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The Journal of Bone and Joint Surgery 80:1853 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

David J. Fleiss, M.D., David G. Armstrong, D.P.M. and Lawrence A. Lavery, D.P.M., M.P.H.

TO THE EDITOR:

Armstrong and Lavery, in "Elevated Peak Plantar Pressures in Patients Who Have Charcot Arthropathy" (80-A: 365–369, March 1998), make a valuable and elegant contribution by demonstrating that increased plantar pressure is associated with ulceration and arthropathy. To prevent these lesions, they recommended "therapeutic footwear and insoles to reduce pressures on the foot."

My experience in a sports-oriented general practice is that contracture of the gastrocnemius is the greatest cause of increased plantar pressure. As Armstrong and Lavery stated, "the Achilles tendon pulls the hindfoot into plantar flexion, causing the forefoot to bear a considerably increased load." I teach patients that they will have increased plantar pressure unless they stretch the gastrocnemius until they can fully dorsiflex the ankle with the knee in full extension.

Athletic patients can usually use the . . . [Full Text of this Article]


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