Department of Surgery, Faculty of Medical and
Exercise & Sports Medicine, University of Health Sciences, University of Auckland,
Melbourne, Australia Auckland, New Zealand
Mike Frecklington BHSc(Hons), MPhil Bill Vicenzino BPhty, GradDipSportsphyty, MSc, PhD
Lecturer, Department of Podiatry, School of Professor in Sports Physiotherapy, School of Health
Rehabilitation and Occupation Sciences, Faculty and Rehabilitation Sciences; Physiotherapy,
of Health and Occupation Sciences, Auckland University of Queensland, St Lucia Campus,
University of Technology, Auckland, New Zealand Brisbane, Australia
Fiona Hawke BAppSci(Hons), PhD Anita Williams BSc(Hons), PhD
Lecturer in Podiatry, Faculty of Health and Medicine, Senior Lecturer and Post Graduate Research Student
University of Newcastle, Callaghan, NSW, Australia Co-ordinator, School of Health Science, Orthotics
and Podiatry, University of Salford, Salford, UK
Peter McNair DipPhysEd, DipPT, MPhEd(Distn), PhD
Director of the Health and Rehabilitation Research
Institute, Professor in Physiotherapy, Auckland
University of Technology, Auckland, New Zealand
viii
List of Commentary Writers
Robert L. Ashford DPodM, BA, BEd, MA, MMedSci, Phillip S. Helliwell MA, DM, PhD, FRCP
PhD, MChS, FCpodMed, FFPM, RCPS Senior Lecturer in Rheumatology, Leeds Institute of
Director of Postgraduate Research Degrees, Faculty Molecular Medicine, Section of Musculoskeletal
of Health, Birmingham City University, City South Disease, University of Leeds, UK
Campus, Birmingham, UK
Tim Kilmartin PhD, FCPodS
Consultant Podiatric Surgeon, Hillsborough Private
Mario Bizzini MSc, PhD, PT
Clinic, Belfast and Ilkeston Hospital, Ilkeston,
Research Associate, FIFA – Medical Assessment &
Derbyshire; Lecturer, School of Podiatry, Ulster
Research Centre Schulthess Clinic Lengghalde,
University, Derry, UK
Zürich, Switzerland
Karl B. Landorf DipAppSc, Grad Cert Clin Instr,
Roslyn N. Boyd BSc, BAppSc, MSc, PhD, PGRad
GradDipEd, PhD, FFPM, RCPS
Professor of Cerebral Palsy and Rehabilitation
Senior Lecturer and Research Co-ordinator,
Research; Scientific Director, Queensland Cerebral
Department of Podiatry, Faculty of Health Sciences,
Palsy and Rehabilitation Research Centre, School
La Trobe University, Bundoora, Victoria, Australia
of Medicine, University of Queensland, Brisbane,
Australia Nicola Maffulli MD, MS, PhD, FRCP, FRCS, FFSEM
Professor of Musculoskeletal Disorders, Consultant
Nicola Dalbeth MBChB, MD, FRACP Orthopaedic Surgeon, University of Salerno,
Consultant Rheumatologist and Associate Professor, Salerno, Italy; Honorary Professor of Sport and
Department of Medicine, University of Auckland, Exercise Medicine, Queen Mary University of
Auckland, New Zealand London, London, UK
ix
1  Osteoarthritis of the Ankle Joint
Chapter 1 
Osteoarthritis of the Ankle Joint
Peter McNair and David Rice
Chapter Outline INTRODUCTION
Introduction Osteoarthritis (OA) is the most common form of
Predisposing Factors arthritis. While the main characteristic of OA is a loss
of articular cartilage, it is apparent that as the disease
Diagnosis
progresses a number of additional joint structures
History
including the subchondral bone, capsule, ligaments,
Physical Examination
synovial membrane, and periarticular muscles are
Imaging
affected to varying degrees (Madry et al. 2012). With
Impairments
this progression, joint pain together with reduced
Function
physical, emotional, and social wellbeing commonly
Quality of Life occurs (Busija et al. 2013). Furthermore, OA has a
Management Strategies notable financial impact on the individual, and on
Pharmacological Strategies direct and indirect costs associated with diagnosis and
Physical Strategies treatment (Bozic et al. 2012; Le et al. 2012). Due to
Surgical Strategies improved health practices and medical advancements
Lifestyle and Education Strategies that can potentially increase our lifespans, OA is
also forecast to increase in prevalence (Zhang and
Future Directions
Jordan 2010).
