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Tendinopathies of the foot and ankle, including posterior tibial, peroneal, and tibialis anterior, are commonly overlooked by primary care physicians. The posterior tibial tendon is the main dynamic stabilizing muscle of the medial longitudinal arch. Patients who have posterior tibial tendinopathy present with medial ankle pain, pes planovalgus deformity, and a positive too many toes sign. Nonoperative treatment options include support for the medial longitudinal arch and physical therapy focusing on eccentric exercises. Surgical treatment is considered for patients who do not respond to nonoperative treatments after three to six months and is based on the specific stage of tendinopathy. Peroneal tendon disorders are commonly mistaken for or occur concomitantly with lateral ankle sprains. Varus hindfoot is a known risk factor for peroneal tendinopathy. Treatments include immobilization, laterally posted orthotics, and physical therapy for progressive tendon loading. Tibialis anterior tendinopathy presents as anterior ankle and medial midfoot pain and can be diagnosed with a positive tibialis anterior passive stretch test. Initial treatment includes immobilization followed by physical therapy. Surgical debridement can be considered if nonoperative treatment is ineffective.

INTRODUCTION: Novel research suggests that children engaging in physical activity during recovery from concussion may recover more rapidly. OBJECTIVE: To determine if level of physical activity at presentation to a rehabilitation-based concussion specialty clinic predicted days from injury to recovery. DESIGN: Retrospective cohort. SETTING: A concussion sub-specialty clinic at an academic institution. PATIENTS: Retrospective review of medical records between September 2015 and February 2017 identified 178 children ages 6–17 years (mean age = 13.7 years; standard deviation [SD] = 2.7 years) who presented within 60 days of concussion and were ultimately deemed recovered and cleared to progress to full return to high-risk activities. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical activity at initial visit was classified as none-to-light (79%) versus moderate-to-heavy (21%). A doubly robust, inverse probability of exposure weighted linear regression model was used to examine the relationship between physical activity level and days to recovery, while adjusting for 10 demographic and clinical variables. RESULTS: Children participating in moderate-to-heavy activity at initial evaluation in concussion clinic averaged recovery 21 days quicker (95% confidence interval [CI] −27.1, −15.5, P < .001) than children who were engaging in none-to-light activity. This finding did not change when removing children who were deemed recovered at the first visit (who may have initiated physical activity after becoming asymptomatic). CONCLUSIONS: These data add to growing evidence that progressive physical activity during recovery from concussion does not appear to be harmful. Physical activity represents a modifiable variable in recovery, and physicians can potentially expedite symptomatic recovery by recommending noncontact physical activity as tolerated during concussion recovery.

Objective Advancements in medical knowledge and technology are enabling people to live longer with chronic medical conditions, and creating a need for physiatrists to help maintain and restore function. Clinical excellence in physical medicine and rehabilitation (PM&R) is not well documented in the literature. The aim of this paper is to provide examples of clinical excellence in PM&R as they relate to the definition formulated by the Miller-Coulson Academy of Clinical Excellence (MCACE). Methods and results A review of the literature revealed 1,686 published articles that were evaluated to determine their relevance to the definition of clinical excellence in PM&R. From these articles, exemplary case reports and research studies were identified for each of the domains of excellence. Conclusion The application of the definition of clinical excellence to PM&R is more than just an intellectual exercise, as it can help to establish the model to which physicians and trainees may want to aspire.