Invited Commentary
Estimations of the prevalence of OA differ and the
accuracy of the estimates is confounded by the lack of
a standardized definition for OA, and the use of dif-
ferent clinical and radiological criteria to grade disease
severity. In a review of epidemiological data based on
radiological findings, Lawrence et al. (2008) reported
the prevalence of OA at the hip or knees to be approxi-
mately 18–25% for men and 19–30% for women over
45 years old. In those over 60 years, the prevalence at
the knee increased to 31% for men and 42% for
women. These figures are likely to be conservative, as
studies have tended to collect data up to the age of 75
years only. At the ankle joint, the prevalence of the OA
has been reported to be between 1 and 13% (Cole and
Kuettner 2002; Glazebrook et al. 2008).
OA can be divided into primary and secondary
types. Primary OA is idiopathic and generally affects
those from middle age onwards. In the lower limb, the
hip and knee joints are most affected by primary OA;
1
2 1  Osteoarthritis of the Ankle Joint
however, a minority of patients present with primary Posterior
OA at the ankle joint. Most patients with ankle OA
have secondary osteoarthritis, which, as the name
Tibia
implies, occurs following an initial insult to the joint.
Examples include infection, trauma, and dysplasia. At
the ankle joint, OA is most associated with previous
Lateral Anterior Medial
trauma (Valderrabano et al. 2009) and may present
in up to 70% of cases attending a hospital orthopae-
dic department with chronic ankle pain (Saltzmann
et al. 2005). Talus
PREDISPOSING FACTORS
Posterior
General Risk Factors
Heel strike Mid-stance Toe off
General risk factors for OA have been most extensively
FIGURE 1-1 Typical in-vivo cartilage contact areas in the ankle
studied at the knee and hip joints. Of note, there is
during the stance phase of gait. (Reprinted from Wan L, de Asla RJ,
an increased risk of OA associated with increasing age
Rubash HE, Li G, 2006. Determination of in-vivo articular cartilage contact
(Felson et al. 1987). Furthermore, a gender effect is areas of human talocrural joint under weightbearing conditions. Osteoarthritis
apparent, with an increased risk for women (Lawrence Cartilage 14(12):1294–1301 with permission from Elsevier.)
et al. 2008). Genetic polymorphisms associated with
OA have also been identified (Dai and Ikegawa 2010;
Lanyon et al. 2000). In addition, studies have high- greatest at mid-stance. In contrast, the landing forces
lighted increased mechanical loading on the joint as are largest at footstrike. Vertical ground reaction forces
an important risk factor for OA. Increased loading is of 1–2 BW during walking rise to 2–3 BW during
multifactorial and may reflect body mass increases jogging, and in activities such as landing from a jump
(Felson et al. 1988; Hochberg et al. 1995), as well as can reach as high as 10 BW (McNair and Prapavessis
the extent and intensity of participation in manual 1999; Zadpoor and Nikooyan 2011). Furthermore,
work (Jenson 2008a, 2008b; Kaila-Kangas et al. rates of loading are considerable during such tasks and
2011), and some sporting activities (Kujala et al. have been associated with chronic lower limb disor-
1995; Spector et al. 1996). ders (Zadpoor and Nikooyan 2011). The combination
of these forces with a limited joint contact area results
Anatomy and Biomechanical Loading in high levels of stress being placed on the articular
at the Ankle Joint cartilage, increasing the risk of damage.
Certain anatomical and biomechanical features of the During physical activity, the deformation in the
ankle joint are thought to increase the risk of develop- articular cartilage can be considerable. Waterton et al.
ing OA. For instance, the articular cartilage is thinner (2000) reported a 0.6 mm change in the thickness of
(1.0–1.5 mm) compared with the knee joint (1.7– knee articular cartilage over a day of normal loading.
2.6 mm) (Adam et al. 1998; Shepherd and Seedhom More acute changes were observed by Boocock et al.
1999). Furthermore, the area of the articular cartilage (2009), who noted 4–6% deformation in articular car-
is considerably smaller (~ 350 mm2) than in the hip tilage at the knee after 5000 steps of jogging, which
or knee joints (~ 1100 mm2) (Brown and Shaw 1983; took approximately 30 minutes to complete. Given
Ihn et al. 1993; Kimizuka et al. 1980). In a study that the closer proximity of the ankle to initial ground
utilized magnetic resonance and fluoroscopic imaging, reaction forces at footstrike, and the lesser motion
Wan et al. (2006) showed that ankle joint contact was available at the ankle joint to absorb energy, deforma-
less than 50% of total possible cartilage area through- tion of cartilage at the ankle joint is likely to be higher
out the stance phase of gait (Figure 1-1). Contact areas than that observed at the knee joint. Cartilage defor-
during walking gait were lowest at footstrike and mation occurs primarily through the movement of